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Notes: A Stepwise Guidebook on Signing Physician Assistant Collaborative Plan 2014 Form Online

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The Definite Guide to Physician Assistant Collaborative Plan 2014 Form

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Check How to Enter the Physician Assistant Collaborative Plan 2014 Form

good afternoon everyone I very much.appreciate you being here three o'clock.in the afternoon is when my glucose.levels tend to drop and I want to take a.nap so I commend you to be here because.I know it's been a long day already my.name is Jamie Smith and I'm a faculty.member at the rutgers PA program and I.am passionate about simulation and I'm.very excited that you're all here to.hear more about simulation because I.think it is something that we really.need to develop NPA education we're.going to talk a little bit about some.specific parts of simulation and how to.put it into PA education this is by no.means a comprehensive overview of things.we certainly couldn't do that in an.hour's time but hopefully enough to give.you some interest and a little bit of.snippets of information that you can use.going forward in your programs thanks.Jamie I would like to echo Jamie's.welcome to all this afternoon to our.session and nuts and bolts of simulation.and PA education and I'm Nina motek I'm.from Drexel University here in.Philadelphia so we hope you're having a.warm welcome despite the rain during.your time here that is when you get.outside in between the sessions and we.would just like to get a sense from you.all what kind of simulation mode.allottees that you're using at your home.PA programs and we know you all are.using something already and probably are.interested in more so I'd like to see a.show of hands how many people are using.standardized patients in their PA.programs right now wonderful almost all.of you Thanks how about task trainers.are ib arms simulated skin wonderful.that's great how many of you have at.your PA program a human patient.mathematic and simulator terrific also a.great number of you all super so as you.all probably are aware all of those are.types of modalities of simulation and.we'll talk about simulation as a whole.but we know that simulation can be used.to meet a lot of learning objectives and.so neither Jamie r I have anything to.disclose these are some of the learning.objectives we want to talk a little bit.about the literature for simulation.modality describe some resources that.you can use to.help support your simulation programming.and also talk a little bit about a RC PA.standards which you can use simulation.to help your program meet those.standards and also some components or.elements of a simulation scenario if you.would like to use simulation or enhance.your current simulation as part of a.formative element of your your.curriculum or a summative testing.element so we want to talk about a.couple of literature examples and the.first one these are both very current.examples the first one is from a guy.named David GABA dr. Ngaba is an.anesthesiologist in San Francisco he was.one of the developers of the early one.of the early simulation manikins in the.1960s it was further enhanced of the.1980s he's a leader worldwide and.simulation and what he he wrote about.the diverse applications of simulation.in terms of providing training our.providers our student providers to keep.patient safety in mind he talked in this.article which came out earlier this year.in the Journal of similar Society for.simulation healthcare the different.types of domains at different content.areas where simulation could be applied.the various types of learners which can.use simulation and pas are alluded to.but they we were included a lot of the.literature the different types of.resources and the different curricula.that can be approached and he really he.really hit a lot of the nail on the head.when he talked about the future uses of.simulation and patient safety and I.think I encourage you to read that.recent article as well as some of his.previous articles and also another.recent evidence based literature cited.cited a number of best practices for.using simulation in learning was by the.authors that you see here and it was.built on a previous literature search.that was.accomplished 40 years initially they.found a test 10 best practices for using.simulation health care education and.this recent article which came out.earlier this year highlighted 12 best.practices among them they talked about.debriefing or feedback so debriefing is.a type of discussion that you have with.your learner's your with your students.and so you use that as a way to incite.them to think about their knowledge gaps.deliberate using simulation for.deliberate practice giving our students.a chance to practice certain skills or.practice an approach to a patient and.various ways such as a cardiac exam.would be a good example until they.achieve proficiency team training we see.a lot of posters downstairs on inner.professional experiences and team.training and curriculum curriculum.integration was another feature of this.of the findings that they noted okay so.that's a smidgen of some of the.resources that are out there in.simulation there's many many articles.that are related to simulation in.medicine and also in nursing.unfortunately not yet is there much.regarding pas and use of simulation but.hopefully with this talk and other.things you hear with simulation it won't.spire you to start doing some research.and looking more into simulation and we.can build a body of knowledge so now.you've read some research and you.realize how great simulation is it's.been shown to improve patient safety.it's been shown to improve educational.outcomes how can we implement it into.our programs what are the steps and all.the barriers that are that exist that we.can use simulation to kind of work.through so generally when you're.implementing something you need to.establish the need for change you need.to do a needs assessment is this.something that's very exciting and very.sexy and we have a very expensive.simulator so we should use it or does.this make sense and there's a need in.our curriculum this can help fill once.you establish that there's a need then.you need to develop your goals and.objectives and goals and objectives just.like in any other part of education are.the key to decide what where the.curriculum goes and what needs to.be done so once your goals and.objectives are developed the next step.is determining the best educational.modality hopefully not hopefully but.sometimes that will be sim sometimes it.will not be sim and there's plenty of.other good educational modalities that.we know that exist but if you decide.that it's some then you need to figure.out how to put it into your curriculum.so once you do that you need to develop.your plan what is the plan to make this.change happen how can you develop your.resources how can you inform your.stakeholders where can you get the.funding and supplies and things that you.need so you need to develop your plan to.do so once you develop a plan then you.need to make a process to make sure that.any problems that arise are addressed.quickly and efficiently so that that.doesn't become a barrier for future.implementation or future use of.simulation in your program and of course.any time you're going to spend this much.effort into making a curriculum you want.to make sure that its viability is.secured so can you get additional.funding can you get additional resources.to continue it and possibly even.continue and provide some scholarship.that will help the viability and.long-standing of your curriculum ok so.what resources do we need for simulation.we need personnel we need time.facilities and funding costs all the.things in a PA education are just.sitting around waiting for us to grab.right not exactly so we may need to be.creative and think outside the box and.try to develop other ways to address.these needs that we have as far as.personnel so you need a curriculum.director you need your simulation.champion to help push this through and.make things happen but as you know with.anything in PA education things need to.be collaborative it's difficult in a.program for only one person to be the.simulation champion and try to do all.the simulation that happens it makes it.very difficult so in addition to having.the curriculum director you need to.educate your faculty in how to use the.simulation modalities how to use a.simulator itself how to create a good.scenario a lot of Education should go in.to debrief your students so your faculty.should all be comfortable to briefing.because it is a skill that is acquired.it's not something that many people are.able to do just off the fly it's also.important to develop your support staff.so you want someone who will administer.your curricula.develop the schedules order the supplies.make sure the room is reserved make sure.everything that is available that you.need for your curriculum and you may.need additional personnel like ESPYs and.there's a whole nother piece that goes.into training ESPYs scheduling the SPS.and doing things like that for the.standardized patients if that's what.your simulation curriculum is focusing.on at that point time we all have so.much time don't we just throw in some.simulation and no problem everything.will work itself out so it's important.to have time in the curriculum and as we.all know you can't just keep piling and.piling things on a PA education if.you're adding something new something.else has to be taken away we only have.so many hours in a day to do what we.need to do so it's important for the.faculty to have time dedicated for.curricular change whether it be.simulation or otherwise it's also.important for faculty development so you.certainly can't expect faculty to come.in and be able to do simulation well off.the start they need training and.simulation and training and debriefing.at a minimum there's additional time.that needs to be set for the learners so.if you're adding something to the.curriculum what can be taken away if.there's time where they're actually in.the sim lab they may need additional.time for preparation so maybe you have.some pre reading or material that's.online that you want them to view before.they come into the sim session so their.time there is more effective so you need.to build that time into the curriculum.and also time that they're actually.doing the simulation and having some.reflection afterwards so that their time.as well spent and again support staff.people to help you do the scheduling to.help make copies of things to order.supplies that are needed to schedule.rosters and schedule the standardized.patients and make sure that everything.flows all these people need to have time.built in their schedule if you're adding.something new into the curriculum.facilities so hopefully who here comes.from a PA program that has a nice big.sim Center so you're all very lucky.consider yourselves very lucky not all.of us come from that and just because.you may or may not have that doesn't.mean you can't do effective simulations.so the more you do sim the more you.realize you have to be creative you have.to be a recycler you have to think out.of the box you don't always have the new.and best things but you still can do.effective simulation.by being resourceful but ideally you.have some dedicated space for simulation.you have a place to store your mannequin.you have a place to actually have the.hands-on type of activities that occur.you also need a place for storage so.where are you going to put all those.supplies how are you going to keep.people from coming in and putting their.hands all over that mannequin because.it's just interesting and people want to.touch things so it's important to kind.of have a separate space for your.simulation activities if you're doing.something in a clinical setting which.may or may not not happen sometimes in.simulation we do things called nc2.simulation in which we actually go into.a clinical setting and do simulation at.the patient's bedside or outside the.patient's room for those high acuity.less common types of things that happen.in a clinical setting in that case it's.really important to think about access.to patients and what sort of equipment.you need in that setting costs so.nothing is free and I know in many PA.programs funding is tight so the.question is can you redeploy something.that's already being spent somewhere.else and focus it on simulation in your.program or can you look for external.resources can you look for additional.sources of funding within your program.or even from external sources and the.more that a curriculum has a good.sufficient funding the more likely that.it will be that it will become scholarly.and something that is of sufficient.scholarly content that it can be.published and the content be.disseminated widely so when you're.obtaining support for the curriculum you.need internal support and you need.external support so by internal support.I mean the stakeholders so who are the.people in your program or department or.school that make these sorts of.decisions you need to have your program.directors on board you need to have your.Dean's on board you need to have the.people that are controlling the purse.strings on board you also need people to.be champions of simulation within your.program to help support the.implementation of simulation it's.important to talk to these people in the.beginning rather than at the end you may.go through all this planning process.come out to this really great idea think.you have everything figured out and then.you go back and talk to the people at.the top and realize that this is just.not feasible there's no money.or this there's no time or whatever the.issue is so if you involve the.stakeholders in the beginning and work.through those barriers with the.stakeholders it's more likely to the end.your implementation plan will be.successful you may also need to develop.conflict resolution skills hopefully.that's not the case in your PA.department but sometimes that is.something that you need to be able to.negotiate and work politics in order to.make your curriculum successful sources.of external funding so sometimes you.need a start you need to start up seed.money to get things going once you have.a curriculum that has started and.successful then you can go to your.internal sources of support and ask for.funding or ask for more resources so.there are things such as grants paea.gives a grant maybe within your.university their startup money there's a.whole list of agencies that potentially.could be giving money for grants but.that may be a place to start to get your.foot in the door and get things moving.until you're more successful as far as.administration of the curriculum so you.do want an administrative structure in.place again lots of times you're the.only person kind of starting things out.in a simulation curriculum so you may.need to do a lot of these things on your.own but ideally you want to have a whole.administrative structure in place to.make things flow most effectively you.want to keep in good communication with.the stakeholders so you want to let them.know when things are going well because.you want to gain additional support but.also if you do have some barriers that.you're dealing with you may be able to.get additional support and it's.important to keep those people in the.loop as well make sure that you have.people in a in operations form so.they're making sure that day-to-day.things are going with in your curriculum.the way you want them to go it's.difficult for a faculty member to come.in and be able to do all these different.things at the same time and sometimes.when it's new you have to but as you.start to develop the curriculum it.becomes bigger you want to pull in these.additional sources of support for you.and scholarship I i can't say enough how.important scholarship is in PA education.we're not that new of a profession.anymore people know who we are and what.we're all about it's time to really get.into the literature and and show some.things that we're doing in education and.why they're effective to our particular.student population as far as barriers.there's lots of barriers potentially.compensations of barrier you may or may.not have your time compensated this may.be something that's added to your.faculty workload already I guess it.depends on how much of a sudden champion.you want to be whether or not you want.to take on that additional.responsibility but it's something that.maybe once the curriculum is shown to be.effective that could then be.renegotiated and and be more equitable.personnel certainly can be barriers so.if the rest of your faculty are not.really interested in this type of.educational modality you may need to.garner some support we're going to talk.a little bit more about ways to do that.and one of those maybe to show how we.can match simulation to our PA standards.another is to start be more familiar.with the literature and the research.that's out there and to really show that.this is working in nursing and medical.education hey maybe this is something.that could work in PA education as well.ok so now in Tina's going to talk about.the simulation scenarios thanks Jamie so.these next few slides will talk about.components or elements of simulation.scenarios and one of the things that we.really need to think about is you know.to begin with the end in mind what are.we trying to learn what are our student.outcomes and what we eventually try to.assess via simulation or be a written.test of knowledge about our students the.first thing you may want to consider is.to identify as I said identify the out.the learning outcome and the focus of.your simulation and create a title for.your simulation scenario you may label.all these by the year by the course.you're going to teach it in or by the.the domain or the medical content area.that you would like to that you would.like to include the next thing you want.to think about of the scenario.participants and this could be students.or other people are we just going to.test are we just going to use PA.students in our simulation scenario i.should say is this a case based scenario.or is it not a non case based in error.just a exercising.evaluation a wicked do we have access to.other people who would like to.collaborate with us via simulation or.our institution dental students are.doing a lot of simulations not only.Dental simulations but medical.complications which might occur in a.dental office and nurses are doing a lot.of simulations and medical students and.residents and the other thing you might.want to consider if you haven't already.used it is some of your standardized.patients may be part of the simulation.scenario and we commonly use sterilized.patients as Confederates or family.members so if we have a case about a.geriatric patient we may have a.sterilized patient in in our scenario as.a Confederate to add another dimension.to the case such as delivering bad news.or or DNR orders or something specific.that would it would dovetail into our.learning objectives for that case so you.want to set all that out ahead of time.because as Jamie mentioned that one of.the things to concern are our personnel.and our resources in any standardized.patients or other participants from.other programs would need to be.contacted ahead of time sometimes six.months ahead of time may be a.Confederate or a standardized patient.six weeks ahead of time but you want to.consider the participants in your.scenario because if they're not just PA.students that adds a different layer of.complexity to your planning so I alluded.to the content we want to think about.what we want to address their do we want.to consider one purpose more than one.purpose do we want to have a sterilized.patient or a mannequin simulator for.exam skills do we want to have our.scenario content be used clinical.decision making as an emphasis of our.scenario what area of medicine are we.going to choose should we choose.clinical decision making do we want to.use this case for didactic your learners.or clinical year students when we call.them back on on their Clint.on their post rotation visits back to.campus if that's something you do at.your institution do we want to assess.their acls skills or by listed here I've.listed here cardiac respiratory or.pediatric topics as common common domain.areas for simulation scenarios again.depending on your learners you may.choose to have the same case for your.didactic learners but add some more.complex issues for the student students.to address if they're if they're.clinical your students versus if they're.didactic your students so these are some.of the content issues i mentioned.learning outcomes you don't you want to.develop these as you develop the case.you don't want more than three or four.objectives for your case scenario you.want to consider things that you can.measure so you can identify if the.student has successfully achieved these.learning outcomes or if it's a skill.maybe a mannequin based case and you may.ask the students to do some kind of.perform some kind of skill start an IV.on the mannequin as part of a summative.assessment for this particular case so.again 3324 kate of objects objectives.for each case setting the stage we want.to decide where where are we with this.scenario where are we simulating that we.are are we in the clinic our simulation.center is set up like a needy so do you.want the ED too sometimes we convert it.to an underserved area somewhere a rural.warehouse in Philadelphia we've changed.a scenario to be the Dominican Republic.we bump up the heat like 90 degrees and.we have audio of birds chirping and a.little campfire in the corner and then.all our ESPYs dress up either like.tourists or victims or whatever we.decide the case is so you want to choose.what your scenario is and depending on.your staff and resources decide to do.that the other choices as Jamie.mentioned might be to do an insight to.simulation if you don't have a lot of.space and arrange for the ed or a local.clinic that you might use for SP.encounters to go in all of a sudden and.have a surprise simulation in one of.those locations again we also want to.consider the participants I talked about.the SPS and the students but what should.each person do how many students do you.want in each scenario and how many.patients are simulated patients do you.want in each scenario so if you have not.enough time you will want to decide what.will my students do when they go into.this case are there two or three.students that's great are they all going.to be pretending to be the PA or the.peano giving the care or will one have.another role the participants you know.if you need someone who's a role other.than a PA ask someone to be a family.member or you can ask somebody to take.on some other role in at the medical.environment that and tell the student.ahead of time this is your role during.this case or do you want them all to as.didactic students to collectively take a.history and maybe perform different.elements of the physical exam so you.want to let them know what they wanted.what you expect of them before they go.in because in order for them to sustain.belief in this you know we asked them we.tell them we know the mannequins are.plastic we know this is in a real.situation but try to immerse yourself.and and bill to suspend that disbelief.for a few minutes and they can engage.with the scenario and the simulated role.such that they actually will behave as.you're you're anticipating they might if.you give them the appropriate.participation or roll scenario timing.typically simulation scenarios will last.15 to 20 minutes usually closer to 15.minutes depends on what your endpoint is.in the simulation if the learners.achieve their goal you'll have a couple.different paths they may achieve and if.they're going down the wrong path you.may have to make some changes on the fly.and say you know gosh they didn't notice.that the respiration rate was on.a six we're going to have to send in a.Confederate to say oh my gosh it doesn't.look like my patient is you know my my.family member is breathing you know or a.nurse can someone as a nurse Confederate.to say do you see does anyone have any.idea what they're doing in here so some.kind of little nudge to you know prompt.the students to go the path that you.want and in fact a lot of a lot of the.learning we will be talking about after.the scenario is over so again about 15.minutes for for your case 15 to 20.minutes and you'll want to provide ample.time for a debriefing afterwards so the.debriefing will be up to can be up to.three times the length of your actual.case scenario depending on the mode out.the type of debriefing that you choose.to use and there are several that are.available some r plus delta which we.discuss at the bedside where you tell.them what they did really well and you.tell them what they could have changed.and then talk about the case content and.other issues that's very common in in PA.education to to our knowledge so far.another type that's commonly used is.debriefing with good judgment where you.say gosh I see that you you did x y and.z really well and you might be wondering.why on earth they didn't you know.resuscitate the patient or a minister.ahmet instead of saying why didn't you.do that you'll say can you help me.understand the reasons behind your.action so that we're encouraging them to.do some self-reflection and come back to.us with their rationale what are they.thinking and can we help them as as.clinician educators to bridge that gap.between where they are as student.learners and where we want them to be as.really you know safe clinicians who have.patient safety in mind so when we.continue to develop our case we want to.know what the details are the background.of the patient are we what's the medical.background I would usually typically.just you know write up a little case.vignette like weed.you for exam question stems with include.information an hpi a past medical.history druggin allergies or social.history whatever you want the patient to.have or possibly have if the student.asks the right questions you may want to.consider some simulated patient data a.simulated EMR might be possible you may.have access to one if you're teaching.your students at your institution you.may just use paper if you're doing a low.resource type case you may have nothing.or give them a scratch paper just tell.them to bring their own note paper and.you'll decide what kind of clinic chart.that you want to have their lot of.options to consider and if you're using.a mannequin you want to note these basic.settings that you want to start the.scenario out some of us will be.responsible for being the mannequin.operator as faculty members and other.times you might have the good fortune of.having a simulation tech to help you set.or change the the parameters of the of.the mannequin other times some of the.mannequin products allow you to.pre-program the mannequin for the the.direction of options that you would like.so it can link certain vital signs and.sequence to each other and you can.decide how long you want between the.intervals that the change in each act in.each vital sign or each actually you may.want changed on the mannequin you may.need you know you may need some things.like pulse oximeter or ECGs we have some.defibrillators you may want the students.to have access to that the other thing.is if you're using a mannequin what do.you want the patient to say because you.may not be the one behind the mannequins.voice so do you want to use the.pre-programmed voices or do you as a.faculty member one of your faculty.colleagues want to be the voice of the.mannequin or do you want to get a.standardized patient to be the voice of.the mannequin and give them a script of.the kind of things that they should say.a couple of things to consider the vocal.sounds and their responses supplies and.equipment we talked a little about the.clinic supplies that the supply should.be appropriate to the environment you're.trying to simulate so clinic supplies or.ed supplies or nothing if you have low.resource or trauma trauma Bay a.situation what type of chart or.electronic medical records you like if.any any emergency response equipment or.other things down at the bottom of the.slide we have listed something about a.participant instruction it's a really.great idea just like they we do at the.beginning of a course we give the.students a syllabus we sometimes I look.we have a learning management system we.upload it to there what can you expect.in this course and we do the same thing.with simulation what can you expect out.of this learning experience and we'll.tell them you know this is going to be a.cardiac case bring your stethoscope and.bring something to write with and maybe.it's also about communication two team.members and other team members there's.going to be a telephone in the room you.can call for help there are these are.the life these are the simulated things.that are life like that you may want to.consider so they have an idea of what to.do if I have a number of students I may.let them decide what role if I'm looking.for leadership in a team I may say you.guys go in here's the case and decide.what role you know and see how the role.decision involves or I've given them a.little index card and say if we you know.if we're doing a resuscitation event.this is your role or the team leader.will decide on your role so some kind of.instructions this is what you can expect.I think that they seem to respond better.when they're not in total surprise and.they're a little bit prepared we'll have.a debriefing plan one of the things we.talk about is a simulation safety and so.we come with send me to the simulation.environment with a number of assumptions.one is that each student who's there.wants to learn wants to do their best.and.who wants to reflect that in their.actions so we tell them you know if you.see someone who may be administered the.wrong medication or didn't know the.right dose of the medication they're.going to take that that should stay here.in simulation and when you go to lunch.with your student friends you shouldn't.be sharing that you know so-and-so you.know made this error so errors.simulation is a safe place to make.errors and places for students to think.that or and understand that their.actions their actions are to be learned.and built upon we want to as instructors.and faculty let the students do the talk.you want to facilitate their comments.and and responses to their actions so we.want to see if our learning objectives.went but we may ask the students.immediately after scenario what did you.think about that or how did you feel and.they'll say anxious surprised you know.unprepared or very prepared so they'll.give you a whole host of responses and.then you may ask them you know how did.you what didn't go so well or what did.you learn a couple questions that are.listed here that you that you may want.to use in terms of evaluation and.assessment we have opportunities I know.all of you have when you develop your.oskis a summative blueprint that ed and.grading rubric you have for your.students when you consider mannequin.based simulation there are a number of.assessment tools that have been.developed most of them are for the.nursing and medicine medical resident.population medical student population.and certainly we can do we can have an.opportunity to discuss with the.colleagues what you're trying to.evaluate if it's a skill or knowledge.and decide on what's the best way to.evaluate your your student learners ok.so again you've decided that this is.something that you want to be a champion.of you want to do more simulation in.your program but how do you sell it to.the rest of the your stakeholders how do.you get everyone else to understand how.important it is.so one of the ways we know how important.the RK standards are and how we need to.tie what we're doing to arc PA standards.so I'm going to talk about a couple of.standards this is way too many words for.a PowerPoint slide so we'll break this.down and go through each of these.separately but you can see that there's.six standards right off the top that we.can use to match to simulation.modalities okay so the first one is be.107 the curriculum must include.instruction related to the development.of problem solving and medical decision.making skills this is my personal.favorite standard for simulation.education because I feel like it's so.wide open there's so many things in.simulation that you can do that could.meet this standard so just an example.here you could have your high fidelity.mannequin with a complained of chest.pain so part of the evaluation would be.to do the history physical examination.determine appropriate diagnostic testing.for this patient interpret those tests.and then develop a treatment plan.depending who your student population is.whether this is a didactic learner who.it for the first time is putting their.hands on a simulator or this is a.clinical year student depends on what.your scenario could look like so if it.was a didactic year student who you.probably thought a lot about mis to you.may want to make that classic 50 year.old male who's diaphoretic and nauseous.and clutching his chest you know very.textbook presentation of an mi have.classic EKG findings and work through.that scenario if it was your clinical.your student you may want to have that.68 year old female with a little nausea.and epigastric tenderness or epigastric.pain who ends up having some less.obvious findings on her EKG and still.goes on to have an mi so the idea is.that you start to incorporate some of.the Zebras in your clinical year some of.the higher acuity more complex scenarios.and more straightforward things in the.didactic year but this guy's the limit.with what you could do with this you.could have any sorts of complaints and.then work your way around again.depending on your goals and objectives I.do want to just talk about that for a.second I know that sometimes we walk.into scenarios or situations where.someone will say hey here's the.simulator use it and the question is.should we use it and we all goes back to.your goals and.objectives so I really think that's such.the important point to stress here your.goals and objectives the simulation.needs to reflect it because simulation.is just a tool to carry out your goals.and objectives but if you don't have.refined goals and objectives your.simulations can go completely off track.and be very complex for not really a.good learning purpose so it's really.important to keep those in mind okay so.back to our scenario what do we need for.this high fidelity mannequin and what.that means is a mannequin that can.respond to what the students are doing.so this is something that you may have.in your practice or in your educational.setting sim man a simian 3g those are.some examples there's certainly lots of.other examples of that but the idea is.that they're high fidelity or you could.have a standardized patient if this was.during your didactic gear and the focus.is the history and physical less so.maybe the resuscitation of this patient.then a standardized patient may make.more sense because they can actually.interact with that that person more.effectively than with a mannequin so.don't think just because you have a man.can you have to use it think about what.best meets your goals and objectives and.then use the tools that fit that we did.something similar to this recently and.we had a faculty member who acted as a.standardized patient and it worked very.well and then also you know in this.scenario would want a cardiac monitor.maybe you wouldn't need that depending.on what your goals and objectives were.so the next arc a standard is be 108 and.the curriculum must include instruction.to prepare students to work.collaboratively in interprofessional.patient-centered teams so.interprofessional we're all hearing.about this thinking how the heck can i.make an interprofessional educational.session when I'm just in my program and.I may not have a lot of collaborative.collaboration of other schools around me.so depending on what resources you have.available obviously depend on what you.can do in this scenario the example was.from a medical school where there was.residents nurse practitioners pas.nursing students so they all came.together and worked on an obstetric case.the case is something called a.longitudinal case and this is often used.in clinical settings where a patient may.present to the ER be evaluated and moved.to the next section in the hospital like.the surgical center so they may kind of.work through that setting so it's called.a longitudinal case.and in this particular case the patient.presented she was 34 weeks pregnant with.severe acute abdominal pain some vaginal.bleeding it was found to have an.abruption of her placenta that was.diagnosed in the ER she then moved to V.evaluated by the OBGYN team anesthesia.came in nursing and she was taken to the.ORS stat c-section so the idea is it can.be as complex or straightforward.depending on what resources and time and.personnel you have available but in this.setting there are lots of different.learners who all can work within their.roles but at the same time they're.working together as part of a bigger.team one thing i will say about this is.that it's important to make sure that.your learners are leveled so it's.difficult to pull in a third-year ER.resident second or third year anesthesia.resident and a undergraduate nurse and.put them all together in the same sim.and expect it to be effective there are.people at very different levels of their.education so keep in mind that if you're.working with PA students you may not.want to have a first or second your.medical student you want to have the.higher-level medical student working.with the PA students you would want to.have a higher level nurse so that you're.closer in level and then when you're.going to debrief and try and understand.what happened people have more similar.expectations in the learning can occur.at a higher level in this particular.modality we use another high fidelity.simulator so this was actually one that.can simulate childbirth and standardized.patients as well so we combine the two.together and that's called a hybrid.model so hybrid can be a standardized.patient and high fidelity mannequin it.could be a standardized patient and.attached trainer there's lots of.variations that can go together so you.can also throw in things that are called.Confederates which Nina alluded to and.that's just someone to come into the.role to kind of add a level of.complexity it could be a spouse that's.unhappy it could be a family member it.could be the parent of a pediatric case.depending again on what your goals and.objectives are okay so be 20 for the.program curriculum must include.instruction and interpersonal and.communication skills that result in the.effective exchange of information and.collaboration with patients their.families and other health professionals.so effective information exchange so.many of you.we're all may be doing oskis already and.that's a great example of meeting this.RP standard for effective information.exchange another one could be a hybrid.scenario where you're using a mannequin.you're using some sort of task trainer.or or even a high fidelity mannequin to.do a specific task but in addition.you're doing working with a standardized.patient to get some communication.information that's exchanged so you.could either stand standardized patient.you could use a high fidelity mannequin.with a Confederate family member and you.could have a scenario where someone.calls for a consult so one way that you.could do this could be an elderly.patient who has acute mental status.changes could be the mannequin so.they're not very responsive you can't.get much of a history from them and then.you have the family member who could.might be the wife who's giving some.information and maybe it's determined.that the patient's pretty sick you know.and maybe part of your goal and.objective is to talk about end-of-life.decisions does the patient have a DNR.how do you ask someone if you have a DNR.if they say oh no does that mean you're.not going to resuscitate my husband if.he's unwell how does a student have that.conversation so again depending on your.goals and objectives there's lots of.ways to accomplish that effective.communication exchange one thing that I.found in some of the one of the programs.that I worked was that some of the.students didn't feel very comfortable.giving communication in a con to a.consult so they're calling the internal.medicine physician on the phone to give.a report of the patient or they're.calling for a specialist and they just.didn't know how to organize all their.thoughts quickly together to make a good.summary of information that need to be.communicated in one of the ways you can.work on that is to end a scenario by.calling for a consult so you had the.patient with the mi you determined it.was an mi you started appropriate.therapy but now he needs to go to the.cath lab so to get the team on the phone.from the cath lab and have the student.kind of sign out that patient to the.cath lab so they're working on.communication skills and they're working.on lots of other pieces as well as you.can see some of these flow back and.forth into each other it's not always.just one scenario to meet one standard.sometimes you can get multiple standards.with one scenario the program curriculum.must include instruction in the.provision of clinical medical care.across the lifespan.sometimes think this can be one of the.more challenging ones because it's.sometimes difficult when all of our.students are generally young 20 30 year.olds who aren't at the population.spectrums of age you know how do you get.a realistic encounter with these age.groups one option would be to have a.geriatric patient is your SP so they may.have a complex medical history they have.to go through this full history and then.do a physical exam on a normal geriatric.patient which is going to look very.different than the 20 year old they.practice doing their pd practical on so.just that in itself you know goes into.the lifespan so you may have also.talking about code status end of life.choices some of those difficult.conversations to have and they could be.simulated with a standardized patient in.real time something else that's.difficult I don't know about you but my.program does not have a whole list of.expectant mothers on the list of waiting.for that pediatric module to come up.that you can call them and bring all.their babies in it's difficult to get.your hands on babies or the students to.get their hands on there and really get.a good physical exam I don't have a.magic answer for that there is a really.expensive high fidelity mannequin that.you could use but again I think for the.purposes of physical exam it can't be.simulated quite as normal but you could.you could focus on some of the other.things in pediatrics for example suppose.you have a doll and a Confederate.meaning somebody who knows the scenario.the students interact with this.Confederate and the problem is that she.absolutely does not want to vaccinate.her children absolutely not going to.happen and how does the PA student react.to that how do you convince someone to.do something that you believe is correct.and its best for their child or for.themselves how do you work through that.as a student what kind of conversation.do you have and it could be you know.something like dietary modification it.could be someone who smokes but in this.particular scenario you could focus on.the pediatric version of that another.option for Pediatrics would be to take a.baby doll that is not very responsive.and focus focus the scenario on the.mother away from the child but moulage.or trying to think of a word and it's.gone moulage or try to.disguise the child in a way that would.make them look like they were abused so.maybe put some bruising on the head some.bruising on the torso have part of the.evaluation that there's an xray that.shows classic findings a bunch of non.healed fractures on the child or.multiple rib fractures so the the P.student should realize that this is an.abuse case and then they have to talk.about this with the mother and how would.they deal with that how would they let.the mother know that they're going to.involve social services and that the.child would have to come in to the.hospital into custody so again these are.higher level things to work on with.students probably something that were.more applicable to the clinical year but.they're things that they'll encounter in.real life and this is a way to bring.that realism into your classroom as far.as modalities so I mentioned geriatric.SPS or high fidelity mannequins again I.think that depending on what your goals.and objectives are you may not need.these high fidelity mannequins you can.you can use other means to accomplish.the same goal and be 207 the program.must include instruction and technical.skills and procedures based on current.professional practice I think this is.also another arcpy standard that's.relatively easy to hit when it comes to.simulation so one of the things that you.can use our TAS trainers things like.urine for urinary catheterization.putting in IVs injections lumbar.punctures central line suturing if you.can think of a skill that needs to be.done chances are there's at a stranger.out there to do it so certainly that's.something that you could use the other.thing that you could use is to combine.high fidelity simulators into the tasks.that actually need to be done so you.could have a patient who presents with.an acute tension pneumothorax and you.want the page or the students to needle.decompress that tension pneumo you could.have them place an interosseous line you.could have them do CPR and maybe CPR.skills and defibrillation so you.certainly don't have to only use task.trainers but you could have a whole.patient scenario and attach trainer off.to the side and suppose it's a 60 year.old male who comes in with abdominal.pain and decreased your nation over two.days they evaluate the mannequin and.find that he has acute urinary retention.they could then go to the side and.there's a task trainer and they could.practice putting in their Foley catheter.and interpreting lab values that show.acute renal failure.for example so there's lots of different.ways that you could weave things and.together okay and the last standard.focuses on patient safety quality.improvement prevention of medical errors.and risk management so a scenario that.you could have could involve an.incorrect administration of a medication.so one of your Confederates could be a.nurse and have a patient within a.musculoskeletal abnormality a shoulder.dislocation a try male yogurt try Mahler.ankle fracture where they're in tons of.pain they're very unwilling to give a.good history because they want lots of.pain medication the student likely would.then say okay I'm going to order.something for pain you have the.Confederate nurse come and give a big.dose of pain medication that's the wrong.dose the patient then has an opioid.overdose and then the scenario has to.unfold well how do you admit a mistake.was made even if it wasn't your mistake.how do you communicate that to the.family how do you communicate that to.the patient so that's one way you could.do it another way is to work on team.management skills in the midst of.resuscitation so in the midst of ACLs.things you could work on crisis resource.management or crewmate resource.management skills and those are things.like identifying a leader assigning.roles using a shared mental model and.using closed loop communication and.those things will help your students.develop lifelong skills and effective.team communication that they would.actually use in a clinical setting so as.we wind up this this talk we want to.mention that it's important to use the.literature that's already available.that's been done over the last years in.simulation to educate yourself and use.them to educate people at your.institution your program directors your.Dean's your other institutional.administrators on on the effectiveness.of simulation modalities for student.learners and the other thing is we need.to remind you that simulation shouldn't.be an adjunct to the curriculum it.should be implemented as Jamie mentioned.earlier in the talked into your.curriculum woven in and the studies have.shown that if you require the students.to attend the outcomes.are better so don't make it a voluntary.activity it may not be a graded element.it may be one of your other learning.activities like your lectures but.requiring students to attend will ensure.better outcomes with their learning in.summary we just want to you know.reiterate that healthcare simulation has.been extensively researched and widely.published and presented all over the.world with increase in volumes over the.last decade it's a modality that now.it's our time as PA educators to use and.to do scholarly research about the.effectiveness of this in in the global.environment the nurses did a big study.recently about use of simulation in lieu.of clinical training time we may want to.have conversations in light of.decreasing clinical sites and maybe.decreasing funds to to supplement that.that gap how to use simulation to teach.and assess our students we also do want.to mention that we had in the last few.days that a pre-conference workshop on.simulation well attended by a number of.your colleagues and your presence here.shows the increased interest we have a.simulation interest group tomorrow.morning at seven o'clock for anyone who.would be interested in furthering the.discussion of simulation use in PA.education and and scholarly work and we.encourage your participation and thank.you so much.if anyone if anyone has any questions.Jamie and I'll stay up here for a few.minutes.

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Physician Assistant Collaborative Plan 2014 Form FAQs

Check the below common queries about Physician Assistant Collaborative Plan 2014 Form . Communicate with directly if you still have other queries.

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How much autonomy does an oncology physician assistant have in comparison to an oncology MD or DO? What exactly is each able to do when it comes to formulating a patient's treatment plan?

It will depend on how much experience that PA has in oncology and what kind of an arrangement they have with their supervising physician. Potentially a lot or a little depending on these and the scenario. Their abilities and involvement are not black and white.

Is it normal nowadays for U.S. physicians to charge $100+ to fill out a 2-page form for a patient?

I don't know about normal but it's not unusual for doctors to charge for a number of things that used to be free. This includes things like filling out time-consuming forms. This is a task that is taking time that the physician could instead use to see a paying patient. I’m sorry but I doubt that you have any recourse.

Can I fill out the IBPS RRB office assistant form twice due to a mistake the first time?

Yes, you can fill new application form. Make sure you take exam only once and that too with your last registration number. If the system don't allow you to fill the new application then send a letter/mail to ibps.

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