PA Education COVID-19 Response Forum: Clinical Phase - Shared screen with speaker view
Sheree here from Connecticut
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San Antonio here.
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So nice to connect with everyone.
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Hey everyone from Elon PA!
LEIGH ANNE PICKUP
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Miami Dade medical PA
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Edward Giarrusso Stony Brook University
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Glad you have all joined..
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Elizabeth Di Prospero
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Does anyone have audio on their web-based app?
Yes, I have audio on web-based app.
Got it! Thank you
You can control audio in the lower left hand side of the app.
Hello from Gainesville, Florida!!
Hi from Charlotte, NC
Hello form California!
Good morning HEather!
Hi from Minneapolis, MN!
Hi Heather and Lindsey!
Good morning Sandra:)
good morning ladies:)
Thank you for organizing this!
Really curious how folks are interpreting and responding to the recent ARC statement.
What do we do for EOR if we cannot have a live proctor? Proctor U and Examity is not taking new schools
Good afternoon to all.
Question: Are programs planning to continue “End of Rotation/End of Clerkship” exams on schedule even though our students will only be seeing “patients” on a digital platform (like Aquifer or something similar?)
Yes, we had exams on this past Friday
How are you navigating the use of digital patients and ARC compliance?
Thanks everyone who has questions! There will be an opportunity Raise your Hand and be un-miced to ask questions in a little bit!
Woohooo!!!!!!! THANK YOU
Not a problem!
Amazing news, greatly appreciate it. THANK YOU!
does this mean we can use webex/zoom to monitor them
Proctoring for PAEA EOR you ca have proctors remotely. They can be done by having gogle meet.. st
Literally, I want to cry.
Hang in there ELi
I’m with you Elias
This is great news!!!!!
Please clarify. We do not need to use a remote proctor program to administer the EOR exams?
We are using Zoom to proctor in house exams. students will have Zoom on their phones, and take the exams using our usual examsoft lockdown
anyone know how to interpret the Summative exam standard? We have already administered some components, but now with graduation potentially being delayed, unsure how this affects the 4 month requirement
Did understand correctly, a remote secure proctor is not needed to give the EOR, I being a Faculty member can proctor and monitor the remote EOR being given.
Exam Information https://paeaonline.org/assessment/. 301-617-7820 • exams@PAEAonline.org
Questions will be done at the end…save your questions. They’re good questions:)
please consider doing questions using the chat function rather than by using audio.
how do we register
Heres the link to the upcoming webinars and how to register. https://paeaonline.org/resources/coronavirus-resources/virtual/
Agree with having a moderator take questions from chat rather than having us all trying to raise our hands to ask on-mic
We had success with MonitorEDU to proctor EOR exam last week.
To answer the question to David for everyone: PAEA is waiving our proctoring policies for the End of Rotation exams effective immediately and until the end of June. You can administer End of Rotation exams to students at home without a remote proctor.
what are your module block themse?
The following is what we were doing till we took all our students off rotations and would like some feedback please. We we looking at is the number of hours and if the student has met the objectives for each rotation – IF the student has met all the requirements for a rotation in less than the # of weeks they are supposed to be on one, we are taking them off. If the site will take on another student who needs the rotation, we put them in there.So for example – our rotations are 4 weeks [OB, PEDS, ED etc] of 8 weeks – [IM, FM and Gen Sx]. However, this is also in hours – so 144 hours for a 4 week rotation is what is required.We first make sure they have met all our requirements – the hours [not the weeks], patient logging, their ICD-10, CPT codes etc. The preceptor also MUST sign off on their evaluation which does state they have met the LO. There are various other requirements – H&P etc. etc. They may be able to do all this in less than the # of weeks.
that is what we are doing Grace as well
Am I correct that LockDown browser will not work with ExamDriver?
Shout out to Dr. Lucy Kibe at Charles Drew!
Yes, you are correct, ExamDriver is not compatible with lockdown browsers
what happens to student's loans if rotations are delayed?
Thanks Grace! Good to see you!
I am really interested in what ARC-PA thinks about substituting clinical hours with online education in the clinical year
great ideas presented... but are we allowed to do these things?
that is the issue Holland
Would be nice to get more info from them to guide us.
I think that’s part of the plan...
Olivia Ziegler our chief assessment officer is on and answering some of your questions about the exams. Due the fast speed of the conversation, if we missed anyone at the end of the webinar, please reach out: 301-617-7820 • exams@PAEAonline.org
Please slow down!
re: student loans---check with your university. we were told students must remain engaged with the curriculum in some way to verify they maintain "enrollment"
Great ideas, but are those on line experinces sufficent to repalce clinical hands on?
Kim, do these options in contingency plan take place of the clinical rotation? Or do they still make up the clinical rotation.
Hi Katie - There is information on the Federal Student Loans at https://studentaid.gov/announcements-events/coronavirus
A few said you’ll have questions but don’t want to get on the mic, please chat your questions to Kendall (PAEA Admin) and she’ll ask on your behalf.
I agree with Holland regarding substituting clinical experiences vs didactic online content
Kim your resource posted is a great guide and one helping to create our ideas as well! Would encourage us all to post our creative ideas and resources to the Learning hub, thanks PAEA for creating this!
I thought you can't "substitute" clinical rotations as per ARC-PA?
Which alternative options are ARC-PA approved?
Solid work Kim!
Thank you Kim!
You are fantastic, Kim!
The ARC-PA is put that message out initially but will they consider other options as we come up with them
Elizabeth Di Prospero
Thank you for the clarification Kim - exercises only for supplementing the 2 weeks but not for the full rotation
So ARC made a reivsed staement Friday to being more fluid to allow you to chagne as long as you meet all of your learning outcomes ..Think in terms of outcomes versus hours or weeks
We are considering shortening our remaining rotations from 4 weeks to 3 with supplemental online courses to "make up this time"
We consider the 2 week contingency as a supplement/augmentation, not a true replacement. Students will not have to repeat Rot 3, but they do have to finish this coursework. WE will be using a checkpoint OSCE/OSLER as we get them back.
Anyone in California wishing to join the California discussion, email me at email@example.com
At a prior program, we had a nonclinical faculty development elective rotation. Since it is an elective, it doesn't fit into a Standard. We are viewing this current "COVID-19 Elective" in the same light.
One of our concerns is that sites will open up to students in a staggered manner. And that some will be quite delayed.
Hi Carol, definitely agree. Meeting learning outcomes vs. clinical hours
Kim, will that be a face to face OSCE/OSLER? or will you do that distance based?
We were at the very beginning of rotation 3, so our students will have to complete the 4 weeks later no matter what but we are still doing lectures/questions etc to keep them in the game until we can figure out a solution
Will the schedule of webinars be made available?
When we get them back, face to face
Raise your Hand using the Raise Hand Feature to let us know if you’d like to talk!
@ashely Larsen..we are doing the same
Can you restate the question
How are programs managing SUMMA evaluations such as clinical skills virtually?
what was the question?
I don't have a raise hand feature
Agree with Loni
(I have the same question)
Missed the question, I don’t have the raise hand feature either
On your screen, click on Participants and it should be at the bottom of the participants screen
all: if you click the "participants" button at the bottom of your screen (looks like three people) a side bar will pop up with a few peoples names at the top. right under those names and befor the chat - that's where you will find "unmute" and "raise hand"
there are some really get Apps for iphone as well. 'Full code' has simulated cases, and 'Touch surgery' has simulated procedures. We are using those to adjuct. Looking for more simulated cases
how are people addressing "electives" creatively? Do we still need to have clinical hours for elective rotations?
vCases.com is offering a free year subscription to their simulation cases to as many programs as they can support
We are creating a few non-clinical electives and running those up front to buy some time.
Heather is there a cost to those Apps?
That's what we are thining of doing Michele Toussaint
Michele, so are you creating new syllabi for those rotations?
yes- In the midst of this right now as the first one will start 3/30
'Full code' is free for 8 cases, but for full access it is $8/mo. 'Touch Surgery is free
Thank you Heather Ontiveros
Moving from sufficient exposure language to meeting program learning outcomes released that pressure to meet
You are very welcome
Over 64% of programs have already committed to having students (didactic or clinical) become MAT-waiver trained prior to graduation. As programs are scrambling to put online content together for both cohorts, these resources might be a mechanism to provide high quality content (24 hours) to your students at no charge—and may be applicable to behavioral health rotations. Of course, with their certificate of completion, Grads will be eligible for x-waivers after PANCE/licensing/DEA. etc.https://pcssnow.org/calendar-of-events/?tribe_eventcategory=12
Michele and Kim: we are considering this for our first year students - so we have less overlap between those graduating and those entering
can you post your email? Carol?
How are programs handling the supervisor’s sign off for competency for a CORE rotation, if this is a part of their documentation?
Carol Gorney, firstname.lastname@example.org
SAje- can you repeat those..it was a little fuzzy coming though
i would love to join a small group
Saje is talking about ReelDx and i-Human
RealDx and iHuman is what she said
me too thanks Carol for sharing your email.
Holland, Agree with you. Focus on learning outcomes and assessment. Exposure/logging (unless it involves a sign off of competency) plays a secondary role....
REEL DX cases aren’t really evidence based..a lot of them are of paramedics talking to patients and providers that use poor techniques (H/P)
God speed David!!
Sorry David - we all feel for you
Thanks for that info, Alicia.
Man what a start David!
Alicia : We are weeding through the ReelDX: cases for those that are pertinent and well done.
alternative elective content: we are looking at something evidence based to bolster our outcomes for EBP
Man that is rough David...we all feel for you!
David, we are providing an elective which includes a telehealth component, professional practice and development and PANCE prep
happy to share
how are you using telehealth
erin, can you share with me too? My email is email@example.com
Erin, I would love for you to share this!
I would love to see too Erin- firstname.lastname@example.org
If someone has an alternative elective syllabus/plan of modules they could post in the digital learning hub, that would be great to give us some examples!
me too! email@example.com
Erin- me too! firstname.lastname@example.org
Michael De Rosa
We haven't yet reeached a body count that will move the ARC on in-person experiences. Fingers crossed.
simulation, scenarios, cases, all are great ideas to assist with learning BUT, is there any substitute for actual time and experience with patients? If we can’t prove sufficient exposure from Typhon in their family med rotation (for example), their graduation will have to be extended??
I would like to see it as well Erin. email@example.com
We are still working on it but trying to have students either sit on site with the preceptor or for students to remote in with preceptors providing telehealth
Ditto. thanks, Erin! firstname.lastname@example.org
Virtual cases are great, but they are not real people, so I'm cautious on how much we use them.
would love to see the syllabus that is providing alternatives for the elective
Same here. Please share Erin! email@example.com
Erin.would like to see. firstname.lastname@example.org
Seems like a few people would like resource we’ve developed. Can you email me if you would like? I’m having trouble keeping up with everyone
Bill- that is my uderstanding
Bill: Agreed - they have to have sufficient contact with real patients - the crux will be - have they had enough patient exposure to meet program defined competencies.
The PAEA digital learning hub is the easiest way to share with everyone.
I appreciate that we are going to do our best to provide a quality education and get students graduated. However, i think it is also important to acknowledge that at some point, the only solution is - delayed graduation
Ashley agreed, very interested in a syllabus for virtual elective
I noticed that European countries are actually graduating physicians and nurses EARLY to help with the crisis. Hopefully ARC realizes that we will need PAs working clinically and we shouldn’t be delaying graduation!
Erin please share as well email@example.com
thank you so much
I am curious if sites/preceptors are still accepting students, are you still sending them to try and get as many clinical hours as they can?
Erin, I would also like to hear how you utilize telehealth firstname.lastname@example.org. Thank you!
Erin - if you could share :) email@example.com thank you so much!
There are a few of our students still willing, but our university (more than our program) says no. And I think that is smart to decrease vectors and decrease their personal risk.
me too Erin, thanks! firstname.lastname@example.org
PAEA is planning a webinar on Telemedicine/Telehealth. Please look for more information coming soon.
We also have a few willing preceptors but thus far administration has stated no students to be on rotations.
Our legal counsel advised to pull students from rotations
Hello, is there a way to save this chat conversation, so much great information on here?
I've seen a lot of PAs lamenting being laid off from specialty rotations. Just something to consider that some of these sites may not be available even once students are permitted back on rotations.
Yes, the chat will be saved.
that’s very true Amy
We are also using Medscape CME cases, and the students submit certificates as accountability. Medscape also has simulated patients that are free.. I havn't checked them out yet
I have all students placed. No student opted out given the option. Preceptors want them and we allow it as long as PPE is available and no exposure to COVID+ patients. Interestingly, our rural/remote sites are really stepping up. Some sites are taking multiple students because they need the extra help triaging and doing H&Ps.
WE recently severed our agreement with iHuman because it was inconsistent and often incorrect. Created more confusion and frustration that it was worth.
I am nervous about exactly that when they are able to go back, how many of our sites will actually accept them...
ER and SURGERY is out though…need to solve that problem.
What platform is Lisa speaking about?
I think its important to think that this will likely be effecting us all summer
Elias: have you looked at JOMI for surgery cases?
I agree Katie!
thats grea tto hear Eli, her ein California, most of us went as long as we could. But PPE's are in short supply
I havne’t…great idea Saje
How is everyone managing angry and frustrated students who are upset that their timeline has been altered?
the video is amazing!
our partners want our students as volunteers but our university will not sponsor it.
Our students have been amazingly patient with us but we are keeping contact with them regularly
they do not want the respoositibilty
Angry frustrated students... i am listening and trying to encourage persepctive
I should also mention on top of our contingency assignment, we are meeting with students once a week in small groups per rotation to run through cases.
We had a virtual Town Hall with our class at noon. We highlighted that they are now PA pioneers in a new world. PAs solve problems.
I keep saying the same thing to them. Not our fault. Not anyone’s fault. And their anger is acknowledged but outbursts and unprofessional behavior is neither helpful nor useful.
Thoughts regarding some students fulfilling rotations with a few community preceptors that will still take students with remaining of the class using alternative rotations? In this scenario, the students wouldn't have the "same experience".
Our students have been understanding so far, they are disappointed but know that this is not our fault
Sorry, for some reason my mic was not working. I wanted to point out that if you are having trouble financing something like Aquifer or Ihuman, medscape has medsims for free. I also think it is important to discuss with your university when a student has to have completed their requirements to graduate on time. At this point our university requires that all requirements must be completed within 30 days after graduation. Just wanted to make sure everyone was aware that some universities may allow students to graduate on time, as long as they complete their courses by that time frame
the students are going to volunteer but it doesn't count as contact hours
Great question, Heather! Can we also add to the question about Simulation exercises?
I called each of my students individually to let them know they were displaced which helped a lot
Ian Vanderwoude, PA-C
Wondering if any programs have been operating with clinical rotations continuing with most students, but having others follow alternatives. My program is nearing not having enough rotation sites for all students, so would be short 1 or 2, but want to maintain equity among all students. Delaying all rotations for being short a few preceptors/sites is a hard pill to swallow
We are holding class zoom meetings to address their stress and questions which has been helpful. One of the counselors from the campus counseling center is also willing to have a group meeting to discuss the stress of graduation more likely being delayed
Heather, I discussed that with our dean (a former ARC-commissioner). His impression was that due to the extenuating circumstances, there will likely be some flexibility in that time requirement for summatives. We are in a similar boat with our summatives occurring this week and the potential for delay of graduation. Just some thoughts from discussions that I've had!
Same at UL. It takes time, but the personal individual video conferences with the students has seemed to help tremendously!
Pat we have done Zoom meetings with the class to discuss the issues with them and being honest about where we stand. It has allowed them to voice their concerns and actually offer come solutions. I think open communication has worked best for us. It won't prevent upset students but it has helped us.
Thank you, Jacquelyn
We are not allowing volunteering/shadowing, etc b/c we don't want students coming back later saying how many hours they did somewhere. The university says no, so we are saying no. I don't need a news headline saying an ECU PA student has COVID and was in medical clinics despite what the university said
Will you be providing a follow-up communication with the answers to the questions needing “circling back” e.g. Summative Evaluation 4 month window/ARC-PA view of if this window can be elongated for programs who had already started portion of the Summative?
Has anyone considered shortening their clinical rotations (when we come back), to help catch up to the standard timeline, when we come back?
Laura Ernst---yes, several programs are considering htat
We are seeing barriers in availability of health screens, immunization, and drug screening — even though we use a large national vendor. Just sharing in case other programs need to revisit policies and consider flexibility.
Yes considered shortening rotations for sure. I’m not sure ARC will be ok with that mid year though
We are thinking about shortening to 3 weeks from 4.
We are planning on shortening rotations from 6 weeks to 4 weeks, after a almost 8 week removal of students.
I agree- will ARC approve shortening rotations mid-year?
I have problems shortening rotations b/c sites have already accepted students for specific date ranges. I can't mess with the timeline
We promise to meet our learning outcomes. We use simulation and assignments already so we are just changing the delivery to meet current resources to continue to meet the outcomes
Zehra - The good news is that ARC doesn't have any guidelines or standards on the length of rotations - as long as they can meet the learning outcomes
Has PAEA leadership reached out ARC-PA to start a dialogue about this unique situation?
With the mention of Ihuman,, Aquifer Real Dx or Medsim is one more consistent and definitve than others
We have discussed decreasing from 5 weeks to 4 weeks but have not done anything to this point.
We are thinking about shortening rotations by a week or two, moving all end of rotations except exams to the next few weeks, AND moving electives to the end of the year, so that if we need to overlap classes, we can do it, since none of our students begin on clerkships.
thank you kim i wiil bring that to my administration
There are options for students to volunteer through state or national response teams if they are looking for things to do that would not be through the university.
What is the best way to do remote testing?
i think that is a good idea
In Pennsylvania, there is SERVPA
I know I'm on call in the Philly area
Nathalie Ortiz Pate
Michael Ramcharan - I'm typing up minutes including questions/answers that I can share if anyone is interested, I can post on PAEA Learning Hub
Hi Laura Ernst. Thank you. But don’t we have to stick to our current syllabi or can I change those now?
ARC needs to clarify a lot, I think....
Thank you Nathalie!
Darlla PAEA can walk you through remote testing options for PAEA exams, other programs can share what they are doing for non-PAEA exams.
I think ARC is vague and we need more direction..
@nathalie, yes please
@ashely. I totally agree
ARC needs to step up and provide direction
Agree with Starr and Lindsey!
Also, for students looking for things to do, and feel the need to help or ways to direct their frustration, there are PAs looking for student help to try to advance legislature for disaster response to allow PAs to be involved.
I wouldn’t rule out asking for institutional support to revise program curricula or programs of study, if normal timelines can be expedited and overall learner outcomes can be preserved.
are people referring to learning outcomes - talking about the program learning outcomes or the course objectives?
I am hopeful people will be generous when this is over and take more students
I hope so as well
I have a contingency plan for prolonged time, but do not know how to raise my hand
We've thought about a lottery type distribution of sites
Cody can you please let us know if simulation, I Human, real Dx are appropriate substitutions for clinical clerkships. Based on ARC-PA statement none of these can be used in place of Clinicals but some programs are using them. I am still a bit confused.
To synthesize comments from a few questions - one pathway seems to be creating an “Academic Elective” which satisfies the learning objectives listed in your elective syllabus.
Some of my preceptors said they would take more students but I don't think this will be in the majority :(
Ian- yes. We are shorted all rotations by a few days to make a bonus rotation at the end. If anything falls through for any rotation, they will fall into this bonus rotation
I had preceptors already offer to do that (take extra students when rotations resume)! Hopefully that's a trend
great ideas Amy- so appreciated
We thought of that Ian. Our students were set to start their 7th rotation today. Last Monday we had 1 rotation drop out. Within 36 hours, we had 9 sites drop out. We were worried what it would look like after the rotation started. Ultimately the rotations were postponed for all students.
Sorry I have to start my 2pm on line class. My first time to go on line for class. Good luck everyone.
good luck David
Great question, Loni
If there is a large chunk of time off...5-7 weeks. Determine how much time is acceptable with independent study. We have 3.5 rotations of 5 weeks left. we are allowing independent study for one week of the remaining rotations. They will do a week of independent study for each of the rotations they have remaining during the time they have off. We will then shorten to 3-4 weeks depending on when we get back
Any possible time line for ARC PA answers?
Michael De Rosa
soften stance on board certificaation? Allow a fraction of outcomes to be checked off on simulated patients?
thank you Mary JO
For ARC-PA communication, advocating for a similar Zoom call between ARC-PA and PDs from each program would be valuable and is what is happening in other health professions. For example, pharmacy schools with their accreditation agency.
Time is not competency unless you defined competency as time-dependent
I see a large variety of length of clinical rotations and how programs are modifying the clinical rotations once students are able to return - forgive me as I am new to academia, but does ARC have a minimum number of hours or weeks of rotation?
Michael De Rosa
Both NP and DPM are allowed to use simulated patients to count for clinical experiences so they have figured it out
Great suggestion Mark
me too Erin, thanks! email@example.com
Good point, Eli
Bill asked the golden question. Either we are going to “lower our standard” for education, or we are going to delay graduation
That’s right Elias. And it isn’t the number of procedures etc. either
Would it be possible to schedule another webinar next week, as more questions arise?
ARC does not say how long or time, but once you say what you are going to do they expect you to do it, not sue if they will be flexible with the current state of affairs
Interesting comment Mike! Good to “see”you!
Exactly, the elephant in the room!
Great points Eli
thank you Ashley!
One of the major difficulties is that we can't follow what we said in our syllabi - which can definitely get us in hot water with ARC-PA.
Michael De Rosa
Lots of love, Mitz
that is what we are sturglling with Bill
My concern is that ARC statements indicates some flexibility on "time" as long as learning outcomes are met. However, what about B30.07 when students have to have SCPE with board certified specialists...this will be a challenge.
Some competencies need to be accomplished in surgery settings or other specific areas. Not all of the competencies or program learning outcomes are generic. Good point, Bill!
75% of clinical experiences have been experiential in NP training with 25% allowed via simulation, noting total hours is much lower than most PA programs
I forgot about the time zone difference! Was this meeting recorded?
I agree with Katie and very concerned.
Erin, I would like to see that as well. Scofrench@southuniversity.edu
That's a very good point Mark. I would happily reach out to ARC if you will all be doing the same. Are we suggesting greater impact in numbers, or will PAEA advocate for PDs with ARC-PA on our behalf?
Yes ….what do to about new students coming in for us in July??
I agree Alicia, this can be a domino effect..
Cindy, We have recording today’s meeting and it will be sent to all attendees and posted in the Digital Learning HUB.
@alicia Quella- We are currently considering this. I would be happy to discuss with you.
thank you Cody
Alicia - we are discussing delaying matriculation.
Please remember to register for the upcoming webinars https://paeaonline.org/resources/coronavirus-resources/virtual/
Thank you so much!! All of you
thanks everyone - this is so helpful !
Thank you so much for this webinar!
Do we delay taking in the new class/
Michael De Rosa
Also discussing delayed matriculation
Thanks, Cody and faculty dev MAC!
Thank you this was very helpful!
Thank you Cody!
Thank you for this
Thank you....stay safe and well!
Thank you, very helpful.
Cody great job moderating!
Thank you all!
Thanks Cody, FD MAC.PAEA and fellow faculty members!!
stay safe and healthy everyone
Thank you Cody!
Thank you PAEA
Thank you for organizing!
Thank you all!
Thank you Cody and PAEA!
Thank you all! stay healthy and stay safe!
Thanks to everyone who put this together and posed outstanding discussion points. This has been helpful to us as a developing program as well!
Thank you! Stay safe everyone!
thanks! much appreciated.
Nathalie Ortiz Pate
Thank you for organizing this PAEA and MAC! I'll post minutes when I get them organized =)
Thanks so much for structuring this1
Mary Jo Pilat
Appreciate knowing we are all in this together! Thank you all!
Thanks to all!
cheers for a hope of 2021 to be a great year
Thank you PAEA and everyone on the call.
Thanks you. Job well done. There is alo to do but remaining positive. Be safe. Take care.