Clinical Year

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 associated exam with the elective rotation. 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.

In addition to successful completion of the didactic and clinical phases of the Program, the PA student must also successfully complete American Heart Association BLS and ACLS certifications, Professionalism criteria, and all components of the summative evaluation to graduate from the PA Program.

Overview

During the clinical year all required core rotations, elective rotation, Core Topics, Issues of Professional Practice, and Summative Practicum (a total of fifty-three credits) will be completed. 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 (twelve months) unless approval is granted by the Program Director and Dean.

Our curriculum is designed such that students are enabled to meet our programmatic goals by completing core clinical rotations in largely primary care specialty experiences: 8 weeks in family medicine, 8 weeks in internal medicine, 8 weeks in emergency medicine, 4 weeks in pediatrics, 4 weeks in women’s health, 4 weeks in mental health, 4 weeks in surgery, and 4 weeks in an elective of their choice.

Clinical Rotation experiences will expose students to preventive, emergent, acute, and chronic conditions of patient care. 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.

Eligibility for Clinical Year

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.

Advising and Registration

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).

Coursework

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.

Total program curriculum = 108 credit hours.

Grade Standards

The faculty of record assigns grades for all courses and clinical rotations in the PA curriculum.

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.

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. Students of the Program who have successfully passed these exams are predicted to have the medical knowledge base to adequately pass the PANCE and meet programmatic goals. Starting with Version 6, End of Rotation™ (July 10^th, 2018) 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
≥445	A
425-444	A-
404-424	B+
365-403	B
<364	F

Women’s Health

Scale Score	Letter Grade
≥439	A
419-438	A-
398-418	B+
359-397	B
<359	F

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.

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 Topics I	2 credit hours
MPAS 658	Emergency Medicine I Rotation	4 credit hours
MPAS 650	Internal Medicine I Rotation	4 credit hours
Total Credit Hours		14 credit hours

Fall Semester

Course Number	Course Name	Credit Hours
MPAS 680	Core Topics II	2 credit hours
MPAS 648	Family Medicine I Rotation	4 credit hours
MPAS 626	Issues in Professional Practice	2 credit hours
MPAS 652	Internal Medicine II Rotation	4 credit hours
MPAS 630	Pediatric Rotation	3 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 Topics III	2 credit hours
MPAS 634	Elective Rotation	4 credit hours
MPAS 660	Emergency Medicine II Rotation	4 credit hours
MPAS 662	Family Medicine II Rotation	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
Total Credit Hours		20 credit hours

Coordination of Rotations

The Program will assign and coordinate all clinical sites and preceptors for program required rotations.

(Accreditation Standards A1.10; A3.03)

Preceptors/Sites

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.

Clinical Setting Policies

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.
• 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-Suggested Sites and Preceptors Distant to Campus Policy

Students may make suggestions for experiential sites and preceptors for their rotations that fall outside of the Program’s normal “catchment area” (i.e. distant rotations) but are not required to do so. (Accreditation Standards A3.03) Students must identify potential distant experiential sites BEFORE the start of their final didactic semester (January) and must complete and submit required paperwork to the Office of PA Experiential Education at that time for consideration. 

Student-suggested sites and preceptors are a privilege earned and not a guarantee. Student-suggested preceptors may not be family members or personal friends.

The Director of Experiential Education will consider suggested sites and preceptors for educational suitability, and final approval is at his/her discretion. Students are responsible for all costs incurred related to rotations, including return to campus for end of rotation activities, exams, and any other required meetings determined by the Program.

Required Site-Specific Documents

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

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 the needs of our students, to include allowing student access to physical facilities and appropriate supervision necessary to fulfill requirements of the rotation. (Accreditation Standard C2.01)

Students must “check-In” with the Office of Experiential Education via Canvas before the end of the first seven days from the start of the rotation. Students should answer all questions below when checking in!

1. Provide your name and contact information (cell number).
2. How many shifts have you completed prior to submitting this report?
3. Provide the name of your preceptor(s).
4. Do you have any concerns about the preceptor(s)/site/environment?
5. Are you receiving appropriate supervision?
6. What is your current level of involvement in patient care? (e.g., Observation only, direct patient care, etc.)
7. Do you notice any concerns in the office environment in which you are working that are unusual or that you would like to report?
8. Do you anticipate any days off during this rotation? If so, have these been approved by the Office of Experiential Education?
9. 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. If so, what day and time is best?

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.

eValue System

The PA Program uses an on-line tool called eValue to log clinical experiences, access rotation schedules and required orientations 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/experiences to be prepared and cleared to start. Failure to do so in a timely manner may result in delay in rotation start, and even delay in graduation. Additionally, students must maintain accurate and current contact information in eValue to allow the Program to make contact immediately in emergency situations.

All information logged into eValue must be accurate and complete while maintaining patients’ anonymity. All entries must be entered within a week of the patient encounter. Failure to log accurate clinical data will result in a professionalism violation.

Students will use the eValue system as follows:

• Enter current contact and emergency contact information into the eValue system.
  • Update information as necessary.
• Log all patient encounters on the eValue system. (PxDx)
  • Patient demographic information
  • All procedures and diagnoses including student’s role
• Complete site and preceptor(s) evaluation(s) before the end of rotation exam
• Sign off on the end of rotation evaluation completed by the preceptor within two business days

Rotation Specific Assignments

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.

Clinical Year Curricular Objectives

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:

1. History Taking and Physical Examination
2. Diagnostic Studies
3. Diagnosis
4. Health Maintenance
5. Clinical Intervention
6. Clinical Therapeutics
7. Scientific Concepts
8. Professionalism
9. Acquisition of Knowledge, Skills, and Attitudes

Clinical Year Assessment

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

1. 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. This form can be found on the Canvas PA Experiential Year site.
2. Students are to complete a final evaluation of the preceptor and the site on the eValue system before 12:00PM the day before the end of rotation exam.
3. Students are to sign-off on the end of rotation evaluation completed by the preceptor within two business days on the eValue 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.

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 12:00PM on the day preceding the EOR meeting; and
  • complete the eValue student evaluation of the Preceptor by 12:00PM 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).

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.

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. (Accreditation Standard A3.15c)

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. (Accreditation Standard A3.15c)

Safety at Rotation Site

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 to 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. (Accreditation Station A1.02g) It will be the preceptor’s responsibility to take reasonable steps to ensure personal safety and security of students during the rotation/experience. This is clearly communicated to preceptors and agreed upon in a signed Preceptor Agreement executed prior to the rotation/experience. (Accreditation Standard A1.01)

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. (Accreditation Standard B3.01) 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.

White Coats

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.

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. (Accreditation Standard C3.04)

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