2 Slides - Putting The Pieces Together

Clinical Coordinator 101 Putting the Pieces Together
PAEA Workshops
Clinical Coordinators 101 Workshop
Putting the Pieces Together:

Clinical Rotation/Course Goals and Objectives
Elana Min & April Stouder
Objectives
Upon completion of this session, the attendee will be able to:
• Differentiate between instructional goals and instructional

objectives
• Formulate goals and objectives related to clinical rotations
• Develop written objectives that are measurable and address

course goals
• Recognize how the ARC-PA Accreditation Standards and PA

Competencies can match up to the goals and objectives
PAEA Workshops 2018 1

Why do we need instructional objectives

for clinical rotations?
• ARC-PA 4th Ed Standards
• Section B: Curriculum and Instruction

• B1: Curriculum
• B1.09: For each didactic and clinical course, the program
MUST define and publish instructional objectives that
guide student acquisition of required competencies.
• B2: Clinical Preparatory Instruction
• B3: Supervised Clinical Practice

Accreditation Standards for Physician
Assistant Education. 4th Ed. 3/2016
3 Domains of Learning
• Cognitive  “Thinking” (Bloom, 1956; Anderson, 2001)

• Facts, knowledge
• 6 taxonomies
• Affective  “Feeling” (Krathwohl, 1964)

• Attitudes
• 5 hierarchies based on level of involvement
• Psychomotor  “Doing” (Simpson, 1972)

• Skills

Terminology
• Instructional Goals
• A broad overview of what is expected
• Instructional Objectives
• Inform learners and others of what the learner is to achieve
• Competencies
• Abilities required for clinical practice
• Learning Outcomes
• Abilities attained by the student during their time within the PA
program
ARC-PA. Syllabi, Instructional Objectives
and Learning Outcomes. Standards 4th
edition
What are Instructional Goals?
• General statements that define the major purpose of a:

• Course
• Clerkship / Rotation
• Unit of Instruction
• Broad reference to a general process or outcomes
• Not readily measurable and may have several interpretations
• Gives general direction

Example: Instructional Goal
“During this four-week rotation the student will be exposed to and

participate in the management of patients with a variety of acute
and emergent medical conditions under the supervision of
emergency department providers.”
Terminology
• Competencies
program
edition

What are Instructional Objectives?
• Statements that describe what the learner will be able to do after

completing a unit of instruction
• A statement of an observable proficiency in which the criteria for

acceptable performance is specified and measurable.
Taxonomy of Objectives
• A system for ordering behaviors from simple to complex
• It is easy to write objectives at the lower levels
• Objectives answer this question:

• What behaviors or actions demonstrate the requisite skill,
attitude, or knowledge has been met by an individual?

Bloom’s Revised Taxonomy
Complex
Simple

Bloom’s Taxonomy Summary

• Knowledge – “Remembering” Simple
• Define, recognize
• “…state the signs and symptoms of hyperthyroidism”
• Comprehension – “ Understanding”
• Describe, identify, discuss, explain
• “…describe three causes of hypovolemic shock”
• Application – “Applying”
• Apply, demonstrate, develop, interpret, utilize
• “…apply ACLS protocol in a patient presenting in atrial Complex
fibrillation”
Waller K. Writing Instructional Objectives
Components of Objectives – “ABCD”
• Audience
• Behaviors (Performance)
• Conditions
• Degree (Criterion)

Audience
• Who will perform the intended behavior(s)?
• Usually only appears once at beginning of list
• “…the clinical year physician assistant student should be able

to…”
Behaviors
• Describes observable and measurable behavior

• Action verb
• What the learner must do following instruction
• Applies to Bloom’s Taxonomy

• Examples: define, match, explain, compare, formulate,
prioritize, classify, inject, suture, demonstrate…

Conditions
• Conditions under which behavior will be demonstrated
• Includes: tools, time factors, source materials, materials to

perform on, etc.
• “At the completion of the course…”
• “Given a diagram…”
• “On a mannequin…”
Degree
• Level of performance required
• Reference standards:
• Speed: “within ten minutes”
• Quality: “according to the standards identified in…”
• Accuracy: “no more than two omissions in performing focused
physical exam”
• Quantity: “no more than two attempts”

Example: Instructional Objectives
• “Upon completion of this rotation, the learner will be able to

differentiate, to the satisfaction of the preceptor, the management
of atrial fibrillation from that for PSVT when given a cardiac rhythm
strip.”
• “Upon completion of this rotation, the learner will be able to

demonstrate appropriate management of hypertension in adult
patients in primary care settings according to the JNC8
Standards.”
Group Activity
• Review instructional objective example assigned to your table
• Discuss at your table
• Determine if the objective meets all the components of an objective
(ABCD) and is it measurable?
• Which Bloom’s hierarchical level does this objective fit?
• Flip chart:
• From your table discussion, rewrite the objective you were assigned
• Were changes made based on your table discussion?
• If yes, document those changes and write the new objective
• If no, be prepared to explain your reasoning
• Large Group Discussion:

• Share the flip chart objective
• Share your reasoning

Checklist for Instructional Objectives

• Have the instructional objectives been stated in terms of learner
behavior as opposed to faculty performance?
• Is the terminal behavior specified?
• Are the instructional objectives measureable?
• Are the instructional objectives realistically achievable for the
length of the learning experience?

edition
Goals vs. Objectives
Instructional Goal Instructional Objective

• Gives general direction • Statement of observable
behavior
• Broad overview
• What must be completed
• Not measurable
• Measureable
• Written with ABCDs
• Taxonomy determines level of
complexity
• Connected to competencies

Summary
•Didactic vs. Clinical year Objectives
Part Two:
The PA Competencies

• ARC-PA 4th Ed Standards
• Section B: Curriculum and Instruction

• B1: Curriculum
• B1.09: For each didactic and clinical course, the program
MUST define and publish instructional objectives that
guide student acquisition of required competencies.
• B2: Clinical Preparatory Instruction
• B3: Supervised Clinical Practice
Accreditation Standards for Physician

Assistant Education. 4th Ed. 3/2016
Terminology
• Competencies
program
edition

PA Competencies
• “The knowledge, interpersonal, clinical and technical skills,

professional behaviors, and clinical reasoning and problem
solving abilities required for PA practice.”
• Developed by the four PA organizations (“the 4 Orgs”)

• NCCPA, AAPA, ARC-PA, PAEA
• Finalized in 2005, revised in 2012
• Reflect competencies for physician assistant practice
PA Competencies – “the Big C’s”
6 Domains:
• Medical Knowledge
• Interpersonal & Communication Skills
• Patient Care
• Professionalism
• Practice-based Learning & Improvement
• Systems-Based Practice

Medical Knowledge
• Identify signs and symptoms of medical conditions and
underlying pathophysiology
• Select and interpret diagnostic studies
• Manage general medical/surgical conditions
• Identify appropriate health maintenance/promotion
• Formulate differential diagnosis
• Provide appropriate care for chronic conditions
Interpersonal & Communication Skills
• Use effective listening and adapt communication style to context

• Develop a trusting, therapeutic relationship with patients
• Work effectively with others on team
• Demonstrate emotional resilience and stability
• Accurately, concisely and adequately document

Patient Care
• Work effectively with team to provide patient-centered care

• Demonstrate caring and respectful behaviors
• Gather essential and accurate information
• Counsel and educate patients and families
• Competently perform medical/surgical procedures
• Provide preventative care and education
Professionalism
• Demonstrate respect, compassion, integrity
• Accountability to patients, society and profession
• Understanding of institutional/ legal regulations
• Commitment to ethical principles & confidentiality
• Sensitivity and responsiveness to patients’ culture, age, gender
and disabilities
• Commitment personal and professional development

Practice-Based Learning & Improvement

• Analyze practice experience and perform practice-based
improvement activities
• Integrate evidence from scientific studies related to patients’
health
• Apply knowledge of study designs and statistical methods to the
appraisal of clinical literature
• Utilize information technology to manage information, access
medical information, and support learning
• Facilitate learning of students
• Recognize and address personal biases, gaps in medical
knowledge, and physical limitations in themselves and others
Systems-Based Practice
• Effectively interact with different types of medical practice and
delivery systems
• Understand the funding sources and payment systems that
provide coverage for patient care and use the systems effectively
• Practice cost-effective health care and resource allocation that
does not compromise quality of care
• Advocate for quality patient care and assist patients in dealing with
system complexities
• Apply medical information and clinical data systems to provide
effective, efficient patient care

Program Defined Expectations –

“the Little c’s”
• Competencies
• Integrate knowledge, behaviors, attitudes and skills
• Required for entry into clinical practice
• How do you know your student is prepared to enter clinical

practice?
Competencies vs. Objectives
• Competencies are:
• Often expressed in terms of learning objectives
• Objectives are:
• Integrally related to competencies
• Terms are often used interchangeably but mean different things

Example: Designing Rotation Objectives

with Competencies in Mind
• Goal of PAS 869 • Objectives for PAS 869
• Upon completion of the pediatric
• The PA student should have rotation, to the satisfaction of the
exposure to common medical preceptor, the learner will be able to:
problems encountered in
general pediatrics. At final • Obtain an appropriate focused
medical history
assessment of the clinical
course, the student will be able • Perform an appropriate focused
to evaluate and manage these physical examination
common medical pediatric • Demonstrate the ability to prioritize
problems… clinical information for presentation
in both oral and written form
• Propose pharmacologic and non-
pharmacologic treatment strategies

• Objectives for PAS 869 • Domains of Competence
• Upon completion of the pediatric • Patient Care
rotation, to the satisfaction of the
preceptor, the learner will be able to: • Interpersonal & Communication
Skills
• Obtain an appropriate focused
medical history • Medical Knowledge
• Perform an appropriate focused
physical examination
• Demonstrate the ability to prioritize
clinical information for presentation
in both oral and written form
• Propose pharmacologic and non-

Terminology
• Competencies
program
edition
Learning Outcomes
• Knowledge, interpersonal, clinical and technical skills,

professional behaviors, and clinical reasoning and problem
solving abilities attained at the completion of a curricular
component, course or program
• How are you evaluating instructional objectives and

competencies?
• B3.02 & B3.03 – SCPEs must enable students to meet the
program’s learning outcomes…
• Preventive, emergent, acute chronic encounters
• Infants, children, adolescents, elderly
• Women's health – PNC, GYN
• Surgical – pre, intra, post-op care
• Behavioral & mental health conditions and Learning Outcomes. Standards 4th
edition

B3.02 & B3.03
• Frequent citations by ARC-PA – Why?

• Need to clearly define your learning outcomes for students &
preceptors
• Need to clearly link those outcomes to an assessment tool
• Be very clear WHO is assessing, WHAT is being assessed & WHAT

tools are being used, and HOW your program is ensuring stated
outcomes are being met by ALL students
• What tools are you using to assess outcomes – what competency

domains to do they cover?
Measurement of Competencies
• Do we need to evaluate these?
• What methods are acceptable?
• How do we measure?


• Objectives for PAS 869 • Domains of Competence
• Upon completion of the pediatric • Patient Care
rotation, to the satisfaction of the
preceptor, the learner will be able to: • Interpersonal & Communication
Skills
• Obtain an appropriate focused
medical history • Medical Knowledge
• Perform an appropriate focused
physical examination
• Demonstrate the ability to prioritize
clinical information for presentation
in both oral and written form • Demonstrate Learning
• Propose pharmacologic and non- Outcomes…
Putting the Pieces Together
Goals Objectives
Standards Competencies
Measure to Demonstrate Outcomes

Where do we go from here?
The goal of putting these pieces together:
“Patient-centered, physician assistant practice

reflects a number of overarching themes. These include
an unwavering commitment to patient safety, cultural
competence, quality health care, lifelong learning, and
professional growth.”
NCCPA, Competencies for the PA Profession 2012
References
• Council on Medical Student Education in Pediatrics.

http://comsep.org/educationalresources/currobjectives.cfm
• Emerging Perspectives on Learning, Teaching, and Technology.

https://textbookequity.org/Textbooks/Orey_Emergin_Perspectives_Learnin
g.pdf
• NCCPA Competencies for Physician Assistant Practice

https://prodcmsstoragesa.blob.core.windows.net/uploads/files/PAComp
etencies.pdf

Acknowledgements
• David Fahringer, Darwin Brown, Jackie Sivahop, Melecia

Helwig, Danielle Kempton, Rachel Ditoro, Dan Provencher

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Clinical Coordinator 101 Putting the Pieces Together

Clinical Coordinators 101 Workshop

Putting the Pieces Together:

Elana Min & April Stouder

Upon completion of this session, the attendee will be able to:

• Differentiate between instructional goals and instructional

• Formulate goals and objectives related to clinical rotations

• Develop written objectives that are measurable and address

• Recognize how the ARC-PA Accreditation Standards and PA

PAEA Workshops 2018 1

Why do we need instructional objectives

• Section B: Curriculum and Instruction

• B2: Clinical Preparatory Instruction

• B3: Supervised Clinical Practice

• Cognitive  “Thinking” (Bloom, 1956; Anderson, 2001)

• Affective  “Feeling” (Krathwohl, 1964)

• Psychomotor  “Doing” (Simpson, 1972)

PAEA Workshops 2018 2

What are Instructional Goals?

• General statements that define the major purpose of a:

• Broad reference to a general process or outcomes

• Not readily measurable and may have several interpretations

• Gives general direction

PAEA Workshops 2018 3

Example: Instructional Goal

“During this four-week rotation the student will be exposed to and

PAEA Workshops 2018 4

What are Instructional Objectives?

• Statements that describe what the learner will be able to do after

• A statement of an observable proficiency in which the criteria for

• A system for ordering behaviors from simple to complex

• It is easy to write objectives at the lower levels

• Objectives answer this question:

PAEA Workshops 2018 5

Bloom’s Revised Taxonomy

PAEA Workshops 2018 6

Bloom’s Taxonomy Summary

Components of Objectives – “ABCD”

PAEA Workshops 2018 7

• Who will perform the intended behavior(s)?

• Usually only appears once at beginning of list

• “…the clinical year physician assistant student should be able

• Describes observable and measurable behavior

• Applies to Bloom’s Taxonomy

PAEA Workshops 2018 8

• Conditions under which behavior will be demonstrated

• Includes: tools, time factors, source materials, materials to

PAEA Workshops 2018 9

Example: Instructional Objectives

• “Upon completion of this rotation, the learner will be able to

• “Upon completion of this rotation, the learner will be able to

• Large Group Discussion:

PAEA Workshops 2018 10

Checklist for Instructional Objectives

ARC-PA. Syllabi, Instructional Objectives

Goals vs. Objectives

Instructional Goal Instructional Objective

PAEA Workshops 2018 11

PAEA Workshops 2018 12

• ARC-PA 4th Ed Standards

• Section B: Curriculum and Instruction

• B2: Clinical Preparatory Instruction

• B3: Supervised Clinical Practice