Clinical Training Opportunities

For over 30 years, MEDEX has trained a diverse group of individuals for physician assistant practice in the Pacific Northwest. From its beginnings, the MEDEX program has worked collaboratively with physicians, administrators, legislators, other health professionals, community leaders and researchers to respond to the changing health care environment. MEDEX has a strong primary care tradition with special emphasis on training physician assistants to increase access for medically underserved people.

Key to the success of the program is the contributed time and energy of a broad group of clinical preceptors who provide clinical opportunities and instruction to MEDEX students. This manual is intended to provide an overview of the MEDEX program and the PA profession as well as specific guidelines and evaluation tools for the clinical components of the MEDEX program.

In addition to supporting and evaluating its students, the MEDEX faculty and administration regularly provide technical assistance to clinics employing PAs or considering the development of PA jobs. This technical assistance can include the creation of job descriptions, assistance with recruitment and retention, facilitation of contract negotiation and advice on licensure and reimbursement issues. We hope that you will see us as a resource.

Rotation Types

MEDEX training program includes 11 months of didactic instruction in anatomy and physiology, physical diagnosis, pathophysiology, pharmacology, etc. Instruction is provided by a variety of health care professionals including private practice physicians, pharmacists, practicing PAs and university-affiliated medical staff, as well as our PA faculty.

The second year involves structured rotations in various medical and surgical subspecialties (26 weeks) and a primary care preceptorship (16 weeks) where students work with a family practitioner in an outpatient clinical setting. There are also several weeks of orientation, examination and board review activities. During the specialty rotations (clerkships), we require that students spend four weeks each in emergency medicine, ambulatory medicine, general surgery, underserved populations, behavioral medicine and inpatient medicine.

Preceptorships

The intensive MEDEX four-month primary care preceptorship remains the foundation of our primary care training. The program is committed to identifying physician preceptors who have both an appropriate patient mix of primary care problems and enough time for attention to teaching. The preceptor–PA student relationship is designed to provide the mentoring that is necessary to teach the art of medicine. While the exposure to a single physician preceptor may be a limiting factor in terms of exposure to a variety of practice styles, the four-month clerkship period provides a balance of diverse clinical experiences.

The Family Practice Preceptorship for the Primary Care Practitioner is designed to train the physician assistant to do the following.

1. Assess, diagnose and manage common acute problems and chronic primary care problems across the life-span.
2. Provide preventive health and health maintenance listed in the national objectives.
3. Integrate him- or herself with other members of the health care team.
4. Establish medical practice standards.
5. Utilize evidence-based principles as part of a physician–PA student team.
6. Record and communicate medical data in an organized, intelligent process.
7. Identify role limitations and indications for referral and consultation.
8. Develop skills and habits necessary to life-long learning.
9. Provide compassionate, culturally competent health care to all patients.
10. Develop professionally in the role of a PA.

By working in the offices of practicing physicians, MEDEX students are assured of exposure to common problems seen in primary care practice, an experience difficult to achieve in an academic medical center. The one-to-one relationship between student and preceptor provides valuable guidance. Since training often occurs in the potential future employment setting, both the preceptor and the MEDEX student can test the feasibility of the arrangement before making a final commitment. Finally, the preceptorship model taps the creative potential of the practicing physician, both as a teacher and as an innovator in the provision of medical care.

Clerkships

The clerkships are designed with the intent to give students direct ‘hands-on’ patient contact under the supervision of the clinic or staff physician(s) or PA(s). We strongly encourage the involvement of staff PAs and nurse practitioners in providing clinical instruction to the students. The students are provided with professional liability coverage through the University of Washington’s Office of Risk Management. We ask that all training sites sign an affiliation agreement and a preceptor data form that formalizes the relationship between the university, the preceptor and the site.

The primary objective of the students during a clerkship is to receive supervised patient contact and medical management instruction designed to promote and enhance their clinical skills. The ideal clerkship situation would allow the student to do the following.

1. Interview the patient and obtain the pertinent medical history.
2. Perform the appropriate physical examination.
3. Present his or her findings to the preceptor.
4. Formulate a diagnosis and assessment with substantial input and teaching from the preceptor.
5. Decide on a plan of therapy that integrates the student’s level of knowledge with the preceptor’s clinical experience.
6. Write or dictate appropriate notes in the medical record to be reviewed and countersigned by the preceptor.
7. Function effectively as a member of the clinical team appreciating the unique roles and strengths of other team members.

The degree of student involvement in the practice is determined by the type of practice, the demands of the patients, the student’s skill level and, ultimately, the discretion of the supervising physician. Our experience has shown that a student who is allowed only to follow the physician without being able to perform clinical activities will achieve a no more than a minimal improvement in his or her clinical knowledge and understanding of disease processes. We require that a student evaluation form be completed and returned to MEDEX at the end of each clerkship.

If you are interested in providing clinical training, please contact the Clinical Training office.

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