Guest Paula Posted August 6, 2015 Share Posted August 6, 2015 I start precepting a PA student mid August. This will be my second student and I need all the tips and help I can get. I have read over the programs requirements, expectations of the student, etc. How do you schedule patients so the student gets a good experience and how do I keep up with all the documentation? I know I will need to examine every patient and document and do the billing/coding. I've reviewed the CMS rules and our facility policy on documentation. It seems like it will take twice as long with both of us doing the exam, etc. I'm still getting clarification from management on scheduling. HELP!!!! Link to comment Share on other sites More sharing options...
SHU-CH Posted August 6, 2015 Share Posted August 6, 2015 What is the practice setting? The best preceptors ask a lot of questions. Not necessarily pimping questions, but questions to tease out a student's thinking. What do you think is going on? What do you intend to do? Why are you selecting that course of action? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 6, 2015 Moderator Share Posted August 6, 2015 I feel like having students actually speeds me up. after they have been there a week or 2 if someone comes in with a big lac, abscess, etc I go look at it with them and then inspect the final product. while they are suturing for 30 min I go see 2 or 3 other patients.that's the same way I was taught as a student. see one, do one. Link to comment Share on other sites More sharing options...
cinntsp Posted August 6, 2015 Share Posted August 6, 2015 For you more experienced folks, how much experience should one have before precepting? I've taken on junior fellows(think senior resident & intern roles) from other services when they rotate on mine and have enjoyed it. I think I'd like to precept an occasional student once I start a regular job. I feel like I could provide a solid experience. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 6, 2015 Moderator Share Posted August 6, 2015 For you more experienced folks, how much experience should one have before precepting? I've taken on junior fellows(think senior resident & intern roles) from other services when they rotate on mine and have enjoyed it. I think I'd like to precept an occasional student once I start a regular job and feel like I could provide a solid experience. as a residency grad you should be good to go now. for other folks, 2+ years in the same specialty is probably sufficient. you don't need to be a rock star yet, you just need a firm understanding of the basics. Link to comment Share on other sites More sharing options...
Guest Paula Posted August 6, 2015 Share Posted August 6, 2015 I'm in IM/FP so the rotation will cover family medicine mostly with some peeds too and women's health. The student will spend one day a week with a pediatrician on my day off. I do not expect I will be doing a lot of procedures but plan on letting the student do as much as they can. My procedures are much less now that I'm in FP and not working on the rez any more where the scope was much broader as far as procedures. Now patients go to our urgent care instead of FP clinic. Link to comment Share on other sites More sharing options...
Acebecker Posted August 6, 2015 Share Posted August 6, 2015 Students in the office setting do take time. What I have done to help myself is 1. make sure they have a log in to your EMR. 2. you guys can see a patient together and then they can do the write up and forward it to you for signing (or sign it with you addending or co-signing). 3. identify their weaknesses or have them self-identify their weaknesses when they start and focus your attention on those. 4. identify for yourself the two or three things you wish you had had a better grasp of before graduating and hammer those home for your student (for me it was bugs and drugs, primarily). I work in urgent care so I have not scheduled patients for my students to see - the nurse just checks with the patient and says, "we have a student, they will start the visit and Andrew will come in at the end and check everything over. Is that ok?" We get plenty of business for our students that way. My expectation was for my students to see about 6 patients/day (PA students still in didactic year doing a short rotation with me and NP students at any stage of their training). Our medical students (msIII) are expected to see 8 patients/day which I think is a fine requirement and would require that of a PA student who was near graduation. I'm not sure an NP student would be able to keep up with that pace, though (I have not yet met one who could). You can build this into your scheduled day most simply by having your nurse or MA clear it with the patient while the patient is being roomed. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 6, 2015 Moderator Share Posted August 6, 2015 my current student (rock star paramedic from medex, today is her last day of clinicals) has been seeing about 80% of the pt volume, while I see pts when she is doing procedures. last shift (pre-new emr) I saw 39 in 12 hrs. she saw about 30 of them. with the new emr this week, I expect to see around 20 today with her seeing 15 or so and doing all procedures. Link to comment Share on other sites More sharing options...
Acebecker Posted August 6, 2015 Share Posted August 6, 2015 not to hijack the thread, E, but I hate seeing a patient every 15 minutes. drives me bonkers. I'm more of a 30 in 10 hours kinda' guy. Your student rocks more than the ones I have had, for sure. Any chance she wants a job in urgent care (we're potentially hiring)? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 6, 2015 Moderator Share Posted August 6, 2015 not to hijack the thread, E, but I hate seeing a patient every 15 minutes. drives me bonkers. I'm more of a 30 in 10 hours kinda' guy. Your student rocks more than the ones I have had, for sure. Any chance she wants a job in urgent care (we're potentially hiring)? I'll check, but I think she has an fp job with loan repayment already set up. I also hate more than 2/hr. at my favorite rural job I see 12 in 24 hrs...of course most of them are pretty old and pretty sick. Link to comment Share on other sites More sharing options...
Febrifuge Posted August 6, 2015 Share Posted August 6, 2015 When it comes to patient volumes, my favorite quote is from The Princess Bride: "Never rush a miracle man, sonny. You get lousy miracles." Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 6, 2015 Moderator Share Posted August 6, 2015 When it comes to patient volumes, my favorite quote is from The Princess Bride: "Never rush a miracle man, sonny. You get lousy miracles." just saw that again a few days ago with the kids. great flick! 39 patients in 12 hours! inconceivable! I've spent the last several years building up an immunity to high census days..and iocane powder...:) Link to comment Share on other sites More sharing options...
SHU-CH Posted August 7, 2015 Share Posted August 7, 2015 If you are in an office, leapfrog with the student once you are comfortable they are fairly competent. Send them four doors down the hall. When you catch up, ask them what is happening and what they want to do. See the patient and confirm the findings and plan. When they get faster, maybe it will be every third or every other room. (Just remember to give them a chance to see any interesting findings you come across.) Properly done, precepting should not be time consuming. As noted above, it might even save time if you can hand over procedures, have student explain instructions, etc. Link to comment Share on other sites More sharing options...
gbrothers98 Posted August 7, 2015 Share Posted August 7, 2015 Paula First, make sure the student gets a good orientation. They show up bright eyed and bushy tailed, want to get right to business. But a well done reasonable orientation will do wonders to establish expectations, boundaries, etc. Take a look at this page: http://www2.paeaonline.org/index.php?ht=d/sp/i/157956/pid/157956 Scroll down to the part 3 and download the pdf. 2/3rds of the way through are listed effective teaching methods. Make some of them your own. I discuss with students my philosophy, Take Ownership. Take ownership of the patient. Take ownership of their learning. Take ownership of the rotation. Ask for objectives concerning the rotation. Try to schedule the student with patients that dovetail with the objectives. You could actually go so far and schedule patients to see the student if you have access to your schedule in advance. Start with just 2, one in am and one in pm, then adjust upwards after you see what student can do. Acknowledge where a student is in their clinical year. There will be a difference in rotation one vs rotation 9. I always ask a student what they want to be. FM, IM, surgery, EM, whatever. Then I work the rotation that way. I realized very quickly not every student will want to be an EM PA but if I know what they want to do, I can start associating their desire to how they would interact with the ED. Good luck and make sure they eat lunch. G Brothers PA-C Link to comment Share on other sites More sharing options...
Guest Paula Posted August 8, 2015 Share Posted August 8, 2015 thanks, all. Good advice and I love Princess Bride! I downloaded the pdf from paea. Link to comment Share on other sites More sharing options...
Guest ERCat Posted August 8, 2015 Share Posted August 8, 2015 As someone who JUST graduated PA school :-) I do have some advice about what distinguishes an awesome preceptor from an okay preceptor. 1) Try to make sure that the student is able to follow at least SOME cases all the way from beginning to end. Too often in my rotations I would be instructed by a preceptor to go see a patient, and then go see another patient, and then go see another patient...so I got really good at doing H+Ps but I was not so good with actually diagnosing and treating. Haha. 2) Observe the student. In my entire PA school education I was only observed TWICE doing my history and physical. TWICE -- and that's nuts! Make it a point to watch at least a few patient encounters from beginning to end so you can give the student feedback on their PE skills and patient rapport. 3) Don't be afraid to challenge the student. I feel like most of my preceptors were "too nice." The ones that challenged me (in a respectful, gentle way) were the ones I learned the most from. Don't worry about pimping them too much or asking them to do too much. That's what they want -- at least the good students -- because it helps them grow. My favorite preceptors were the ones that said "Quick! What is the most common cause of hyperkalemia" or "Tell me what CREST stands for." It put me on the spot, but 1) it made me feel really good when I knew the answer (it's a way of instilling confidence, not just challenging your student) and 2) you betcha that the questions I didn't know, I learned the answers and they are forever burned into my brain! 4) Be aggressive about making sure the student gets to do procedures. They can be hard to come by so if there are other clinicians around who have procedures, see if they would let the student do one. I was so thankful when I was on my rotations and random docs would be like, "Want to do a reduction/suture/help with CPR?" Link to comment Share on other sites More sharing options...
KateD Posted August 11, 2015 Share Posted August 11, 2015 I agree with the above! Going through a fellowship the past year and having more opportunities to work with various preceptors... really, the days where I find myself thinking, wow, that was an awesome day, are the days where I interacted with patients but also my preceptor -- they were engaged, questioning my clinical reasoning, allowing me either show where I have a clear understanding of the particular case or where I'm missing something... missing a particular lab test or something in my workup... or missing an important pt ed issue, whatever it might be. I've met some awesome people who have been preceptors to me... but just because I think they're great people that I'd like to grab a drink with doesn't mean they were my "favorite" preceptor. Challenge is good. And yes, the student/preceptee needs to be self-motivated to challenge themselves, but you can certainly facilitate in a very meaningful way! There's also literature out there like the "One-Minute Preceptor" that may be helpful... http://www.oucom.ohiou.edu/fd/monographs/microskills.htm Link to comment Share on other sites More sharing options...
winterallsummer Posted August 11, 2015 Share Posted August 11, 2015 39 patients in 12 hours! inconceivable! 30-40 is the norm in our fast track. A slow day is 25-30, a busy day you can easily see over 40. If a lot lf procedures come in, it is still 30-35. Granted many of them don't need a work up, just a discharge plus or minus a script! The worst is when you have 5+ patients waiting for you and in walks grandma who decided to cook steak / do lawn work / explore the attic for her first time and is waiting for you with five finger lacs on one hand and a bottle of coumadin in the other. Link to comment Share on other sites More sharing options...
SocialMedicine Posted August 11, 2015 Share Posted August 11, 2015 Great advice. I learned a lot reading this. Students should go in indep and evaluate the patient. Provided the patient has provided consent in some fashion. Maybe they evaluate the 11AM patient while you see the 1115 at the same time. Hard to give flow advice since we do not know how the office schedules. Making sure the students is thinking about a differential and management is important. Making sure patient is interacting properly is also important. Maybe you guys see a few patients at same time. Giving the student some reading guidance and constructive criticism is important. Link to comment Share on other sites More sharing options...
Guest Paula Posted August 11, 2015 Share Posted August 11, 2015 Thanks all! I will be keeping all of this in mind. Link to comment Share on other sites More sharing options...
Guest Paula Posted August 21, 2015 Share Posted August 21, 2015 My first week of precepting a PA student is over. It was fabulous! I have a dynamo student who is so excited and wants to see and do as much as she can. I am impressed so far even tho her prior health care experience was minimal. The student is a direct entry student in her program and started PA program in her junior year and getting the Masters. 22 y/o. She will be a fine PA. I'm already inculcating her to PA issues, dependent practices, supervision, delegation, title. She does not like the title either. She's hearing the elevator speeches on autonomy. Poor thing.......(to listen to me....hahahaha). Link to comment Share on other sites More sharing options...
JohnnyM2 Posted August 22, 2015 Share Posted August 22, 2015 just saw that again a few days ago with the kids. great flick! 39 patients in 12 hours! inconceivable! I've spent the last several years building up an immunity to high census days..and iocane powder...:) I don't think that word means what you think it means. But you probably already knew that since you know that I know what it means and I, of course, know that you know that I know what it means. Sent from my SM-G900V using Tapatalk Link to comment Share on other sites More sharing options...
JohnnyM2 Posted August 22, 2015 Share Posted August 22, 2015 My first week of precepting a PA student is over. It was fabulous! I have a dynamo student who is so excited and wants to see and do as much as she can. I am impressed so far even tho her prior health care experience was minimal. The student is a direct entry student in her program and started PA program in her junior year and getting the Masters. 22 y/o. She will be a fine PA. I'm already inculcating her to PA issues, dependent practices, supervision, delegation, title. She does not like the title either. She's hearing the elevator speeches on autonomy. Poor thing.......(to listen to me....hahahaha). Wow! You mean that she was a rock star even though she has never been an EMT? That IS inconceivable! Sent from my SM-G900V using Tapatalk Link to comment Share on other sites More sharing options...
Guest Paula Posted August 22, 2015 Share Posted August 22, 2015 Inconceivable!!!!! Link to comment Share on other sites More sharing options...
delco714 Posted August 22, 2015 Share Posted August 22, 2015 Inconceivable!!!!!Crazy. Crazy crazy. Here I thought young PA students sucked Link to comment Share on other sites More sharing options...
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