Tips for PA Clinical Preceptors
The journey of a PA student is a culmination of extensive education and clinical exposure, and they bring with them a wealth of knowledge and eagerness to learn. As a clinical preceptor, you play a pivotal role in unlocking their potential and nurturing their passion for patient care.
I. Understanding the Role of a PA Student as a Clinical Clerk
a) The Educational Journey of a PA Student
Second-year PA students have already traversed a comprehensive educational path in their first year of PA school before arriving at their clinical rotations. PAs are trained in the same medical model as physicians.
Typically, they hold a bachelor's degree in a related field and have completed rigorous didactic coursework, covering medical foundations, anatomy and physiology, clinical skills, pharmacology, professionalism and bioethics, clinical reasoning and more.
In second year of PA school, PA clerks complete 4-6 week rotations in different areas of medicine. This includes core rotations in Family Medicine, Emergency Medicine, Internal Medicine, Psychiatry, General Surgery, Paediatrics, Women’s Health, and more. They also have the option to complete elective rotations in other medical specialties.
b) Medical Students vs. PA Students in clerkship year
They have already completed one year of PA school, which includes learning medical foundations, clinical skills, very similar to 1st and 2nd year medical students. By the time they reach 2nd year of PA school, they function much like 3rd and 4th year medical students (CC3 and CC4).
c) Expectations for PA Clerks
Under direct or indirect supervision of clinical preceptors (who are typically MDs, or PAs), PA clerks can:
perform history and physical examination
interpret investigations (imaging, labs)
perform interventional and diagnostic procedures under supervision
discuss provisional diagnosis and treatment plan
assist in surgery
place orders with co-signature
round on patients
hold the pager/be on call
medical documentation (progress notes, SOAP notes, consults, follow-ups, admission orders, brief OR notes, etc.)
II. Overview of the PA Clinical Preceptor Role
a) Expectations of a PA Clinical Preceptor
As a PA clinical preceptor, you play a pivotal role in guiding and mentoring PA students during their clinical rotations. Your expertise and support are essential for the student's learning experience and professional development.
Here are some key expectations of a PA clinical preceptor:
Clinical Supervision: As a preceptor, you are responsible for providing direct clinical supervision to the PA student. This involves overseeing their patient interactions, procedures, and decision-making while ensuring patient safety.
Teaching and Mentorship: Preceptors are expected to actively engage in teaching and mentoring the PA student. This includes explaining medical concepts, discussing patient cases, and offering insights into clinical reasoning.
Setting Learning Objectives: Work with the PA student to set clear and achievable learning objectives for the clinical rotation. These objectives should align with the PA program's goals and the student's interests.
Creating a Positive Learning Environment: Foster a supportive and inclusive atmosphere where the PA student feels comfortable asking questions, seeking guidance, and sharing their thoughts and reflections.
Providing Feedback: Regularly offer constructive feedback to the PA student on their clinical performance and professional conduct. Feedback should be specific, timely, and geared towards facilitating their growth.
Encouraging Active Participation: Encourage the PA student to actively participate in patient care, medical rounds, and team discussions. Provide opportunities for the student to present cases and actively contribute to patient management.
Demonstrating Professionalism: Model professionalism, compassion, and ethical behavior in your interactions with patients, colleagues, and the student. Serve as a role model for the student's professional development.
Understanding the PA Student's Role: Be aware of the PA student's scope of practice and the level of autonomy they have during their clinical rotation.
Promoting Interprofessional Collaboration: Encourage the PA student to work collaboratively with other healthcare professionals, fostering effective teamwork and communication.
Preparing the Student for Future Practice: Help the PA student understand the realities of clinical practice, including time management, patient load, documentation, and the challenges they may encounter in their future career.
Complying with Program Requirements: Familiarize yourself with the PA program's guidelines and requirements for clinical rotations. Ensure that the rotation meets the program's educational objectives and accreditation standards.
Maintaining Communication with the PA Program: Stay in communication with the PA program faculty to provide updates on the student's progress and address any concerns or questions that may arise during the rotation.
b) Benefits of being a PA Clinical Preceptor
Being a PA clinical preceptor offers numerous benefits, both personally and professionally. It is a rewarding experience that can positively impact the preceptor, the PA student, and the future of healthcare.
Here are some benefits of being a PA clinical preceptor:
Contribution to Medical Education: As a preceptor, you play a crucial role in shaping the next generation of healthcare professionals. Your guidance and mentorship directly impact the PA student's learning and future career, fostering competent and compassionate healthcare providers.
Enhancement of Teaching Skills: Precepting PA students provides an opportunity to refine your teaching and communication skills. Explaining complex medical concepts to students hones your ability to convey information effectively, benefiting your interactions with other team members as well.
Opportunity for Reflection: Engaging with PA students allows you to reflect on your own clinical practices and experiences. By sharing your knowledge and experiences, you reinforce your understanding of medical concepts and patient care.
Contribution to Professional Development: Precepting provides a sense of fulfillment and contributes to your professional growth. Witnessing the progress and success of PA students you have mentored fosters a sense of pride and accomplishment.
Fresh Perspectives: Working with PA students introduces fresh perspectives and innovative ideas to your practice. Their enthusiasm and curiosity can reinvigorate your passion for patient care and the medical field.
Improving Patient Care: By nurturing the skills of PA students, you indirectly improve patient care. As these students become proficient healthcare providers, they contribute to the delivery of high-quality care in their future careers.
Interprofessional Collaboration: Precepting PA students fosters interprofessional collaboration. It encourages effective teamwork and communication among healthcare professionals, ultimately benefiting patient outcomes.
Networking and Professional Connections: As a preceptor, you have the opportunity to build professional connections with PA programs and educational institutions. This networking can open doors to further collaboration and educational opportunities.
Fulfillment of Giving Back: Many preceptors find immense satisfaction in giving back to their profession and community by mentoring aspiring PA students. It offers a chance to contribute to the growth and success of the healthcare field.
c) Preparing for the PA Student Arrival
As you prepare to welcome a PA student into your clinical setting, taking the time to familiarize yourself with their specific PA program is a valuable step. Each PA program may have its unique curriculum and educational objectives.
Understand competencies: PA programs often define specific competencies that students must achieve during their rotations which are often outlined in a “Clinical Preceptor Handbook” provided to preceptors prior to taking on a PA student. Familiarize yourself with these competencies to guide your student's learning and ensure they gain proficiency in essential skills.
Confirm clinical rotation time and orientation: Confirm the dates the PA student will be with you, as well as necessary IT access (e.g. ID badge, EMR training and access, scrub machine, n95 mask fitting, scrub session etc.).
Confirm the PA student schedule: Will the PA student be working with you each day? or rotate with different attendings or preceptors throughout the week? Determine if the PA student will spend time in different clinical areas (e.g. ambulatory clinic, inpatient/ward management, operating room, etc). PA clinical clerk schedules are often very similar to a schedule you would assign to a medical student (CC3/CC4).
III. Nurturing the Preceptor-PA Student Relationship
Creating a positive and supportive learning environment is at the heart of effective precepting. As a clinical preceptor, your role extends beyond imparting medical knowledge; it involves fostering a mentorship dynamic that empowers your PA student to grow both professionally and personally.
a) Welcome and Orientation
Orientation: Begin the orientation with an in person meeting on the first day. Introduce the student to the health care team with a tour of the setting. Offer an orientation for protocols, resources, patient care routines and patient flow/documentation.
In-person one-on-one meeting on the first day: This is an opportunity to establish clear objectives and expectations. This can begin with an open conversation with the PA student about their clinical interests and career aspirations, as well as what they hope to gain out of the rotation. PA students can send their learning objectives to you ahead of time. The rotation can then be tailored to include experiences (e.g. clinic, procedures, OR time, interprofessional rounds, teaching rounds, etc.) that align with the student’s goals.
A period of shadowing: It is not uncommon to have PA students shadow in the first few days to gain an understanding of the patient care routines, protocols, and familiarity of the EMR. PA students can then dive into seeing patients on their own.
b) Fostering a Mentorship Dynamic
Encourage Questions and Curiosity: Promote a culture of inquiry by encouraging the PA student to ask questions and express their curiosity. Assure them that no question is trivial and that seeking knowledge is an essential part of their learning journey. Questions can be well timed to be after a patient interaction or towards the end of the day to minimize disruption to flow of the day.
Active Involvement in Patient care: Clerkship is NOT an observership, PA students should be actively involved in patient care. You can involve the student in patient care activities, allowing them to participate in history-taking, physical examinations, investigations, procedures and patient education under appropriate supervision. This hands-on experience enhances their clinical skills and instills confidence.
Share Experiences: Engage in open discussions about your own experiences as a healthcare professional. Share cases, challenges, and insights from your career to inspire the student and help them navigate potential hurdles.
Interprofessional Collaboration: Facilitate interprofessional collaboration by involving the PA student in multidisciplinary meetings or patient care conferences. This exposure enhances their ability to work effectively within the healthcare team.
Research and Presentations (Optional): Support the student's involvement in research or evidence-based projects related to their specialty interests. Allow them to present their findings to the healthcare team, fostering a sense of achievement and contribution.
Promote Reflection: Encourage the PA student to reflect on their patient encounters and clinical experiences. Engaging in reflection allows them to analyze their decisions, identify areas for growth, and develop a deeper understanding of patient care.
c) Encouraging PA Clerk Growth & Learning
Opportunities for PA Student Feedback:
Listen to Case Presentations: Offer opportunities for the PA student to present cases during rounds or team discussions. Presenting cases helps them refine their communication skills and critical thinking abilities. Ask follow up questions: “Why does X finding tell you? What is in your differential? What do you think is going on? What tests would you like to order? What do you think we should do next for this patient?”
Observe Patient Encounters: Part of the evaluation includes observing a few patient encounters the PA students (history taking, physical, assessment and plan). Use this as an opportunity to provide feedback on the PA students’ professionalism, rapport building and communication skills with the patient, time management.
Review PA students’ documentation: Review the PA students’ SOAP note/documentation of patient encounters and provide feedback, especially at the beginning of the rotation. Make note of accuracy, succinctness.
Provide Constructive Feedback:
Timely Feedback: Ensure that feedback is given promptly after each patient encounter or procedure. Prompt feedback allows the student to reflect on their actions while the experience is still fresh in their mind.
Balancing Praise and Areas for Improvement: Acknowledge the student's strengths and commend them on their achievements. Balance praise with constructive feedback, offering specific guidance on areas for improvement.
Encouraging Growth Mindset: Emphasize the concept of a growth mindset, where challenges are seen as opportunities for learning and development. Encourage the PA student to embrace feedback as a means to grow and excel in their profession.
IV. Leveraging the PA Students’ Skills
As a clinical preceptor, you have the opportunity to harness the unique skills and experiences that PA students bring to the healthcare team. Understanding their capabilities and encouraging their active participation can lead to a mutually beneficial learning experience.
Like working with most medical learners (e.g. PA students, med students, etc.), PA clinical clerks have a learning curve in the beginning, but become increasing proficient as they spend more time in the rotation.
Here is how you can leverage the PA student’s talents to enrich the dynamics of your clinical setting:
Comprehensive History-Taking: Leverage the PA student's expertise in history-taking, allowing them to conduct thorough patient interviews. This skill is crucial in obtaining accurate medical histories and building rapport with patients.
Performing Physical Examinations: PA students often excel in performing comprehensive physical examinations. Preceptors can encourage their involvement in patient assessments, allowing them to practice and refine their examination skills . This not only contributes to accurate patient evaluations but also instills confidence in the PA student's clinical abilities.
Ordering and Interpreting Investigations: Given their prior medical background and training, PA students can proficiently order and interpret certain diagnostic tests, such as routine laboratory tests and imaging studies. Preceptors can empower the student to engage in evidence-based decision-making by allowing them to request appropriate investigations and interpret the results in collaboration with the healthcare team.
Diagnosis and Formulating an Assessment and Plan: PA students possess a strong foundation in medical knowledge, enabling them to participate in formulating a diagnosis and developing comprehensive assessment and treatment plans. Preceptors can involve the student in case discussions, encouraging them to contribute their insights and engage in critical thinking to arrive at the best possible patient management.
Assisting in Surgery: For rotations in surgical specialties, preceptors can leverage the PA student's prior experience in assisting during surgical procedures. Under direct supervision, the student can actively participate in surgical cases, learning valuable surgical techniques and gaining exposure to the intricacies of perioperative care.
Patient Education: PA students often excel in patient education, explaining medical conditions and treatment plans in accessible language. Encourage them to educate patients about their diagnoses, medications, and self-care strategies.
Procedural Proficiency: Depending on their prior experiences and the PA program's curriculum, some students may have already gained proficiency in certain procedures. Offer opportunities for the PA student to participate in procedures under appropriate supervision.
Observing Specialized Interventions: Expose the PA student to specialized interventions relevant to their clinical rotation. Observing such procedures provides valuable insights and enriches their learning experience.
Team-Based Approach: Encourage a team-based approach to patient care, involving the PA student in interprofessional discussions and decision-making processes. This fosters effective collaboration and strengthens the continuity of care.
Learning from Peers: Invite the PA student to observe interactions between different healthcare professionals, showcasing the value of teamwork and collaborative problem-solving in patient management.
Rounding on Patients: Encouraging the PA student to participate in patient rounds fosters a sense of integration within the healthcare team. During rounds, the student can present patient cases, share updates, and discuss management plans, enhancing their communication and presentation skills.
Taking the Pager and Being On Call: Preceptors can assign the PA student to take the pager and be on call, providing exposure to managing patients in urgent or emergent situations. This experience prepares them for the fast-paced nature of medical practice and develops their ability to make critical decisions under pressure.
By acknowledging the PA student's prior experiences, encouraging their involvement in patient care, and emphasizing interprofessional collaboration, you integrate them seamlessly into the healthcare team. This inclusive approach not only enhances the student's learning but also enriches the overall care provided to patients.
Final notes
By understanding the unique role of a PA student, setting clear objectives, fostering a positive learning environment, and leveraging their skills, you empower these aspiring healthcare providers to thrive in their clinical rotations. Your support and constructive feedback inspire them to continuously improve and reach new heights in their medical careers.
