Emory University School of Medicine

Allied Health Professions 1997-1999

Physician Assistant

Program Director V. H. Joslin, PA-C, M.P.H.

Director of Admissions M. R. Bundschu, PA-C, B.M.Sc.

Academic Coordinators M. Mayfield, PA-C, M.Ed., K. Newell, PA-C, B.M.Sc.

Clinical Coordinators T. Himelick, PA-C, M.M.Sc., E. Lepp, PA-C, M.M.Sc., C. Wilson, PA-C, B.M.Sc.

Medical Directors A. Lauber, M.D., L. Lutz, M.D., M.S.P.H.

Professors J.R. Boring III, M.D., Ph.D., R. Hatcher, M.D., L. Lutz, M.D., M.S.P.H., N.C. Moran, M.D., K. Peterson, Ph.D.

Associate Professors B.W. Blount, M.D., J. Boss, Ph.D., M. Duffel, M.D., O.F. Froehlich, Ph.D., G.G. Goodenough, M.D., M.S.P.H., J.M. Kinkade, Ph.D., J. Pooler, Ph.D., R.C. Shuster, Ph.D., J.F. White, Ph.D.

Assistant Professors J. D. Banja, Ph.D., L. Golusinski, M.D., V.H. Joslin, PA-C, M.P.H., A. Lauber, M.D., M. Mayfield, PA-C, M.Ed., F. Murphy, M.D., W.M. Shafer, Ph.D., W. B. Torres, M.D.

Instructors M.R. Bundschu, PA-C, B.M.Sc., T.E. Himelick, PA-C, M.M.Sc., S. Shultz, M.P.H., C. Wilson, PA-C, B.M.Sc., M.O. Yeager, M.P.H., C.H.E.S.

Senior Associates E.F. Lepp, PA-C, M.M.Sc., K.A. Newell, PA-C, B.M.Sc.

Associate C.D. McGraw, PA-C, M.M.Sc.

Clinical Assistant Professors J. Creel, M.D., K. Daus, M.D., G.D. Davis, M.D., J.M. Demicco, M.D., W. R. Dunn, M.D., D. Ebersbacher, M.D., J. Hipkens, M.D., Ph.D., S. Hoy, M.D., J. Ingram, M.D., R.A. Jenks, M.D., D.B. McMicken, M.D., J. Pope, M.D., T. Reeve, M.D., R. Rosenberg, M.D., W. Roundtree, M.D., J. Scott, M.D., L. Skelton, M.D., J. Turner, M.D.

Clinical Instructors J.E. Bellinger, III, PA-C, M.M.Sc., J.B. Harris, PA-C, A.J. Konigsberg, PA-C, B.M.Sc., K.M. Lennon, PA-C, M.M.Sc., H.W. Muecke, Jr., PA-C, B.M.Sc., A.F. Platt, PA-C, B.M.Sc., G. Rose, PA-C, B.M.Sc., H.J. Rose, PA-C, B.M.Sc., J.A. Stearns, PA-C, B.M.Sc., K.F. Vosatka, PA-C, B.M.Sc.

Clinical Associates T.L. McElderry, PA-C, B.M.Sc., T.F. Walker, PA-C

MASTER OF MEDICAL SCIENCE DEGREE

The Physician Assistant Profession

Physician Assistants (PAs) are highly skilled members of the health care team who, working dependently with physicians and under their supervision, provide diagnostic and therapeutic patient care in a variety of medical specialties and practice settings. Typically physician assistants obtain patients' medical histories, perform complete physical examinations and minor surgical procedures, order and interpret routine diagnostic tests, develop diagnostic and management plans, provide treatment for persons with acute and chronic illnesses, and respond appropriately to life-threatening emergencies. PAs provide education to patients regarding illness, health promotion, and disease prevention. They also facilitate patient referral to the community's health and social service agencies.

Appropriately trained PAs have demonstrated that they can relieve physicians of essential but time-consuming patient care duties while maintaining the same quality of care. Many studies have shown that when properly utilized, PAs can increase the availability of primary care services to more people, promote cost savings, and improve practice efficiency and productivity. Acceptance of the PA concept by employing physicians and patient satisfaction in both ambulatory and non-ambulatory settings has been well established.

PAs have shown flexibility in their ability to work in a wide variety of health care settings. Primary care PAs appear to have little difficulty in adapting to new roles in specialty or inpatient settings and have expanded these practice settings to include: health maintenance organizations, preferred provider organizations, independent practice associations, prepaid group practices, occupational health settings, rural or community health clinics, hospitals, surgical settings, emergency rooms, correctional institutions, and long-term care facilities. Other opportunities of increasing interest to PAs include teaching, administration, and clinical research. The number of employment opportunities for PAs both in primary care and in a variety of specialty areas continues to grow and has led to the PA profession being called the fastest growing health care career of the 1990s.

THE EMORY PHYSICIAN ASSISTANT PROGRAM

Mission

Overview

Curriculum

The next phase of the curriculum, the clinical core, includes seven five-week rotations in required primary care areas (fall and spring semesters). During this phase of the program, all students participate in supervised patient care, teaching rounds, and medical-surgical conferences as they rotate on various services in Atlanta and other established clinical facilities around the state and the Southeast. In keeping with the mission of the program, students are exposed to a variety of practice settings and patient populations.

Following the clinical core experience, students enter an 18-week advanced clinical preceptorship phase. The student may choose to do the entire eighteen-week period in primary care disciplines. Alternatively, the student may elect to experience one four-week rotation in a medical subspecialty discipline and one four-week elective in any discipline in addition to the eight weeks of primary care. The two-week mini-elective may be in any discipline or may be used to extend any four-week rotation. During this phase, students wishing to rotate through sites outside of those developed by the program must first obtain permission from the program. Before a student may begin such a rotation, the program must evaluate and approve the site and an "affiliation agreement" between the site and Emory University mut be entered into and approved by the program director and the dean's office of the School of Medicine.

Clinical rotation sites affiliated with Emory Hospital as well as outside the Emory system are frequently utilized to provide a variety of clinical opportunities for the PA student. Increasingly, the PA program is placing more emphasis on student clinical experience in medically underserved areas. During the clinical core all students will be required to experience at least two rotations in clinical settings designated as medically underserved. Opportunities for clinical rotations in designated health manpower shortage areas in rural Georgia and the rural Southeast are continuously expanding, but rotations in metropolitan Atlanta that are federally designated as medically underserved will continue to be utilized whenever possible.

All students are required to experience at least two rotations in clinical sites outside the Atlanta area. During the clinical experience, students are able to build the primary care knowledge and skill base that is necessary to function in all fields of clinical practice. They also gain exposure to a variety of clinical settings that enable them to make a more informed decision regarding the type of clinical practice they may wish to pursue upon completion of the program.

The advanced didactic phase is scheduled for the final semester and includes course work in clinical ethics, health promotion and disease prevention with an emphasis on patient education, and research-oriented courses that provide the skills necessary to interpret the medical literature. Students are required to research the literature on a clinical topic, write a review article, and submit their work to a peer journal. Many students choose topics based on their clinical training experience.

The Emory PA Program, administratively under the Department of Family and Preventive Medicine of the School of Medicine, has been awarded full approval by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), 1000 North Oak Avenue, Marshfield, WI 54449-5788; 715-389-3785, the Composite State Board of Medical Examiners (Georgia), the American Academy of Physician Assistants (AAPA), the Washington State Board of Medical Examiners, the California State Board of Medical Examiners, and other state organizations.

Admission, curriculum, and graduation requirements are subject to change. Information on financial aid and application procedures, including application dates, deadlines, and forms, may be obtained by writing the Emory University Physician Assistant Program, 1462 Clifton Road, Suite 280, Atlanta, GA 30322, or by telephoning 404-727-7825. The application deadline is December 1st.

Technical Standards

The director of the physician assistant program welcomes questions or inquiries from individuals with disabilities regarding the standards and their application to each individual's unique situation. In each case, a determination can be made as to whether the individual is qualified for admission to the program and if reasonable accommodations can be made. While the PA program is prohibited by federal law from making inquiries about specific disabilities prior to admission, applicants who are selected for admission must be prepared to meet the performance standards in order to complete the program.

Skills fundamental to the physician assistant profession and curriculum include:

• Problem solving, given verbal, visual, and written information, within a limited time frame.
• Clinical reasoning and decision making within a limited time frame.
• Visual-spatial integration.
• Insight and judgment for safety and prognostication.
• Written and verbal communication among group members
• Time management to coordinate course requirements and clinical responsibilities.

These skills require that applicants have the abilities to meet technical standards established for this program. They are:

I. Participate in all phases of the educational program within the required time frame, including the various laboratories, teaching conferences, clinics, and rounds; show understanding of classroom lectures, presentations, seminars, etc., through work performance and/or examination in order to:

A. Learn the specific skills and be provided with the experiences necessary to successfully complete the physician assistant program and become eligible for certification.

B. Apply basic principles of the scientific method in reading and interpreting professional literature, participating in clinical research activities, and critically analyzing new concepts and findings provided by others.

C. Apply basic educational concepts of theories in designing, implementing, and evaluating treatment regimens, and in educating patients, families, and health care personnel involved in the patient's care.

II. Function appropriately in interpersonal relationships by exhibiting use of good judgment, empathy, reliability, and emotional stability; must possess the abilities to practice appropriately in stressful situations and to work well with others in order to:

A. Interact with patients and families in a manner that provides the desired psychosocial support by:

1. Recognizing his/her own reaction to illness and disability.
2. Recognizing patients' and families' reactions to illness and disability.
3. Respecting individual, cultural, religious, and socioeconomic differences.
4. Utilizing appropriate communicative processes.

B. Demonstrate safe, ethical, and legal practice as stated by the profession.

C. Engage the greatest possible degree of patient motivation and cooperation in treatment.

D. Function effectively with other health care professionals in providing appropriate patient care and in improving the quality of patient care.

E. Be responsive to ideas and techniques that might be more appropriate or safe.

III. Communicate effectively with patients, their families, and health care professionals in order to:

A. Instruct, confer, and integrate appropriate patient treatment with other aspects of patient care.

B. Stimulate motivation and cooperation in treatment, and assist in the alleviation of anxiety.

C. Give instructions on diet, exercise, other forms of therapy and uses of physical adjuncts to therapy such as prenatal and child care instructions.

D. Instruct or explain projected tests and/or therapy to the patient.

IV. Function appropriately in professional practice in order to:

A. Review and evaluate patient needs; specify which therapy procedures are indicated by obtaining a thorough medical history, performing a complete physical examination, and reviewing previous medical record(s) in order to:

1. Perform a complete health evaluation of growth and development for the patient.
2. Facilitate appropriate diagnostic study for the patient and prompt management of illness or injury.
3. Provide assistance in performing special studies pertaining to: pelvic examination, Papanicolaou smear, proctoscopy, visual testing, etc.

B. Plan, prepare, implement, and modify as necessary, treatment programs that:

1. Include realistic goals in terms of diagnosis, prognosis, physical/psychosocial status, and anticipated lifestyles of the patient.
2. Include effective treatment methods that provide a high probability of achieving treatment goals.
3. Are within resource constraints.
4. Provide for periodic revision according to changes in the patient's physiological or psychological state.
5. Contain specificity and comprehensiveness appropriate to the level of personnel who will execute the plan.
6. Are adequately documented.

C. Properly perform routine laboratory studies, diagnostic tests, and therapeutic duties such as drawing blood samples, performing urinalysis and skin testing, giving injections, and suturing,

D. Provide health care services with the direction and responsible supervision of a physician, and attend to the needs of many diverse patients.

E. Provide appropriate life-support and acute injury evaluation/care until a physician and/or appropriate health professional can be located.

ADMISSION

A new class of students enrolls each year at the beginning of the fall semester. The admissions committee makes every attempt to select those candidates who show promise of becoming outstanding physician assistants. Decisions are made based on a thorough evaluation of the applicant's academic record, written narrative statements, personal references, performance on the GRE, previous health care experience, and a personal formal interview.

Admission Requirements

All successful applicants to the program must have completed a baccalaureate degree, granted by an accredited institution, by the time of matriculation into the program. Additional requirements are as follows:

1. All applicants must have maintained a cumulative GPA of at least 2.8 (on a 4.0 scale) for all undergraduate work completed. Appeals to this requirement may be made in writing to the director of admissions and submitted along with your application. Successful applicants in the past have typically had cumulative grade point averages in the range of 3.0 to 3.3 and higher.

2. All applicants must have completed an academic core of undergraduate course work which consists of at least thirty-five semester hours (fifty-two quarter hours) distributed as follows:

   Fifteen semester hours (twenty-two quarter hours) in natural sciences (such as biology, chemistry, and physics) with specific requirements to include full courses (i.e., two quarters, or one semester) with lab in general biology, general chemistry, and an unabridged (i.e., not a survey, introductory, or "principles of") course in organic chemistry or biochemistry. Recommendations for additional preparatory coursework would include anatomy, physiology, and microbiology.

   Ten semester hours (fifteen quarter hours) in humanities (such as art, classics, English, foreign language, music, philosophy);

   Ten semester hours (fifteen quarter hours) in social sciences (such as anthropology, economics, history, political science, psychology, and sociology) with one course required in psychology (either introductory, general, developmental, or abnormal).

3. All courses taken to satisfy the requirement set forth in (2) above must:
   
   • Be taken at an accredited institution. Graduates of foreign institutions must present transcripts of at least one full academic year as a full-time student or equivalent (preferably in the sciences and English) from an accredited college or university in the United States or Canada. Students who are educated in a country where English is a foreign language must successfully complete the Test of English as a Foreign Language (TOEFL) with a minimum score of 550. Regardless of nationality, priority is given to students who complete all four years of their undergraduate education in an accredited U.S. or Canadian institution;

   • Be completed at a grade level of C or better; be completed prior to matriculation (i.e., not necessarily at the time of application);

   • Be subject to approval by the admissions committee.

   • Not be taken on a pass/fail basis, as College Level Examination Program (CLEP) credit, or audited.

4. All applicants are strongly encouraged to complete an introductory course in computer science or word processing.

5. All applicants are required to submit scores for the general GRE. The test must have been taken within the past five years and must be taken early enough for official scores to be received in our office by the application due date (institutional code is 5196). Testing information may be obtained from: Educational Testing Service, Graduate Record Examination, P.O. Box 6004, Princeton, New Jersey 08541-6004.

6. Previous health care experience is an indication to the admissions committee of an applicant's awareness of and commitment to a career in health care. Therefore, at least one year (two-thousand hours) of health care experience is anticipated for all applicants. Preference is given to applicants having experience that requires a period of training resulting in direct (hands-on) patient care.

7. A personal interview with the program admissions committee is required of all successful applicants. The interview is by invitation only and is conducted on the Emory campus.

DEGREE REQUIREMENTS

To qualify for the M.M.Sc. degree, the student must satisfactorily complete the physician assistant program as set forth by the progress and promotion committee. During the final semester, Emory PA students are required to take the National Certifying Examination for Primary Care Physician Assistants. This examination is developed by the National Board of Medical Examiners and administered by the National Commission on Certification of Physician Assistants.

Minimum performance standards require students to earn at least a grade of C in all basic science courses and at least a grade of B in all clinical courses. The faculty's judgment as to the applicant's fitness for receiving the degree is based not only on scholastic achievement, but also on the applicant's character, health, general attitude, and suitability for the profession.

Part-Time Employment

REQUIRED COURSES

Didactic Phase

Basic Allied Health Sciences

500. Anatomy (with lab)
Fall. Credit, four hours.

501. Biochemistry
Fall. Credit, four hours.

502. Physiology
Fall. Credit, four hours.

503. Microbiology (with lab)
Spring. Credit, five hours.

504. Pharmacology
Spring. Credit, three hours.

Physician Assistant Clinical Courses

505. Normal and Therapeutic Nutrition
Spring. Credit, one hour.
Basic science of human nutrition. Relates biochemical and physiological aspects of nutrition to human nutritional needs in both health and illness; focuses on factors important in nutritional care and the skills necessary for nutritional care in clinical settings.

510. Introduction to Clinical Medicine
Fall. Credit, eight hours.
First of three didactic clinical medicine courses. Focuses on developing patient interview and physical examination skills. Special attention given to the principles and techniques for effective communication with patients and other health care providers. An introduction to clinical reasoning and problem-oriented patient evaluation is included. Clinical data collection skills are enhanced through physical exam skills labs, patient interview sessions under the supervision of an assigned mentor (usually a practicing PA), and the completion of patient writeups and case presentations.

511a. Fundamentals of Clinical Medicine I
Spring. Credit, eight hours.
A two-semester organ-system approach to disease, emphasizing the pathophysiology, clinical presentation, and diagnostic, and therapeutic management of common disorders. Primary care medicine is emphasized along with the development of clinical problem solving skills. Students also learn bedside clinical procedures through special labs. Students continue to develop patient interview and physical exam skills by evaluating patients in a clinical setting under the supervision of an assigned mentor.

511b. Fundamentals of Clinical Medicine II
Summer. Credit, eight hours.
Continuation of 511a.

513. Emergency Medical Problems and Management
Summer. Credit, four hours.
Introduction to current diagnosis and management of acute trauma, including thoracic injuries, fractures, facial injury, hemorrhagic shock, and head and neck injuries. Incorporation of advanced cardiac life support (ACLS), including sudden death, chest pain, acute myocardial infarction (MI), dysrhythmia, cardiopulmonary pharmacology, and airway management. Emergency presentation and evaluation of acute respiratory failure, the acute abdomen, burns, poisoning, altered mental status, near drowning, anaphylaxis, hypertensive crisis, acute ear, nose, and throat (ENT) problems, and radiation emergencies

514a. Clinical Laboratory and Diagnostic Methods I
Spring. Credit, two hours.
Three-part course covering radiology, clinical laboratory tests, and electrocardiolography. Includes basic principles of radiology (indications for, materials used, and information obtainable); pathology; and the correlation between disease process and interpretation of clinical laboratory diagnostic tests. Includes demonstration and practice of various laboratory methods, and EKG theory and interpretation.

514b. Clinical and Diagnostic Methods II
Summer. Credit, one hour.
Continuation of 514a.

520. Issues in Health
Summer. Credit, two hours.
Discussion of topics of interest facing health care practitioners. Emphasis on public health, health policy, medical/legal issues, and PA professional issues.

621. Health Promotion and Disease Prevention
Fall. Credit, two hours.
An introduction to the theories of prevention of disease and its complications, as well as health promotion with a special emphasis on the educational and psychological theories of learning and behavior change. Students present a patient education intervention.

622. Introduction to Epidemiology I
Fall. Credit, three hours.
Basic concepts of descriptive, analytic, and experimental epidemiology. Topics covered include measures of disease frequency, measures of data quality, overview of study designs, and bias in epidemiologic studies, with an emphasis on flaws and fallacies in medical literature.

623. Analysis in Medical Research
Fall. Credit, three hours.
An introduction to the skills needed to review critically the medical literature and write a technically sophisticated journal article. The student chooses a topic pertinent to primary care medicine and then authors and presents a research review paper. The paper justifies the value and importance of the topic, provides a comprehensive and critical review of the current medical literature, provides suggestions for patient care implications, and makes recommendations for future research. The student is required to submit the paper to a peer-reviewed journal.

624. Biomedical Statistics
Fall. Credit, two hours.
Introduction to statistics, with applications to the biological and health sciences.

625. Biomedical Ethics
Fall.Credit, two hours.
Study of ethical rules, principles, and theories relating to health care delivery issues.

626. Directed Study (optional)
Summer. Credit, one hour.
Preparation for clinical experience.

Clinical Phase Courses

640. Internal Medicine (Outpatient)
Fall and spring. Five weeks. Credit, five hours.

641. Family Practice
Fall and spring. Five weeks. Credit, five hours.

642. General Surgery
Fall and spring. Five weeks. Credit, five hours.

643. Emergency Medicine
Fall and spring. Five weeks. Credit, five hours.

644. Gynecology and Obstetrics
Fall and spring. Five weeks. Credit, five hours.

645. Pediatrics
Fall and spring. Five weeks. Credit, five hours.

646. Internal Medicine or Family Practice (Inpatient)
Fall and spring. Five weeks. Credit, five hours.

661. Primary Care Elective
Spring. Five weeks. Credit, four hours.
Family practice, gynecology and obstetrics, internal medicine, or pediatrics.

662. Primary Care Elective
Summer, Four weeks. Credit, four hours. Includes family practice, gynecology and obstetrics, general internal medicine, pediatrics, orthopedics, and emergency medicine..

663. Clinical Selective
Spring and summer. 4 weeks. Credit, four hours. or two of the following for two weeks, 2 hrs. each:
cardiology, dermatology, emergency medicine, endocrinology, ENT, gastroenterology, geriatrics, hematology, infectious disease, nephrology, neurology, occupational medicine, psychiatry, pulmonary medicine, oncology, rheumatology, urology, or any nonsurgical subspecialty discipline.

664. Clinical Elective
Summer and fall. Four weeks. Credit, four hours.
The student may choose any discipline, or may choose an academic medicine experience in which he/she would combine the classic roles of a PA educator (i.e. clinical practice, teaching, research, and administration). This curriculum allows students to enjoy primary care clinical rotations part-time and be mentored by PA faculty in an academic medicine setting, where they experience a "sampling" of teaching, administration, and research skills.

665. Clinical Mini-elective
Fall. Two weeks. Credit, two hours.
The student may choose any discipline approved by the program that provides additional training in managing common problems seen in a primary care setting or may use this option to extend any selective or elective.

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