Clinical Year (MPAS-2)
The clinical phase of the Program is largely composed of four or eight-week core rotations. Core rotations include Community Mental Health, Emergency Medicine, Family Medicine, Internal Medicine, Surgery, Pediatrics, and Women’s Health. At the conclusion of each core rotation, students will be required to take an end of rotation examination. There is one four-week limited elective rotation. There is not an exam associated with the elective rotation.
Rotations (or experiences) begin in the semester immediately following the completion of the didactic year and must proceed as scheduled without interruption for three semesters/terms (12 months) unless approval is granted by the Program Director and Dean.
The PA Program assigns and approves all clinical rotations. All questions regarding rotations for PA students should be directed to the Office of Experiential Education.
Clinical Rotation experiences will expose students to preventive, emergent, acute, and chronic conditions of patient care and will enable students to meet programmatic competencies. Additionally, students will have clinical experiences in inpatient, outpatient, operating room, and emergency department settings. These clinical requirements may include extended hours of instruction, evenings, nights, and weekends. Students must be able to transport themselves to all training sites.
Across the clinical year, students will also complete the Core Topics, Interprofessional Education, and Issues of Professional Practice series along with the Summative Practicum. Students must successful pass all components of the Summative Evaluation to graduate from the PA Program.
To qualify for clinical rotations, students must have successfully completed all didactic, prerequisite coursework and met and maintained professional standards and other requirements as established by the Program (e.g., physical examination, immunity status, BLS, ACLS) before beginning clinical rotations.
The Program will assign and coordinate all clinical sites and preceptors for program required rotations.
All students must participate in early advising for clinical rotations. These will be scheduled in group and one-on-one meetings. Further, all students must be officially registered for all clinical rotations/experiences for the professional liability insurance policy carried by the University to cover them in the clinical portion of the curriculum. Students participating on rotations/experiences without registering will be referred to the Student Professional Conduct Committee for appropriate action to be taken (e.g. warning, probation, suspension, dismissal, or termination).
Students should contact their preceptors no later than 14 days in advance of their start date. Failure to do so is a professionalism violation and may result in the delay of rotation start date(s).
Students must not independently go to other facilities or spend time with preceptors who have not been assigned to them by their site preceptor or Director of Experiential Education. If there are concerns, contact the Director of Experiential Education.
Preceptors/sites should not be family members, friends, or previous places of employment. The Director of Experiential Education on a case-by-case basis will consider exceptions to this policy.
While in the clinical setting, the student must follow the following policies:
The student will be evaluated for professional conduct by the preceptor and the PA Program faculty and staff. A student may be removed from a clinical site for behavior that is considered less than professional and receive a failing grade for the rotation. Students will be referred to the Student Professional Conduct Committee for further evaluation.
PA students must see and discuss each patient with their preceptor and may not treat or release a patient without approval of the preceptor.
PA students may not administer medications without the expressed approval and supervision of the responsible preceptor.
PA students must discuss patient clinical findings, assessment, and treatment plans with their preceptor before discussing them with the patient.
PA students will abide by the rules and regulations established by the participating preceptor and institution including scheduling of hours of attendance.
PA students will follow the dress code of the participating institution or site.
PA students may not independently use any audio, video, or AI-enabled recording technologies in clinical settings. See AI policies for more details.
While it is optimal to enter data into a patient’s medical record, electronic or otherwise, it is not a requirement over the course of a student’s rotation experiences. In cases such as these, students should continue to practice their note taking skills.
Note that PA students, by law, may not sign, phone-in, or enter orders for medication prescriptions. PA students may write or enter the prescription or medication order with the approval of their preceptor, but the preceptor must sign the medication order or prescription. The student’s name or initials must not appear on a prescription or medication order.
Student identification in clinical settings
Students must be clearly identified as PA students in clinical setting at all times. Student photo IDs will be provided during the summer semester. These IDs are to be worn at all Program-related activities (both on and off campus) that relate to training as a Butler PA student. PA students must be clearly identified in the clinical setting to distinguish them from physicians, medical students, and other health profession students and graduates. While in the Program, students may not use previously earned titles (i.e. RN, MD, DO, PhD, PharmD, etc.) for identification purposes. There is a charge to replace any lost or damaged ID card through BUPD. If a student should leave the Program, all IDs must be returned to the Program.
Some clinical sites may issue name badges through their medical education offices that should be worn while at that site. This badge is in addition to your Butler ID. At the end of the rotation, the site’s medical education office may request these badges to be returned directly to them. If they do not, please protect and keep safe the badge as you might have a rotation at that site in the future. Each site may have a replacement fee to replace any lost or damaged ID card. At the end of the experiential year, all badges not otherwise returned to the clinical site should be given to the PA Program Experiential Office. These badges will be returned to the clinical setting by the PA Program.
Students are required to have a long sleeved, short white jacket/coat. A short white coat ends at the upper thigh/top of inseam. A coat that ends lower than this (at mid-thigh) is too long. White jackets are the required dress code for all clinical experiences. They signify “student” status. Coats/jackets are gifts from alumni and friends of the College to students and will be given to the student at the White Coat Ceremony.
Students are encouraged to give professors, staff, and preceptors thank you notes. However, the giving of gifts to individual professors, staff, or preceptors while in the PA Program is prohibited.
The PA Program will provide appropriate training to students regarding Occupational Safety & Health Administration (OSHA) standards prior to the clinical year. The facility at which the rotation/experience takes place shall provide PA students access to the facility’s rules, regulations, policies and procedures with which the PA students are expected to comply, including, the Facility’s OSHA standards, personal and workplace security and personal safety policies and procedures and shall address all appropriate safety measures for all PA students and any instructors on site.
The following documents must be taken by the student to the start of each rotation site and provided to preceptor when requested:
- Student’s personal biographical sketch and resume
- Letter of introduction, competency and good standing from the Program
- Butler University Health Center documentation of physical, immunizations, and titers
- Background check verification
- Drug screen verification
- Butler University certificate of liability insurance
- Insurance certificate rolls over annually–the updated policy will be posted on Canvas every June
All rotations must be completed. Individual student rotation schedules will be determined by the Director of Experiential Education and are subject to change at any time. Students are responsible for providing their own transportation to these sites. Topic Lists are provided to direct student learning and should be used in combination with the objectives of the End of Rotation examinations.
Sample schedule
Below is a sample schedule of the formal curriculum for the clinical year. The timing of the rotations will be different for each student; however, all students will complete all items prior to graduation.
Summer semester
| Course Number | Course Name | Credit Hours |
|---|---|---|
| MPAS 654 | Community Mental Health Rotation | 4 credit hours |
| MPAS 678 | Core Content 1 | 1 credit hour |
| MPAS 658 | Emergency Medicine Rotation 1 | 4 credit hours |
| MPAS 650 | Internal Medicine Rotation 1 | 4 credit hours |
| MPAS 625 | Issues of Professional Practice 1 | 1 credit hour |
| Total Credit Hours | 14 credit hours | |
Fall semester
| Course Number | Course Name | Credit Hours |
|---|---|---|
| MPAS 680 | Core Content 2 | 1 credit hour |
| MPAS 648 | Family Medicine Rotation 1 | 4 credit hours |
| MPAS 626 | Issues in Professional Practice 2 | 2 credit hours |
| MPAS 652 | Internal Medicine Rotation 2 | 4 credit hours |
| MPAS 630 | Pediatric Rotation | 4 credit hours |
| MPAS 656 | Women’s Health Rotation | 4 credit hours |
| Total Credit Hours | 19 credit hours | |
Spring semester
| Course Number | Course Name | Credit Hours |
|---|---|---|
| MPAS 682 | Core Content 3 | 1 credit hour |
| MPAS 634 | Elective Rotation | 4 credit hours |
| MPAS 660 | Emergency Medicine Rotation 2 | 4 credit hours |
| MPAS 662 | Family Medicine Rotation 2 | 4 credit hours |
| MPAS 670 | Surgery Rotation | 4 credit hours |
| MPAS 664 | Inter-professional Experience | 1 credit hour |
| MPAS 636 | Summative Practicum | 1 credit hour |
| MPAS 627 | Issues of Professional Practice 3 | 1 credit hour |
| Total Credit Hours | 20 credit hours | |
Clinical curriculum: 53 credit hours
MPAS 626: Issues of Professional Practice
2 Semester Hours
This course provides the student with an introduction to the historical development and current trends of the PA profession, reimbursement, health policy and public health issues as they pertain to the supervised practice of clinical medicine. It also provides the student with an introduction to medical ethics, coding and billing, cultural issues, PA certification, licensure, malpractice and risk management, financial planning, and PA organizations as they pertain to the supervised practice of clinical medicine.
MPAS 630: Pediatric Rotation
4 Semester Hours
This is a four-week rotation in a pediatric setting where students provide supervised care for newborns, infants, children and adolescents. Patient care activities center on assessing normal growth and development, and diagnosing and formulating management plans for conditions commonly encountered in the pediatric population. Pediatrics Topic List
MPAS 634: Elective Rotation
(Pass/Fail)
4 Semester Hours
Four-week clinical rotation designed to provide the student with an elective opportunity in any of the following disciplines: dermatology, gastroenterology, medical or surgical subspecialty, cardiology, radiology, ENT, or urology. The discipline must be approved by the Director of Experiential Education.
MPAS 636: Summative Practicum
(Pass/Fail)
1 Semester Hour
Students must demonstrate competency to practice medicine as an entry level PA in primary care. This course allows the student to demonstrate the knowledge, interpersonal skills, patient care skills and professionalism required to enter clinical practice.
MPAS 648: Family Medicine Rotation 1
4 Semester Hours
This rotation provides the student with an experience during which students refine their skills in performing a history and physical exam, ordering and interpreting diagnostic tests and developing treatment plans for patients. The student participates in the broad spectrum of primary care by developing skills in acute and long-term patient management. Family Medicine Topic List
MPAS 650: Internal Medicine Rotation 2
4 Semester Hours
This rotation provides the student with experience in caring for adult and geriatric patients in a clinical practice setting. Students will perform history and physical examinations, obtain diagnostic testing and present their data along with proposed differential diagnoses and treatment plans. Students may have additional requirements associated with internal medicine. Internal Medicine Topic List
MPAS 654: Community Mental Health Rotation
4 Semester Hours
This rotation will provide students with an experience in caring for ambulatory or hospitalized patients with psychiatric disorders. The student will perform psychiatric evaluations, develop and support clinical management plans. Students may have additional requirements associated with community mental health. Community Mental Health Topic List
MPAS 656: Women’s Health Rotation
4 Semester Hours
Four-week clinical rotation is designed to provide the PA student with an opportunity to develop proficiency in the unique medical history, physical examination and treatment of the prenatal/gynecology patient. The student will also become familiar with tests and procedures unique to this patient population. Students may have additional requirements associated with women’s health.
MPAS 658: Emergency Medicine Rotation 1
4 Semester Hours
This rotation is designed to provide students exposure to and development of skills in managing patients in the emergency department setting. Skills will include those necessary for triage, stabilization, diagnosis and management of patients that present to the emergency department. Students may have additional requirements associated with emergency medicine. Emergency Medicine Topic List
MPAS 660: Emergency Medicine Rotation 2
4 Semester Hours
This rotation is designed to provide students exposure to and development of skills in managing patients in the emergency department setting. Skills will include those necessary for triage, stabilization, diagnosis and management of patients that present to the emergency department. Students may have additional requirements associated with emergency medicine. Emergency Medicine Topic List
MPAS 662: Family Medicine Rotation 2
4 Semester Hours
This rotation provides the student with an experience during which students refine their skills in performing a history and physical exam, ordering and interpreting diagnostic tests and developing treatment plans for patients. The student participates in the broad spectrum of primary care by developing skills in acute and long-term management. Family Medicine Topic List
MPAS 664: Interprofessional Experience
(Pass/Fail)
1 Semester Hour
This course is designed to prepare clinical PA students to work collaboratively in interprofessional patient centered teams. It provides students with an experience to learn the principles of interprofessional practice and apply these principles by directly communicating with other health care professionals of different disciplines beyond the traditional physician-PA team.
MPAS 670: Surgery Rotation
4 Semester Hours
This rotation is designed to prepare the PA student to function as an assistant to the surgeon in providing pre-operative, intra-operative, and post-operative care. The student will learn how to diagnose and manage common surgical disorders and learn when to make appropriate surgical referrals. General Surgery Topic List
MPAs 678: Core Content I
(Pass/Fail)
1 Semester Hour
This self-study course is designed to guide and encourage the student’s systematic preparation for the Physician Assistant National Certification Examination (PANCE) by means of monthly examinations; and
2) develop and assess the student’s competency in the stated PA Program Goals/Student Learning Objectives.
MPAS 680: Core Content II
(Pass/Fail)
2 Semester Hours
This self-study course is designed to guide and encourage the student’s systematic preparation for the Physician Assistant National Certification Examination (PANCE) by means of monthly examinations; and
2) develop and assess the student’s competency in the stated PA Program Goals/Student Learning Objectives.
MPAS 682: Core Content III
(Pass/Fail)
2 Semester Hours
This self-study course is designed to guide and encourage the student’s systematic preparation for the Physician Assistant National Certification Examination (PANCE) by means of monthly examinations; and
2) develop and assess the student’s competency in the stated PA Program Goals/Student Learning Objectives.
Total program curriculum = 108 credit hours.
Clinical year
Marginal or failing preceptor assessment
Preceptors will evaluate each student and the achievement of meeting curricular goals. The Director of Experiential Education and PA Program Director will review marginal or failing performance by the student in any rotation as evaluated by the preceptor. The Director of Experiential Education and PA Program Director have the right to assign a failing grade to the student based on reported performance.
Additional assignments
If a Clinical Instructor requires assignments (e.g., case presentations, notes, H&Ps, etc.), the assignments must be graded as Pass/Fail (and may be remediated, as needed). Students may fail the rotation for not meeting assignment requirements, including attendance at mandatory meetings.
Check-ins
All students must “check in” at the start of every rotation with the Office of Experiential Education. This allows the Program to continue to evaluate the rotation site to ensure that it is meeting student needs, including access to facilities and appropriate supervision necessary to fulfill rotation requirements.
Students must complete the check-in form with the Office of Experiential Education before the end of the first seven days of the rotation. Students are required to complete at least three (3) shifts prior to submitting the form. If a student will not complete three shifts by the form due date, they must contact the PA Experiential Team for guidance. Students should answer all questions in full when completing the check-in form.
- Provide your name and contact information (cell number).
- Select rotation length (8-week rotations are for the same site & preceptor only)
- How many shifts have you completed prior to submitting this report?
- Preceptor
- Do you have any concerns about the preceptor(s)/site/environment?
- Are you receiving appropriate supervision?
- What is your current level of involvement in patient care? Select ALL that apply. *Direct Patient Care may be applied to in-person and/or telemedicine situations.
- Do you notice any concerns in the office environment in which you are working that are unusual or that you would like to report?
- During this rotation, have you experienced or observed any situations where security measures or personal safety protocols were inadequate, missing, or not followed? (Examples might include: unsecured areas, lack of proper PPE, exposure incidents, verbal/physical threats, unsafe parking conditions, etc.)
- Do you anticipate any days off during this rotation? If so, have these been approved by the Experiential Team?
- Do you want to talk about anything else specifically? Briefly describe and indicate if you prefer to talk about this in private with a faculty member instead of documenting here.
- Does the schedule provided by your site/preceptor allow you to meet a MINIMUM of 32 hours per week on the rotation?*
- If you have any additional concerns, please note them here.
Failure to meet the above requirements may result in a report to the Student Professional Conduct Committee for appropriate action to be taken, including warning, probation, suspension, or dismissal, or termination.
The PA Program uses an online tool called Exxat to log clinical experiences, access rotation schedules, review required orientation materials/instructions at assigned sites, and complete evaluations. Students will have an introduction to this system during the Clinical Year Orientation prior to the start of rotations. It is the student’s responsibility to access necessary information and complete required documents in advance of rotations to be cleared to start. Failure to do so in a timely manner may result in delay of the rotation and even a delay in graduating. Additionally, students must maintain accurate and current contact information in Exxat to allow the Program to make contact immediately in emergency situations.
All information logged into Exxat must be accurate and complete while maintaining patients’ anonymity. All entries must be entered within 10 days of the patient encounter. Failure to log accurate clinical data will result in a professionalism violation.
Students will use Exxat to complete the following:
- Enter current contact and emergency contact information
- Update information as necessary
- Log all patient encounters
- Patient demographic information
- All procedures and diagnoses including student’s role
- Complete check-ins
- Complete site and preceptor(s) evaluation(s) before the end of rotation exam
- Access rotation schedules
- Review required orientation materials/instructions at assigned sites for each rotation
- Sign off on the end of rotation evaluation completed by the preceptor within two business days
Students should successfully complete all assignments given by Butler University faculty, clinical instructors, and preceptors during rotations by the established due dates, and attend all on-campus activities (such as EOR, BOR prep meetings, etc.). Failure to do so may result in an incomplete or a failing grade for that rotation. Specific rotation assignments will be outlined in course syllabi.
The Clinical Year Curricular Objectives are designed to enable students to understand minimum competencies required and are consistent with our programmatic curricular goals. They are included in each syllabus for each supervised clinical practice experience. They are the basis for the preceptor’s formative evaluation of the student. The categories are:
- History Taking and Physical Examination
- Diagnostic Studies
- Diagnosis
- Health Maintenance
- Clinical Intervention
- Clinical Therapeutics
- Scientific Concepts
- Professionalism
- Acquisition of Knowledge, Skills, and Attitudes
Students are evaluated by preceptors at the conclusion of each of the supervised clinical practice experience using a five-point Likert scale. The criteria for each category and the rubric to evaluate the expectations are clearly defined for both the Preceptor and Student prior to the supervised clinical practice experience. Rubrics will be made available to students prior to the rotation.
Categories in this evaluation are intentionally consistent with the expectations of the programmatic curricular goals. The preceptor must provide comments noting the student’s specific deficiency/(ies) for any Likert score marked as 2 or less.
In addition, preceptors are asked: “Given the stage of training within this rotation specialty, I feel the student has acquired the appropriate knowledge, skills, and attitude.” An answer of “No” will result in immediate follow up by the Director of Experiential Education to determine if a failing grade will be assigned.
Evaluations
- Students will request a meeting with his/her preceptor at the midpoint of each rotation to receive feedback at that time. The mid-evaluation form (Appendix B) will be completed by the preceptor and signed off by both the preceptor and the student, and then submitted to the PA Experiential Education office by the established deadline.
- Students are to complete a final evaluation of the preceptor and the site on the Exxat system before 11:59 PM ET two days before the end of rotation exam.
- Students are to sign-off on the end of rotation evaluation completed by the preceptor within two business days on the Exxat system when available.
All evaluations must be completed in order to sit for the End of Rotation Examinations. Failure to meet the above requirements may result in a report to the Student Professional Conduct Committee for appropriate action to be taken, including warning, probation, suspension, or dismissal, or termination.
End of rotation examinations
The Butler University PA Program faculty utilizes the Physician Assistant Education Association (PAEA) written End of Rotation Examinations and endorses the objectives utilized to develop these exams as imperative to enter into practice as a PA. Students will take an examination at the end of each core supervised clinical practice experience.
In order to be permitted to sit for the required EOR exam, each student must:
- successfully complete the required rotation as scheduled; and
- complete patient encounter logs using eValue by 12:00 PM on the day preceding the EOR meeting; and
- complete the eValue student evaluation of the Preceptor by 12:00 PM on the day preceding the EOR; and
- sign off on preceptor evaluation of current clinical rotation, if completed; and
- meet the approval of the Director of Experiential Education and/or Program Director
Failure to meet the above requirements may result in a report to the Student Professional Conduct Committee for appropriate action to be taken (e.g. warning, probation, suspension, dismissal, or termination).
End of rotation objectives
Each exam incorporates current, relevant test items that follow rotation-specific content Blueprints and corresponding Topic Lists. More information may be obtained by going to the following website: https://paeaonline.org/assessment/end-of-rotation/content. The topic list links are included in the course descriptions below. The objectives for specific rotations will be provided during Orientation for the Experiential Year.
End of rotation score
Students take end of rotation exams at the completion of each core rotation to assess the comprehensive medical knowledge required by a graduating PA student. Exam scores are reported as a scale score between 300-500. The following grade scales have been created for students to determine letter grades:
Emergency Medicine
| Scale Score | Letter Grade |
| ≥445 | A |
| 425-444 | A- |
| 404-424 | B+ |
| 365-403 | B |
| <365 | F |
Family Medicine
| Scale Score | Letter Grade |
| ≥442 | A |
| 422-441 | A- |
| 401-421 | B+ |
| 362-400 | B |
| <362 | F |
Internal Medicine
| Scale Score | Letter Grade |
| ≥445 | A |
| 425-444 | A- |
| 404-424 | B+ |
| 365-403 | B |
| <365 | F |
Pediatrics
| Scale Score | Letter Grade |
| ≥448 | A |
| 428-447 | A- |
| 407-427 | B+ |
| 368-406 | B |
| <368 | F |
Psychiatry
| Scale Score | Letter Grade |
| ≥444 | A |
| 424-443 | A- |
| 403-423 | B+ |
| 364-402 | B |
| <364 | F |
Surgery
| Scale Score | Letter Grade |
| ≥436 | A |
| 420-435 | A- |
| 403-419 | B+ |
| 372-402 | B |
| <372 | F |
Women’s Health
| Scale Score | Letter Grade |
| ≥439 | A |
| 419-438 | A- |
| 398-418 | B+ |
| 359-397 | B |
| <359 | F |
Additional assignments
If a Clinical Instructor requires assignments (e.g., case presentations, notes, H&Ps, etc.), the assignments must be graded as Pass/Fail (and may be remediated, as needed). Students may fail the rotation for not meeting assignment requirements, including attendance at mandatory meetings.
Marginal or failing preceptor assessment
Marginal or failing performance in any rotation as evaluated by the Preceptor will be reviewed by the Director of Experiential Education and PA Program Director. The Director of Experiential Education and PA Program Director will review the information provided and have the right to fail a student based on reported performance.
Final rotation grade
If the Preceptor evaluation and Clinical Instructor’s assessment are favorable, rotation grades are based on the end-of-rotation exam scores. Students must submit all required assignments to pass courses. The PA Faculty member(s) have the final determination as to whether a student has met all rotation requirements and will confer the final grade for each rotation less any deductions for late or missed assignments. More specific details may be found in specific course syllabi.
Rotation failure policy
If a student fails the end of rotation exam on first attempt, the student will be able to remediate on his/her own and with the guidance of an assigned faculty member. The student will have the opportunity to re-test the rotation exam that he/she failed on a date agreed upon by the Director of Experiential Education that must take place before MPAS graduation. The student must pay $50.00 to cover the cost to retest the exam and administrative expenses. This must be paid prior to the scheduled retest date. If the student passes the exam on second attempt, he/she will receive the lowest passing grade for that rotation.
If a student fails the end of rotation exam on the second attempt, the student fails the rotation and must repeat the entire course.
If a student has a previously failed course, the student must pass all components of each rotation, including the EOR exam, before being allowed forward progress.
If at any point during the experiential year a student has 2 first-attempt failures on EOR exams, forward progress of rotations is immediately stopped until successful passing of at least one of the first- failed exams.
Marginal or failing performance in any rotation as evaluated by the Preceptor will be reviewed by the Director of Experiential Education and PA Program Director. The Director of Experiential Education and PA Program Director will review the information provided and have the right to fail a student based on reported performance.
If a Clinical Instructor wishes to also require assignments (e.g., case presentations, notes, H&Ps, etc.), they must be graded as pass/fail (and may be remediated, if needed). Students may fail for not meeting additional assignment requirements.
A student who fails the same course more than one time or who fails two different courses across the curriculum—either didactic or clinical courses— will result in dismissal from the Program regardless of overall GPA.
Any student required to repeat a course or rotation must anticipate a delay in the timing of his/her graduation and incur additional tuition and fees necessary to repeat coursework. Further, there may be
implications associated with financial aid. The student should contact the Office of Financial Aid for more information.
A student who is decelerated due to a failed course must maintain competency for coursework previously completed to progress through his/her program of study.
Summative practicum
Students must successfully demonstrate competency to practice medicine as an entry-level PA in primary care to graduate from the Program. Students must successfully complete a Summative Examination that is comprised of knowledge-based exams, clinical skills, and an objective structured clinical examination to demonstrate competency consistent with curricular goals. By successfully completing the Summative Examination, the student will have surpassed expectations regarding programmatic curricular goals and as such, the Program will verify that each student is prepared to enter clinical practice.