Author: Elizabeth Massey, MHS-PAS, PA-C, EMTP
Former Associate Director of Clinical Education of Physician Assistant Studies
Corona virus 19 (COVID-19) first entered the US via social and mainstream media by demonstrating its initial effects on Wuhan, China. Most educators or providers first thoughts were surprise and intrigue, but not necessarily fear. Then Covid-19 completely shut down China. There were news reports on how their citizens were coping with isolation and a decreased food supply. Not to mention the fear Citizens had when leaving their homes. This was startling and surreal to many medical providers even though they were not yet affected. The virus progressed to Italy with devastating effects. Now it is in the United states. Months have come and gone with COVID 19 in our daily lives. COVID 19 was not something educators, practitioners or students had anticipated. Clinical rotations came to a screeching halt, along with outpatient clinics and elective procedures. As re-opening cautiously takes shape, we now look at how to adapt to our new world. Below are 7 Strategies PA and ARNP programs can employ to help ready their students in preparation for Clinical rotations and beyond. These strategies can not only benefit PA and ARNP program educators but can also guide APP applicants when choosing a program. Current Physician Assistant and Nurse Practitioners students should query their programs on these strategies to help relieve some anxiety about COVID-19 and their future as providers.
During the Clinical Year
- Ensure all clinical students have been appropriately fitted for an N-95 mask and make sure each student is supplied with at least one mask before going out on rotations. Some Facilities require the students to have appropriate PPE before they can rotate. Applying students and current students should ask their program who will be incurring this cost. Will the appropriate fitting be scheduled and payed for by the school or will this be the student’s responsibility? Correct N-95 fit is an OSHA requirement for those taking care of COVID patients.
- Have a discussion with the students about potential COVID testing and Quarantining prior to certain rotations. Some Facilities require Negative COVID Testing or have a Quarantining protocol. There are currently rapid tests and PCR tests available. Who will pay for these required tests? The student, the program or the facility? See appropriate facility for individual requirements.
- Focus on more rural areas for finding clinical rotations. Individually run clinics are more likely to accept students because there is less red tape. These providers also tend to enjoy the helping hand of a student.
- Discuss the possibility of Telemedicine rotations with potential Preceptors. These discussions could decrease the clinical students housing costs. They can be done as a 3-way virtual call, which works best for Behavioral Health rotations. However, there are many strategies to assess patients across many different specialties and complaints.
During the Didactic year
- Train and make sure the students are comfortable with Telemedicine. Teach the students how to evaluate patients via video. A good example would be to instruct the student on telling their patient to pull down the lower eye lid to help evaluate for anemia. This not only comes in handy for clinical rotations, but this will expand the student knowledge of Telemedicine, which will be a growing industry moving forward.
- Put more emphasis on ICD 10 coding during the didactic year. Why? Clinical students must be exposed to a minimum amount of a different type of patients to meet graduation requirements. Benchmarks can vary per program. These are monitored by ARC-PA. If the students are more familiar with coding – they can input more appropriate patient contacts during each rotation, regardless of the tracking system the programs use. For example, a student could code for pregnancy AND anxiety. This will help a student and the program with meeting the minimum requirements for both Women and Behavioral health rotations. In September, ARC- PA updated their standards to include ICD 10 coding.
- Appropriate staffing for all portions of the program. Didactic and Clinical. Anyone can get COVID regardless of appropriate protection. One sick person adds a lot of work to other colleagues’ plates, even if equally divided. More Clinicians than ever are feeling burn out from all the changes COVID has brought to both personal and professional lives. The burn out is not isolated to those practicing clinically, but academically as well. Heavy redundancy with regards to clinical preceptors as well as academic staff and faculty can help share the burden and reduce the mental fatigue from the pandemic.
Occupational Safety and Health Administration (2020, April), United States Department of Labor, Temporary Enforcement Guidance – Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak, Retrieved from https://www.osha.gov/memos/2020-03-14/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fit
Accreditation and Review Commission on Education for Physician Assistant, Inc., (2020, November) Accreditation Standards for Physician Assistant Education© Fifth Edition, Retrieved from http://www.arc-pa.org/wp-content/uploads/2020/10/Standards-5th-Ed-September-2020.pdf
For the Published Version of this Article please visit the link below at MELNIC!