1 1 EVMS MPA Program Preceptor Handbook MASTER OF PHYSICIAN ASSISTANT PROGRAM Preceptor Handbook
2 2 EVMS MPA Program Preceptor Handbook TABLE OF CONTENTS Introduction... 3 Eastern Virginia Medical School... 3 Mission... 3 Vision... 3 Values... 3 Physician Assistant Program... 4 Overview... 4 PA Program Curriculum... 4 Competencies... 5 Technical Standards... 7 Clinical Year Schedule and Important Dates... 7 Precepting a Physician Assistant Student... 9 Physician Assistant Student Supervision Policy... 9 Purpose... 9 Scope... 9 Definitions... 9 Introduction... 9 Principles... 9 Policy Responsibilities of the Designated preceptor Student Service/Liability Coverage INTEGRATING THE STUDENT INTO YOUR PRACTICE The One Minute Preceptor Important Phone Numbers and External Links Phone Numbers External Links Bibliography... 17
3 EVMS MPA Program Preceptor Handbook INTRODUCTION This booklet is intended to serve as a guide for potential and current preceptors for the Master of Physician Assistant Program at Eastern Virginia Medical School (EVMS). This booklet contains both generic information about our school and program in addition to data that is specific to the preceptor role. Our preceptors play an integral role in the student s clinical experience. The preceptor guides and teaches the student in perfecting skills in history taking, physical examination, effective oral communication, developing diagnoses, assessment and plans. EASTERN VIRGINIA MEDICAL SCHOOL MISSION Eastern Virginia Medical School is an academic health center dedicated to achieving excellence and fostering the highest ethical standards in medical and health professions education, research, and patient care. We will strive to improve the health of our community and to be recognized as a national center of intellectual and clinical strength in medicine. VISION Eastern Virginia Medical School will be recognized as the most community-oriented medical school in the nation. VALUES Three core values drive our daily efforts: Excellence: We determine with our stakeholders what is valuable and hold ourselves to high performance standards that fulfill our promises. Collegiality: We serve our community and one another, building strong and mutually supportive relationships. We work as a cooperative, united team to further our purposes of education, research and patient care. Integrity: We strive to maintain the highest ethical standards and accept accountability for all we do and say. Adopted April 13, 2010
4 4 EVMS MPA Program Preceptor Handbook PHYSICIAN ASSISTANT PROGRAM OVERVIEW Our PA Program is accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Only graduates of an ARC-PA-accredited program are eligible to sit for the national certification examination. The PA Program is divided into two phases and spans 28 consecutive months (seven semesters). In Phase I, the 15-month pre-clinical year incorporates traditional classroom interaction with clinical skills development through the Sentara Center for Simulation and Immersive Learning. In Phase II, the 12-month clinical year, students complete eight clinical field experiences which form the basis of the professional socialization processes for adaptation to the role and functions of a physician assistant. Clinical sites are located throughout the Commonwealth of Virginia and many of our students are also placed outside the Hampton Roads area for some of their supervised practice experiences during their clinical training.
5 EVMS MPA Program Preceptor Handbook PA PROGRAM CURRICULUM SEMESTER ONE COURSE NUMBER COURSE NAME CREDITS MPA 5001 Pathophysiology for Health Professions 5 MPA 5061 Clinical Anatomy for Health Professions 5 MPA 5341 Legal and Ethical Issues in Medicine 2 MPA 5081 Introduction to the PA Profession and The Business of Medicine 2 MPA 5091 Clinical Assessment I 3 SEMESTER TWO COURSE NUMBER COURSE NAME CREDITS MPA 5112 Clinical Pharmacology I 3 MPA 5132 Clinical Skills and Therapeutics I 4 MPA 5142 Psychosocial Elements of Wellness 2 MPA 5162 Introduction to Clinical Medicine I 5 MPA 5192 Clinical Assessment II 3 SEMESTER THREE COURSE NUMBER COURSE NAME CREDITS MPA 5213 Clinical Pharmacology II 3 MPA 5233 Clinical Skills and Therapeutics II 3 MPA 5253 Introduction to Epidemiology and Evidence Based Medicine 2 MPA 5263 Introduction to Clinical Medicine II 5 MPA 5323 Fundamentals of Surgical Patient Care 4 SEMESTER FOUR COURSE NUMBER COURSE NAME CREDITS MPA 5304 Problem Based Clinical Reasoning 4 MPA 5314 Patient Counseling and Education 2 MPA 5294 Clinical Assessment III 3 MPA 5364 Introduction to Clinical Medicine III 5 MPA 5284/ MPA 5465 Journal Review Seminar/ Introduction to Clinical Practice 2/1 SEMESTER FIVE-19 credits COURSE NUMBER COURSE NAME CREDITS MPA 5705 Supervised Practice in Family Medicine (6 weeks) 3 MPA 5715 Supervised Practice in Pediatric Medicine (6 weeks) 3 MPA 5725 Supervised Practice in General Internal Medicine (6 weeks) 3 SEMESTER SIX-9 credits COURSE NUMBER COURSE NAME CREDITS MPA 5735 Supervised Practice in Emergency Medicine (6 weeks) 3 MPA 5745 Supervised Practice in General Surgery (6 weeks) 3 MPA 5755 Supervised Practice in Women s Health (6 weeks) 3 SEMESTER SEVEN-8 credits COURSE NUMBER COURSE NAME CREDITS MPA 5765 Supervised Practice in Specialty Medicine (6 weeks) 3 MPA 5775 Supervised Practice in Elective (6 weeks) 3 MPA 5807 Service Learning Practicum 1 MPA 5837 PANCE Review Seminar 1 COMPETENCIES
6 6 EVMS MPA Program Preceptor Handbook The following are skills and /or principles in which students have been instructed as part of their didactic curriculum. Each student must have demonstrated competency in all of these areas prior to advancing to Supervised Clinical Practice. History and Physical Examination Adult, Pediatric, Obstetric, Geriatric Laboratory Method Skills Arterial Blood Gas Collection Blood Cholesterol Determinations Blood Glucose Determinations Capillary Blood Collection Complete Blood Counts Blood smear preps Differential count Hemoglobin Microhematocrit Red and White Blood Cell Count Erythrocyte Sedimentation Rates Fecal Analysis Assessing Occult Blood in Feces Collection of Feces Specimen Phlebotomy Serologic Procedures Blood typing Mono test Pregnancy testing Rheumatoid arthritis test Slide preparation for KOH, Saline & Gram Stain Universal Precautions Urinalysis Chemical Macro/Microscopic Analysis Collection Urine Specimen Sterile Technique Gowning Gloving Hand washing Scrubbing Wound Management Wound Cultures/Dressings Evaluation and Management of Burns Packing Medications Drug Administration Oral, Intradermal, Intravenous Drug Dose Calculations Interpreting Drug Sensitivity Data Writing Prescriptions Radiology Introductory Principles Interpretation of Films Normal vs. Abnormal Chest Films Abdominal Films Musculoskeletal Films Tubes, Lines, and Drains Central Venous Catheterization Chest Tube Insertion/Removal Male and Female Urinary Catheterization Nasogastric Intubation Removal of Tubes and Lines Chest tubes CVP lines Penrose/Jackson-Pratt Drains Suturing and Knot Tying Instrument Tie One- and Two-Handed Tie Simple Continuous/Interrupted Vertical/Horizontal Mattress Vertical/Horizontal Mattress Subcutaneous/Subcuticular Other Procedures Ear Irrigation Electrocardiograms Performance of EKG Interpretation of EKG Nasal Packing Ocular Foreign Body Removal Splinting and Casting
7 EVMS MPA Program Preceptor Handbook TECHNICAL STANDARDS The abilities and skills applicants and students must independently possess in order to complete the education and training associated with physician assistant education is referred to as Technical Standards. These abilities and skills are essential for clinical practice as a physician assistant. The Technical Standards listed on our website reflect five categorical areas - observation, communication, critical reasoning (intellectual), motor and sensory functions, behavioral and social attributes - and represent minimum competency levels. Each standard is defined on our website and is followed by examples of indicators of minimum competence in that area. Physician Assistant applicants must be prepared to independently meet the technical standards, with or without reasonable accommodation, in order to complete the program and indicate such ability prior to their matriculation into the program. These technical standards also serve as pre-requisites for continuation, promotion, and graduation from the PA Program. Students found to be non-compliant with the Technical Standards are at risk for dismissal from the program.
8 8 EVMS MPA Program Preceptor Handbook CLINICAL YEAR SCHEDULE AND IMPORTANT DATES Discipline Weeks Dates Supervised Clinical Practice 1 6 May 5-June 11, 2014 Return to Campus ½ June 12-June 13, 2014 Supervised Clinical Practice 2 6 June 16-July 25, 2014 Return to Campus 1 July 28-August 1, 2014 Supervised Clinical Practice 3 6 August 4-September 12, 2014 Supervised Clinical Practice 4 6 September 15-October 24, 2014 Return to Campus 1 October 27-October 31, 2014 Supervised Clinical Practice 5 6 Supervised Clinical Practice 6 6 November 3-December 12, 2014 Excused 11/27-28 December 15, 2014-January 30, 2015 Excused 12/24-1/1 Return to Campus 1 February 2-February 6, 2015 Supervise Clinical Practice 7 6 February 9-March 20, 2015 Supervised Clinical Practice 8 6 March 23-May 1, 2015 Return to Campus 1 May 4-8, 2015 Graduation Week 1 May 11-15, 2015 Graduation Saturday, May 16, 2015
9 EVMS MPA Program Preceptor Handbook PRECEPTING A PHYSICIAN ASSISTANT STUDENT PHYSICIAN ASSISTANT STUDENT SUPERVISION POLICY PURPOSE The purpose of this policy is to provide specific guidelines for the supervision of physician assistant students and to clarify the roles and responsibilities of the designated provider(s) engaged in the education program. This policy also provides guidelines to ensure the safety and proper care of patients in the educational environment. SCOPE This policy applies to all licensed medical providers who are involved in the education, observation, assessment and supervision of physician assistant students and the students involved in approved supervised clinical practice opportunities. DEFINITIONS Designated preceptor: The immediate supervisor(s) of the PA student can be an MD, DO, PA, or nurse practitioner. The provider must be licensed in the appropriate state and meet a minimum requirement of two years of experience. Physician Assistant Student: A student in good standing in the EVMS PA Program, having completed the rigorous didactic curriculum and meeting the technical standards for advancement to clinical experiences. Associate Directors of Clinical Education (ADCEs): Two designated individuals in the EVMS PA Program with a supervisory role regarding the student policies, student placements, student performance and the acting liaison for the DP regarding clinical experiences. INTRODUCTION The Eastern Virginia Medical School PA Program recognizes that student supervision and supervised clinical practice rotations require time and careful consideration. The goal of this policy is to provide guidelines for student supervision to promote an excellent learning experience for the student and overall experience for the precepting provider(s)/group. PRINCIPLES This policy is based on the following principles: I. The central focus of the supervised clinical practice (SCP) experience is the appropriate care of the patient in an acceptable educational environment for the student. II. The autonomy, personal dignity and responsibility of the patient, student, and designated preceptor(s) must be recognized and respected. This will improve the patient care and the student s overall
10 10 EVMS MPA Program Preceptor Handbook educational experience. III. Joint decision-making and exchange of information should occur daily between the designated preceptor(s) and the PA student. IV. To allow PA students to prepare for future practice, an opportunity to obtain hands-on experience and be involved in the delivery of diverse medical care must be provided. Appropriate supervision must be maintained and based upon student performance and ability. V. The PA student s ability to ask questions, obtain information, examine, diagnose, manage and treat patients during this experience will increase preparedness for future clinical practice. POLICY I. Role of Designated preceptor The role of designated preceptor (DP) will be given to an individual licensed as an MD, DO, PA, or nurse practitioner with at least 2 years of clinical experience and a current state medical license. The provider must also be credentialed in any facilities involved during the experience for the specialty of care and diagnostic and therapeutic procedures they are supervising. Multiple preceptors may be designated for one student s experience, but each must meet these criteria. II. III. IV. Identification of the Physician Assistant (PA) Student The PA student will wear an identification badge with a visible student designation at all times. The PA student will also introduce himself/herself as a student to all patients, hospital staff and others. Respecting Patient Rights and Consent to Treatment The DP and PA student are obligated to inform the patient of the educational nature of the patient care, the student status of the PA student trainee, and the option to refuse student involvement. The patient must give informed consent for student involvement. When a patient is incapable of giving informed consent, consent should be obtained from the appropriate substitute decision-maker. For emergent situations, the facilities protocols for consent will apply. Supervision of the PA Student Although the supervising preceptor may not be with the student during every shift, it is important to clearly assign students to another MD, DO, PA or NP who will serve as the student s preceptor for any given time interval. In the case where the supervision is not available, students may be instructed to complete an assignment or may spend time with ancillary staff (radiology, laboratory services, physical therapy, etc.). The preceptor should be aware of the student s assigned activities at all times. Appropriate supervision of the PA student is expected at all times during the clinical experience. A. Orienting the PA student to the practice and facilities, assimilation of the PA student into the practice, review of policies and procedures involved in the experience, and communication with the PA student regarding expectations, hours, and responsibilities. B. Evaluation of the student s level of comfort and expertise through direct observation and ongoing evaluation to determine the PA student s clinical competence and educational requirements. C. Ensuring that the PA student to whom they are delegating responsibility has the appropriate knowledge, skills and judgment to perform the delegated act such that the patient is not put in jeopardy. D. Meeting regularly with the PA student to discuss his or her assessment, management and documentation of patient care. E. Providing direct supervision of technical skills with gradually decreased supervision as PA student
11 EVMS MPA Program Preceptor Handbook exhibits level of expertise. However, every patient must be seen and every procedure evaluated prior to patient discharge. F. Ensuring that all policies are distributed to and followed by any other DPs involved in the PA s training. G. Documenting the supervision of the PA student. No PA student will be allowed to see, treat or discharge a patient without evaluation by the DP. On each rotation, it is the student s responsibility to ensure that the supervising physician or preceptor also sees all of the student s patients. V. PA Student Documentation/Computer Access (if applicable) A. If allowed by the DP, practice and/or facility, PA students may enter information in the medical record. All medical entries must be identified as student and must include the PA student s signature with the designation PA-S. PA student entries are for educational and student evaluation purposes only and cannot be used in lieu of any required DP documentation. All entries must be countersigned by the DP, which indicates that the DP verifies the content as being accurate and appropriate, and a separate entry provided by the DP. B. In facilities with electronic medical records, computer access is to be provided for the PA student to review appropriate patient information, including but not limited to history, physical exam, lab reports, ancillary testing and consultations. C. The current documentation guidelines as published by the Centers for Medicare/Medicaid Services. You are strongly encouraged to follow these guidelines for all patient encounters. D. Preceptors are required to document the services they provide as well as review and edit all student documentation. Although student documentation may be limited for reimbursement purposes, students notes are legal and are contributory to the medical record. Moreover, writing a succinct note that communicates effectively is a critical skill that the PA student should develop. The introduction of EMRs presents obstacles for students if they lack a password or are not fully trained in the use of one particular institution s EMR system. In these cases, students are encouraged to hand-write note for review by the preceptor whenever possible for feedback. E. Any contribution and participation of a student to the performance of a billable service must be performed in the physical presence of a teaching physician or resident in a service that meets teaching physician billing requirements (other than the review of systems (ROS) and/or past, family, and/or social history (PFSH), which are taken as part of an evaluation/management (E/M) service and are not separately billable). Students may document services in the medical record; however, the teaching physician may only refer to the student s documentation of an E/M service that is related to the ROS and/or PFSH. The teaching physician may not refer to a student s documentation of physical examination findings or medical decision making in his or her personal note. If the student documents E/M services, the teaching physician must verify and re-document the history of present illness and perform and re-document the physical examination and medical decision making activities of the service. The preceptor s note must stand alone and include all components of the billable encounter. You are not able to write see above-seen and agreed or anything similar. Please contact the PA program is you any questions. F. Students may transmit prescribing information for preceptor, but the physician must sign all prescriptions. More specifically, the student s name should not appear on the prescription. For site that use electronic prescriptions, the preceptor MUST log into the system under his/her own password and personally sign and send the electronic prescription. These guidelines must not be violated by the student or the preceptor.
12 12 EVMS MPA Program Preceptor Handbook G. The following link provides additional information on Center for Medicare and Medicaid Services (CMS) rules regarding student documentation. https://www.cms.gov/mlnproducts/downloads/gdelinesteachgresfctsht.pdf RESPONSIBILITIES OF THE DESIGNATED PRECEPTOR I. Orientation to the site The DP is responsible for reviewing and following all policies relating to PA student supervision. This includes conversation with the PA student to clarify any policies in question prior to allowing the PA student to participate. The preceptor should communicate his/her expectations of the student during the rotation, to include: hours/schedule, interaction with staff, participation in rounds and conferences, oral presentations, written documentation, assignments, documentation guidelines (site specific), and any additional topics the preceptor feels necessary. II. Expectations Supervise, demonstrate, teach and observe clinical activities in order to aid in the development of clinical skills and ensure proper patient care. Increase levels of responsibility, in clinical assessment and management as appropriate to the student s experience. Co-sign charts to evaluate the student s progress notes, history and physical examinations, assessments and treatment plans for accuracy and completeness. III. Mid-rotation and Final Evaluations The DP is responsible for thoroughly and thoughtfully completing evaluations at the mid-rotation point and at the completion of the rotation. These are completed in E*Value (our web based evaluation program) and should be completed in a timely fashion. Any performance or professionalism concerns prior to the evaluation completion should be directly discussed with the ADCEs. The provider should participate in the evaluation of clinical skills and medical knowledge base through the following mechanisms: Direct supervision, observation, and teaching in the clinical setting Evaluation of oral and written presentations Assigned readings and research to promote further learning Preceptors should encourage students about their strengths as well as provide opportunities to improve upon weaknesses. The evaluation should also reflect the student s knowledge and skills as well as improvement throughout the rotation. It should also assess progress in comparison to other students at the same level. A. Feedback to program The DP is asked to provide all requested feedback to the PA Program in a timely fashion. This will include a once-yearly DP survey to benefit the program. Feedback is encouraged at all times and should be directed to the ADCEs. B. Expected progression of PA student PA students are trained to take detailed histories, perform physical examinations, give oral presentations of findings, and develop differential diagnoses. As the year continues, they should be able to more effectively develop an appropriate assessment and plan, though this will involve discussion with the preceptor. IF the preceptor deems it necessary, students initially may observe patient encounters. However, by the end of the first week, students should actively participate in evaluating patients. As the preceptor feels more comfortable with the student s skills and abilities, the student should be allowed to progressively increase supervised autonomy.
13 EVMS MPA Program Preceptor Handbook IV. Professional Relationships It is expected that DPs involved in the education of PA students will: A. Maintain an ethical approach to the care of patients, colleagues and all involved in the experience. B. Maintain a professional relationship with the PA student at all times. Avoid exploiting the power differential that is inherent in the relationship. Avoid situations involving potential conflicts of interest, and not intimidating or harassing the PA students emotionally, physically or sexually. V. Reporting Responsibilities PA students are required to conform to the highest standards of ethical and professional conduct. These include, but are not limited to: respect, flexibility, academic integrity, cultural competency, accountability, honesty, and trustworthiness. It is expected that any DP involved in the education of a PA student will report to the ADCEs or institution any behavior(s) suggestive of incompetence, incapacity, unprofessionalism, or ethically questionable regarding interactions with patient, supervisors and/or colleagues. It is expected that the EVMS PA Program and hosting facilities will provide a supportive environment for sharing of this information by the DP or PA student and has in place a method for handling such concerns. STUDENT SERVICE/LIABILITY COVERAGE I. Students enrolled in the PA program cannot substitute for practicing physician assistants or provide unsupervised services common to a certified physician assistant while at a learning or employment site. II. Students are not staff and therefore employee policies do not apply, nor may the student earn a salary for their services as a physician assistant student or work in the PA program in any other capacity. III. Students credentialed as other non-pa professionals cannot substitute as staff in that capacity while in the role of the physician assistant student. IV. Students are not employees of the hospital or clinics and, therefore, work entirely under the preceptor s supervision. Students are not to substitute for paid clinicians, clerical staff, or other workers at the clinical sites. Liability insurance will not cover any student assuming the PA student role outside of any assigned clinical rotation. V. EVMS s liability coverage does not cover the student in ANY of the above circumstances. VI. Liability insurance will not cover any student assuming the PA student role outside of any assigned clinical rotation. This is vital in preserving the professional liability coverage provided by Eastern Virginia Medical School.
14 14 EVMS MPA Program Preceptor Handbook INTEGRATING THE STUDENT INTO YOUR PRACTICE A placement letter with the student s picture will be sent to you prior to the placement. You may post this in your lobby as an introduction for your patients. Students are expected to be present for all activities as assigned by the preceptor. In general, students are advised to follow the preceptors schedule. If you attend noon conferences at a local hospital, you can ask the student to attend them as well. You may assign other activities to further the educational experience. Please discuss expectations and scheduling the first day. Introduce the student to your staff and tell the student a little about each staff member s responsibilities. This can help when questions arise. Preceptors are often concerned that a student will slow them down. While this may happen in the beginning, there are some things you can do to minimize or eliminate this. Ask the student to write down questions so they may ask them all at once rather than asking as they go along. Once you are comfortable with the student s history and physical examination and skills, utilize the student to do things that usually take you or one of your staff members time. For example, patient education (i.e. use of an inhaler, wound care management, etc.). Rather than reviewing all aspects of each patient encounter with the student, choose smaller segments. For instance, in the first patient with hypertension seen by the student, focus on the history. The second patient, focus on the physical exam and follow-up, third: treatment plan, and fourth: diagnostic work-up. If you have down time, assign the student reading during that time or have them review lab work for the patients coming in the next day. Make sure the student is aware of your preferences regarding patient charting. If the student is unable to write in the chart/emr, have them write a separate SOAP note, to be reviewed later. The student may work with other areas of your office such as the billing office, lab, etc, during times of high volume for a limited time. Have the student conduct education sessions with patients you have seen. This can be done while you move on to the next patient. You can have the student explain a medication or instruct the patient on a diabetic diet etc. If you get behind, it is acceptable to ask the student to read on a topic and be prepared to discuss it. It will add to the educational process if you can link this topic to one of your patients. If you know a particular patient has an appointment in the next few days, you can ask the student to research the patient s diagnosis and most current treatment for the condition/disease. Be very clear with the student exactly how much time you expect them to take with each patient. This time may start out lengthier but expectations of improvement should be shared.
15 EVMS MPA Program Preceptor Handbook Students may not initiate a patient encounter without permission from the preceptor or their designee. It is acceptable to ask the student to arrive at the hospital at 0600, perform a follow-up visit on all patients, gather and evaluate labs and write notes prior to your arrival. Be prepared to present the patients when I arrive at Students in this case are functioning under your direction. HOWEVER, students may not initiate any treatment plan or diagnostic work-up unless it has been approved by the preceptor or their designee and the preceptor has also evaluated the patient. Patients may not to leave the facility without being seen by the preceptor or their designee. THE ONE MINUTE PRECEPTOR The One Minute Preceptor is a five step technique which can be used in a variety of clinical settings. This technique encourages critical thinking by the learner and can help the teacher assess where the learner is in the clinical reasoning process. It also reminds preceptors to provide feedback. Following a student s patient presentation, follow this technique: STEP ONE: GET A COMMITMENT What do you think is the diagnosis? What is your treatment plan? What test(s) would you order? Avoid prompting the student or discussing the likely diagnosis or treatment plan at this point. STEP TWO: PROBE FOR SUPPORTING EVIDENCE What helped you rule out? Why would you like that lab test/use that medication? STEP THREE: REINFORCE WHAT WAS DONE RIGHT Include specific behaviors/knowledge that showed student understanding, preparedness. STEP FOUR: CORRECT MISTAKES Include in the discussion where the student may need improvement, along with guidance that is specific to any incorrect decisions or behaviors. Describe what was wrong and how to avoid errors in the future. STEP FIVE: TEACH GENERAL RULES Find a practical teaching point (or two) that can be applied to other clinical situations
16 16 EVMS MPA Program Preceptor Handbook IMPORTANT PHONE NUMBERS AND EXTERNAL LINKS PHONE NUMBERS Courtney Anderson, MPA, PA-C Assistant Professor/Associate Director of Clinical Education (away rotations) Angela Conrad, MPA, PA-C Assistant Professor/Associate Director of Clinical Education (local rotations) Sheila Jones Program Manager for Clinical Education Michelle Knight Administrative Support Coordinator EXTERNAL LINKS The following links may be useful in learning more about the PA Profession: The American Academy of Physician Assistants The Virginia Academy of Physician Assistants The Physician Assistant Education Association
17 17 EVMS MPA Program Preceptor Handbook BIBLIOGRAPHY Neher JO, Gordon KC, Meyer B, Stevens N. A five-step microskills model of clinical teaching. J Am Board Fam Pract 1992; 5: The College of Physicians & Surgeons of Ontario. Professional Responsibilities in Undergraduate Medical Education. Accessed August 14, Grathwohl, Durt W MD. Fellow Supervision Policy-San Antonio Uniformed Services Health Education Consortium: Anesthesia Critical Care Medicine Fellowship Program. Physician Assistant Education Association. Preceptor Orientation Handbook: Tips, Tools, and Guidance for Physician Assistant Preceptors. Accessed August 27, 2012.