PCAP– Primary Care Associate Program

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STUDENT MANUAL 2011-2013

Class of 2013

Disclaimer
The information contained in this Primary Care Associate Program Student Handbook is an extension of current policies and procedures of the Program, Stanford University School of Medicine and Foothill College. Since the implementation of curriculum is a dynamic process, the provisions listed in this Handbook are directive in nature and subject to change without notice. In case of change, students will be notified in writing.

Mission of the Program

The mission of the Primary Care Associate Program is to:

• train physician assistants for practice in primary care
• increase deployment of PA graduates in medically underserved communities in California
• increase the enrollment and deployment of underrepresented minorities
• respond to the needs of our communities and stakeholders, including Stanford University Medical Center

Overview and History

The Primary Care Associate Program (PCAP) began in 1971 with the enactment of regulations by the California State Board of Medical Examiners the established the education and practice of physician assistants. The program is a cooperative effort between Stanford University School of Medicine and Foothill College, although Stanford is the sole sponsor for the program’s accreditation.

The PCA Program is a 21-month (seven quarters) PA program and leads to a Certificate of Clinical Proficiency from the Stanford University School of Medicine. Foothill College provides academic credit for all courses.

The program continues its community mission by identifying target areas, recruiting students from these areas, and implementing clinical training through a network of local PA coordinators and physician preceptors. The current target communities are:

• Bakersfield area: Kern county
• Humboldt county
• Imperial county
• Salinas area: Monterey, San Benito, and southern Santa Cruz counties
• San Diego county
• Ventura/Los Angeles area

Accreditation Status

The program was first accredited in 1976, and has been continuously accredited since then. The most recent decision of the Accreditation Review Commission on Education of the Physician Assistant (ARC-PA) was in March 2007, and the program was awarded five years of continuing accreditation. The next accreditation site visit will be in 2012.

Program Philosophy

The program strives to achieve its mission in all aspects of its operations, including student selection, didactic and clinical curriculum, and graduate outcomes. The faculty and students engage in teaching and learning, community outreach, and advocacy that focus on improving the health status of California’s citizens, particularly those in medically underserved areas.

Competencies of Program Graduates

The PCAP curriculum follows competencies guidelines established by the National Commission on Certification of Physician Assistants. These guidelines define the specific knowledge, skills, attitudes, and educational experiences needed in order to train physician assistants who provide uniformly high quality health care and demonstrate greater accountability in their profession. The competencies are:

Medical Knowledge

Medical knowledge includes an understanding of pathophysiology, patient presentation, differential diagnosis, patient management, surgical principles, health promotion and disease prevention. Physician assistants must demonstrate core knowledge about established and evolving biomedical and clinical sciences and the application of this knowledge to patient care in their area of practice. In addition, physician assistants are expected to demonstrate an investigatory and analytic thinking approach to clinical situations. Physician assistants are expected to: 

• understand etiologies, risk factors, underlying pathologic process, and epidemiology for medical conditions 
• identify signs and symptoms of medical conditions 
• select and interpret appropriate diagnostic or lab studies
• manage general medical and surgical conditions to include understanding the indications, contraindications, side effects, interactions and adverse reactions of pharmacologic agents and other relevant treatment modalities
• identify the appropriate site of care for presenting conditions, including identifying emergent cases and those requiring referral or admission 
• identify appropriate interventions for prevention of conditions
• identify the appropriate methods to detect conditions in an asymptomatic individual
• differentiate between the normal and the abnormal in anatomic, physiological, laboratory findings and other diagnostic data
• appropriately use history and physical findings and diagnostic studies to formulate a differential diagnosis
• provide appropriate care to patients with chronic conditions

Interpersonal and Communication Skills

Interpersonal and communication skills encompass verbal, nonverbal and written exchange of information. Physician assistants must demonstrate interpersonal and communication skills that result in effective information exchange with patients, their patients’ families, physicians, professional associates, and the health care system. Physician assistants are expected to: 

• create and sustain a therapeutic and ethically sound relationship with patients 
• use effective listening, nonverbal, explanatory, questioning, and writing skills to elicit and provide information
• appropriately adapt communication style and messages to the context of the individual patient interaction
• work effectively with physicians and other health care professionals as a member or leader of a health care team or other professional group 
• apply an understanding of human behavior
• demonstrate emotional resilience and stability, adaptability, flexibility and tolerance of ambiguity and anxiety
• accurately and adequately document and record information regarding the care process for medical, legal, quality and financial purposes

Patient Care

Patient care includes age-appropriate assessment, evaluation and management. Physician assistants must demonstrate care that is effective, patient-centered, timely, efficient and equitable for the treatment of health problems and the promotion of wellness. Physician assistants are expected to: 

• work effectively with physicians and other health care professionals to provide patient- centered care 
• demonstrate caring and respectful behaviors when interacting with patients and their families 
• gather essential and accurate information about their patients 
• make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment 
• develop and carry out patient management plans 
• counsel and educate patients and their families 
• competently perform medical and surgical procedures considered essential in the area of practice
• provide health care services and education aimed at preventing health problems or maintaining health 

Professionalism

Professionalism is the expression of positive values and ideals as care is delivered. Foremost, it involves prioritizing the interests of those being served above one’s own. Physician assistants must know their professional and personal limitations. Professionalism also requires that PAs practice without impairment from substance abuse, cognitive deficiency or mental illness. Physician assistants must demonstrate a high level of responsibility, ethical practice, sensitivity to a diverse patient population and adherence to legal and regulatory requirements. Physician assistants are expected to demonstrate: 

• understanding of legal and regulatory requirements, as well as the appropriate role of the physician assistant
• respectful relationships with physician supervisors and other health care providers
• respect, compassion, and integrity in interactions with patients, instructors, staff, and fellow students.
• responsiveness to the needs of patients and society 
• accountability to patients, society, and the profession
• commitment to excellence and on-going professional development 
• commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices 
• sensitivity and responsiveness to patients’ culture, age, gender, and disabilities 
• self-reflection, critical curiosity and initiative 

Practice-based Learning and Improvement

Practice-based learning and improvement includes the processes through which clinicians engage in critical analysis of their own practice experience, medical literature and other information resources for the purpose of self-improvement. Physician assistants must be able to assess, evaluate and improve their patient care practices. Physician assistants are expected to: 

• analyze practice experience and perform practice-based improvement activities using a systematic methodology in concert with other members of the health care delivery team
• locate, appraise, and integrate evidence from scientific studies related to their patients’ health problems 
• obtain and apply information about their own population of patients and the larger population from which their patients are drawn 
• apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness 
• apply information technology to manage information, access on-line medical information, and support their own education 
• facilitate the learning of students and/or other health care professionals 
• recognize and appropriately address gender, cultural, cognitive, emotional and other biases; gaps in medical knowledge; and physical limitations in themselves and others

Systems-based Practice

Systems-based practice encompasses the societal, organizational and economic environments in which health care is delivered. Physician assistants must demonstrate an awareness of and responsiveness to the larger system of health care to provide patient care that is of optimal value. PAs should work to improve the larger health care system of which their practices are a part.
Physician assistants are expected to: 

• use information technology to support patient care decisions and patient education
• effectively interact with different types of medical practice and delivery systems 
• understand the funding sources and payment systems that provide coverage for patient care
• 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 
• partner with supervising physicians, health care managers and other health care providers to assess, coordinate, and improve the delivery of health care and patient outcomes
• accept responsibility for promoting a safe environment for patient care and recognizing and correcting systems-based factors that negatively impact patient care
• apply medical information and clinical data systems to provide more effective, efficient patient care
• use the systems responsible for the appropriate payment of services

The PA Competencies Online Center, “Physician Assistant Competencies,” National Commission on Certification of Physician Assistants, Accessed May 20, 2009

Program Structure and Organization

Division of General Medical Disciplines

The PCA program is part of the Division of General Medical Disciplines (DGMD), in the Department of Medicine. Dr. Mark Cullen is the DGMD Division Chief. The PCA program maintains a relationship with the Center of Education and Research for Family and Community Medicine.

Program Committees

The program’s governance and ongoing self-assessment is conducted by the following committees:

Principal Faculty/Staff Committee

The principal faculty/staff committee is chaired by the Program Director. It meets monthly to review issues of day-to-day program operation, long term planning and program development. Issues that require analysis and recommendations for action are referred to one of the other standing committees described below. Most actions regarding admissions, students and curriculum are made by the Principal Faculty/Staff Committee, based on recommendations of other standing committees. The Program Director and/or upper administration are responsible for actions regarding faculty and staff evaluation and budget-related resource issues.

The Principal Faculty/Staff Committee conducts an annual retreat to analyze graduate outcomes and the program’s educational effectiveness. Retreat agendas are set by the Program Director to assure that the program meets the minimum standards for accreditation and to pursue the program’s goal of educational excellence.

Curriculum Committee

The Curriculum committee evaluates all courses, utilizing student evaluations, instructor observations and student performance as criteria. The committee makes recommendations to Principal Faculty/Staff Committee for course and/or curricular modifications.

The Curriculum Committee analyzes student course and instructor evaluations, student performance, preceptor surveys, exit surveys, graduate surveys, PACKRAT and PANCE data, and graduate outcomes to monitor the curriculum for educational effectiveness. The committee utilizes national benchmarks for comparison with the program’s curricular content and sequence. The Curriculum Committee is chaired by the Medical Director, and includes the principal faculty.  Adjunct faculty and site visitors attend when possible, and their input is sought as pertinent to the issues.

Student Progress Committee (SPC)

The Student Progress Committee serves three main functions:

• To assess each student’s progress and readiness for advancement
• To assess and direct remediation of students who develop difficulty in maintaining satisfactory academic progress
• To assess and direct resolution of issues of student conduct

The committee reviews each student’s performance throughout each quarter to determine the student’s eligibility for progress to the next quarter and makes recommendations to the Program Director regarding approving or delaying each student’s progress.  The Student Progress Committee creates and oversees implementation of individual educational plans for those students approved for remediation, deceleration, or leave of absence. At the end of the program, the Student Progress Committee recommends eligible students to the Program Director for graduation, based on successful completion of graduation requirements and the summative evaluation.

The SPC analyzes aggregate student data related to attrition, deceleration, remediation and performance in all PCA program courses. The committee utilizes national/regional benchmarks and analyzes trends in student data in the context of admissions demographics and curricular changes. The SPC draws members from principal faculty who oversee major course content (didactic, pre-clinical, preceptorship). The duties of chair of the committee rotate annually among members. Current members are:

Ron Garcia, PhD (Chair)

Annette Bettridge (voting member)

Camille Gordon (voting member)

Fred Tovar (non-voting member)

Admissions Committee

The Admissions Committee is responsible for setting policy for the program’s admissions process, including screening of applicants, the validation process and student selection.

The Admissions Committee reviews admissions policies and procedures, and assures the accuracy and consistency of admissions publications (web site, outreach material and applications). The committee reviews and evaluates admissions requirements, including prerequisite courses, to assure adequate applicant preparation for the program’s curriculum. The committee analyzes trends in the applicant pool and student enrollment, using national and/or regional benchmarks. Current members are:

           Ron Garcia, PhD (Chair)

           Fred Tovar

           Emilio Francisco

Program Governance

The standing committees outlined above form the governance structure of the program.

Matters related to finance and personnel are reserved for the Program Director and/or upper level administration. The Program Director convenes an executive committee, consisting of the her/himself, Medical Director and Associate Program Director. The Executive Committee provides advice to the Program Director on strategic planning issues.

Stanford PCAP Student Society

The PCA class of 2006 established the Student Academy of the American Academy of Physician Assistants (SAAAPA). For officers, structure and duties see www.saaapa.aapa.org. The current president and members of the student society addresses the incoming class during new student orientation to discuss the function of the Society. SAAAPA officers are elected by the class and receive guidance by a principal faculty sponsor. It is the PCAP requirement that the SAAAPA officers to maintain good academic and clinical standing to be able to continue in their roles.

PCAP Student Class Representatives

Each class elects 2 student representatives. Student representatives meet formally and informally with their classmates to gather information in the aggregate about student issues and concerns. The student representatives communicate these issues and concerns directly to the principal faculty and Program Director. Successful student representatives are effective communicators and are able to identify issues that are of concern to the student body. Class representatives need to maintain passing academic and clinical grades in order to be eligible to continue in their roles. At the discretion of the Program Director, class representatives can be recalled and replaced at any time if they are not fulfilling their role appropriately.

Program Personnel

Program Faculty and Staff Contact Information

The program’s faculty and administrative staff work as a team to deliver the PCA curriculum. Key information about each member of our team is listed below:

Program Faculty
Name	Title	Phone	Email
Lucinda Hirahoka, FNP, PA-C, MPH	Program Director Principal Faculty	650-498-4474	hirahoka@stanford.edu
Valerie Berry, MD	Medical Director Principal Faculty	650-725-5445	vberry@stanford.edu
Ron Garcia, PhD	Assoc. Program Director Principal Faculty	650-725-0354	ron.garcia@stanford.edu
Arturo Armendariz FNP, PA-C, MPH	San Diego Regional Coordinator	619-302-1465	arturoa@stanford.edu
Annette Bettridge, FNP, PA-C	Academic Coordinator Principal Faculty	650-725-5455	annbett@stanford.edu
Tracy Fearnside, PA-C	Clinical Instructor Principal Faculty	650-736-7773	tfearn1@stanford.edu
Carlos Flores, PA-C	Kern County Regional Coordinator	661-304-9750	cflores6@stanford.edu
Camille Gordon, FNP-C, PA-C	Clinical Instructor Principal Faculty	650-498-5242	camilleg@stanford.edu
Patti Hee, PA-C, MPH	Clinical Instructor Principal Faculty	925-352-8977	phee@stanford.edu
Heather Hirsh, PA-C, MPAS	Ventura/LA Regional Coordinator	650-725-6959	hlhirsh@stanford.edu
Veronica Jauregui, FNP, PA-C	Imperial Regional Coordinator	760-791-5437	veronicajauregui@ymail.com
Chantal Lobue, PA-C	Humboldt Regional Coordinator	707-954-1157	chantalobue@gmail.com
Sheila Siegel, PA-C, MPAS	Clinical Instructor Principal Faculty Salinas Regional Coordinator	650-725-5343	ssiegel@stanford.edu
Peter Stonington, MS, PA-C	Clinical Instructor Principal Faculty	650-736-4283	pstonington@stanford.edu
Carl Tjerandsen, PA-C	Clinical Instructor Principal Faculty	415-987-4217	carltjer@stanford.edu
Michele Toussaint, PA-C	Clinical Instructor Principal Faculty	650-725-5340	mtouss@stanford.edu
Administrative Staff
Cynthia Ahrendsen	Preceptor/E*Value Administrator Assistant	650-723-8267	cahrends@stanford.edu
Doris Chou	Financial Manager	650-725-5338	leavers@stanford.edu
Emilio Francisco	Admissions Coordinator	650-725-6959	emiliof@stanford.edu
Randy Fauver, PhD	Data Manager	650-725-4481	rfauver@stanford.edu
Anne Parry	Program Coordinator	650-723-6432	aparry@stanford.edu
Fred Tovar	Director of Student Affairs	650-725-5342	ftovar@stanford.edu

PHYSICIAN ASSISTANT PROFESSION

Definition

The Physician Assistant (PA) is licensed to practice medicine with physician supervision. As part of their comprehensive responsibilities, PAs conduct physical examinations, order and interpret diagnostic studies, diagnose and treat illnesses, counsel on preventive health care, assist in surgery, and write prescriptions. PAs are trained in intensive programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). PAs work in primary care, surgery and specialty practice and in ambulatory, inpatient, emergency and long-term care settings. (Source:  AAPA, 2008)       

Legal Basis for Practice in California

PA legislation was adopted in California in 1971 and amended in 1975 and 2007. The current law gives joint authority over the practice of PAs to the Allied Health Division of the Medical Board of California and the Physician Assistant Committee (PAC). The PAC is responsible for approving training programs for PAs and to certify PAs for practice in California. Requirements for PA practice in California include:

• Graduation from a training program approved by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) and the PAC
• Passing the Physician Assistant National Certification Examination (PANCE) administered by the National Commission on Certification of Physician Assistants (NCCPA)
• Application to obtain a PA license from the PAC

PA Organizations

AAPA American Academy of Physician Assistants
The AAPA is the national organization representing PAs in all specialties and all settings. The AAPA advocates for the PA profession and for quality patient care through its activities related to legislation/regulation, health policy, reimbursement, and access. Member services include continuing medical education (CME) and networking with PAs and other health professionals. The House of Delegates (HOD) is the policy making body of the AAPA. It meets annually to deliberate on a variety of professional issues. AAPA web site:  www.aapa.org
           
SAAAPA Student Academy of the American Academy of Physician Assistants
SAAAPA is the national organization for student enrolled in PA programs. SAAAPA has an elected board and participates in many AAPA activities. It advocates for PA students and provides information about financial aid, survival tips, and clinical pearls. Web site:  www.saaapa.aapa.org

CAPA California Academy of Physician Assistants
CAPA represents PAs in California and addresses state-level issues of legislation/regulation, reimbursement for services, employment, and quality patient care. CAPA sponsors two annual well-attended CME conferences. With one of the largest PA populations in the U.S., CAPA sends a large delegation of representatives to the AAPA’s House of Delegates. Web site:  www.capanet.org

PAEA Physician Assistant Education Association
PAEA is the national organization representing PA education and PA programs. PAEA advocates for excellence in PA education through research, faculty development, governmental affairs, and curricular innovation. Web site:  www.PAEAonline.org
 
NCCPA – National Commission on Certification of Physician Assistants
NCCPA is the national organization charged with assessing PA graduate suitability for entering clinical practice and for maintaining certification while continuing in practice. The NCCPA administers the PANCE for graduates entering the profession and the PANRE, a recertification examination which PAs must pass every six years to continue their certification. Web site:  www.nccpa.net

ARC-PA Accreditation Review Commission on the Education of Physician Assistants
The ARC-PA is the national organization which accredits PA programs. Its commissioners are drawn from national PA organizations, physician organizations and the public. Web site:  www.arc-pa.org

PAC The Physician Assistant Committee of the Medical Board of California protects consumers by licensing physician assistants and approving physician assistant training programs. The Committee ensures that licensees and approved programs have met the minimum licensure requirements. Web site:  http://physicianassistant.ca.gov

CURRICULUM

Curriculum Philosophy

The program’s curriculum, which draws upon the student’s prior academic, clinical and life experience, is conducted on an accelerated timeline. The student is expected to be an independent, adult learner. Faculty members and clinical preceptors facilitate the student’s acquisition of core knowledge, skills and professional.

The following source documents are used to develop, implement and evaluate the curriculum:

1. ARC-PA Standards for accreditation of PA programs
2. PAEA Annual Report (national survey of PA program characteristics)
3. Competencies for the Physician Assistant Profession, developed by AAPA, ARC-PA, NCCPA and PAEA
4. PANCE blueprint, developed by the NCCPA
5. California Physician Assistant Committee guidelines for legal practice of PAs

Curriculum Structure

Students undergo 7 quarters of education whose objectives are based on competencies expected of physician assistants, as well as fulfilling the PCA program mission. The training addresses 5 broad areas:

• didactic coursework (fundamental science and medical knowledge)
• professionalism
• multicultural medicine
• clinical skills (including communications, interview & physical exam techniques, critical thinking, technical procedures)
• community-based preceptorships

Over the course of 7 quarters students participate in approximately 34 weeks of didactic and skills training, and 46 weeks of preceptorship experience. A large proportion of the didactic training takes place in quarters 1-3, with most of the preceptorship experience occurring during quarters 4-7. All lectures and skills training take place at Stanford/Foothill campus. For their preceptorship/clinical experience students are placed with a physician in their home community. Students return to Stanford each quarter for integrated instruction and testing.

Curriculum Delivery

The delivery of the PCA program content is based on five educational concepts: 

• systems-based organization of information
• information that is evidence-based
• spiral curriculum
• patient-centered, inter-professional focus
• needs and styles of adult learners

Systems-based organization is an educational model where medicine is approached by studying functions of each separate body system in health and disease.

Evidence-based information ensures that curriculum information is current, pertinent, appropriate and promotes practice that is standardized, effective and safe.

A spiral curriculum is one in which concepts are presented initially in basic fashion, then revisited in more depth, going from simple recall of information to critical thinking and application, providing opportunity for integration of new content and concepts.

Patient-centered medicine ensures that the needs of the patient are identified and addressed.

Inter-professional teamwork ensures that the student can communicate with and incorporate the expertise of other professions for the benefit of the patient.

Adult learners often have modes or learning styles that respond best to independent, self-directed inquiry; the program makes an effort to support the style of learning each student brings to the study of the material.

Didactic Coursework

Students receive formal class-room education in basic sciences, core medical knowledge, and acquisition of skills for clinical practice, professionalism and multiculturalism. The didactic curriculum prepares students for preceptorship experience.

Basic Science courses are presented in Quarter 1-3. These include:

• Basic Science/Microbiology/Infectious Disease
• Anatomy/Physiology/Pathophysiology I & II
• Pharmacology I & II

Core medical knowledge is presented throughout the curriculum in the Core Medicine courses, with the following emphasis by quarter:

• Health and common medical disorders by system (Quarter 1 & 2)
• Health and medical needs of special patient populations  (Quarter 2 & 3)
• Healthcare across the lifespan (Quarter 2 & 3))
• Patient care in specialized settings (Quarter 3 & 4)
• Public Health (Quarter 5 & 6)

Instruction in information literacy and practical skills in evidence based medicine is embedded in the Core Medicine courses.

Skills for clinical practice are presented in Quarters 1-4. These courses occur in sequence with the Core Medicine content of each quarter. The components of the skills for clinical practice are:

• Social and behavior sciences relevant to patient interview
• History-taking
• Physical exam techniques
• Critical thinking, problem solving, medical decision-making
• Technical procedures (such as phlebotomy, suturing, applying splints)

Professionalism and multiculturalism is taught throughout the curriculum in dedicated courses, with the following emphasis by quarter:

• The history of the PA profession, professional practice issues, laws and regulations affecting the PA practice, components of professionalism, PA scope of practice, and medical ethics
• PA certification and licensure requirements
• Overview of health care delivery systems and health policy
• Preparation for practice topics include quality improvement, risk management, reimbursement, documentation, coding and billing
• Cross cultural issues in PA practice. Topics include cultural competent health care, health literacy, models to assess provider and patient’s health beliefs, and working with interpreters
• Health disparities and its effect on health care delivery, students are required to complete clinical training in underserved sites.

Preceptorship Experience
The initial emphasis in clinical training is to ensure that students experience primary care practice, including a mix of family medicine, internal medicine, pediatrics and women’s health sufficient to provide a broad base of experience in health care of all genders, ages, and across the life span. In keeping with our mission students are required to have a portion of their primary care training occur at an officially determined medically underserved site. In later quarters students complete rotations in emergency medicine, inpatient care, surgical settings, and long-term care facilities.

Before a student is allowed to undergo supervised clinical training, the PCA Program takes responsibility for

• finding and approving preceptors
• finding and approving training sites
• assessing when students are adequately prepared for clinical training
• assigning students to appropriate sites

(NOTE: although a fundamental belief of the program is that students should ideally undergo clinical training in their home community, if a suitable preceptor is not available in the student’s home community then the student will be required to travel or relocate in order to complete clinical training. Students may not decline suitable sites.

Professional Liability

All members of the faculty-student-preceptor team must be mutually indemnified. Students enrolled in the Primary Care Associate Program are, through their enrollment, covered by malpractice insurance in the amount of at least one million dollars ($1,000,000). Stanford employees and agents such as Site Visitors and Faculty Advisors are covered for malpractice by the terms of their employment. We require that physician preceptors carry malpractice insurance for themselves and their employees.

Course Descriptions

Course descriptions for each of the required courses listed on the following table are available through the Foothill College web site,

http://www.foothill.edu/bio/programs/primary/catalog.php?Department=P%20C

Courses

In order to matriculate into the core courses, all students accepted into the PCA program must complete the following orientation course. The course includes self-paced on-line modules as well as 2 days of on-campus orientation.

Quarter	Course Name	Course #	Units
Spring	Orientation to Primary Care Associate Program	PCA 50	1

Satisfactory completion of the following courses is required in order to earn the PCA program’s Certificate of Proficiency:

Quarter	Course Name	Course #	Units
Summer  (Q1)	Basic Science/Microbiology/Infectious Disease	PCA 51A	2
	Anatomy/Physiology/Pathophysiology I	PCA 52A	5
	Pharmacology I	PCA 53A	3
	Pre-Clinical I	PCA 54A	3
	Professionalism/Multicultural Medicine I	PCA 55A	1
	Core Medicine I	PCA 56A	6
Fall (Q2)	Anatomy/Physiology/Pathophysiology II	PCA 52B	5
	Pharmacology II	PCA 53B	3
	Pre-Clinical II	PCA 54B	3
	Professionalism/Multicultural Medicine II	PCA 55B	0.5
	Core Medicine II	PCA 56B	8.5
Winter (Q3)	Pre-Clinical III	PCA 54C	4
	Professionalism/Multicultural Medicine III	PCA 55C	0.5
	Core Medicine III	PCA 56C	9
	Preceptorship I	PCA 60A	4
Spring (Q4)	Pre-Clinical IV	PCA 54D	1
	Core Medicine IV	PCA 56D	5
	Preceptorship II	PCA 60B	6
Summer (Q5)	Core Medicine V	PCA 56E	1.5
	Preceptorship III	PCA 60C	7
Fall (Q6)	Core Medicine VI	PCA 56F	1.5
	Preceptorship IV	PCA 60D	7
Winter (Q7)	Professionalism/Multicultural Medicine IV	PCA 55D	3
	Core Medicine VII	PCA 56G	2
	Preceptorship V	PCA 60E	6
	Total		98.5

Criteria for Successful Completion of the Program

In order to graduate from the Primary Care Associate Program and be awarded a Certificate of Clinical Proficiency from Stanford University School of Medicine, a student must achieve passing grade (“C” or better) in each required course in the curriculum. The student must also meet minimum passing standards of a Summative Evaluation, given at the end of their training, which includes demonstration of:

• adequate fund of medical knowledge (comprehensive multiple choice examination)
• adequate clinical, interpersonal and communication skills (standardized patient exam)
• adequate critical thinking in determining patient care (standardized patient exam)
• appropriate professional behavior (summary of assessments of professional behavior observed and evaluated by principal faculty, site visitors and clinical preceptors throughout the curriculum)
• Physician Assistant Competencies as measured by the above testing modalities
• maintenance of technical standards (see below)

In order to graduate students must also complete payment of all tuition, fees and library charges.

General Information

Technical Standards

The abilities and skills which students must possess in order to complete the training associated with the PCA Program are referred to as Technical Standards. These essential abilities are a group of minimal physical and cognitive abilities as well as sufficient mental and emotional stability to confirm that students are able to complete the entire course of study, participate fully in all aspects of PA training, and be deployable as competent PAs, with or without reasonable accommodation.

The PCA program has the ethical responsibility for the safety of patients with whom students and graduates will come in contact, and to the public to assure that its graduates can become fully competent PAs. Thus, it is important that persons admitted to the PCA program possess the intelligence, integrity, compassion, humanitarian concern, and physical and emotional capacity necessary to practice medicine. Students must verify that they meet these Technical Standards prior to or at the time of matriculation to the PCA Program and maintain them during their PCAP training. Students are obligated to alert the PCA program of any change in their ability to fulfill the technical standards. Students found to be in violation of the Technical Standards are at risk for dismissal from the program.

Technical Standard I: Observation

Students must be able to observe demonstrations and participate in physical examination sessions, clinical skills workshops, observe the difference of normal versus pathological states. They must be able to obtain a medical history and perform a complete physical examination in order to integrate findings based on these observations and to develop an appropriate diagnostic and treatment plan.

Technical Standard II: Communication

Students must be able to communicate effectively and sensitively with patients, their families, and members of the health team. Students must be able to communicate effectively with patients from different social and cultural backgrounds, as well as develop effective professional rapport with patients and co-workers. Students must be able to record examination and diagnostics results clearly, accurately and efficiently. Students must be able to communicate effectively in English with patients, family and other health care professionals in a variety of patient settings.

Technical Standard III: Motor Function

Students must possess the capacity to perform physical examinations and diagnostic maneuvers. They must be able to respond to emergency situations in a timely manner and provide general and emergency care. They must possess adequate sensory function and motor coordination to fulfill minimum competency objectives for inspection, palpation, percussion and auscultation necessary to perform a physical examination. They must possess sufficient postural control, neuromuscular control and eye-to-hand coordination in order to utilize standard medical/surgical instruments to participate in the inpatient and outpatient setting and other clinical activities.

Technical Standard IV: Intellectual-Conceptual, Integrative and Quantitative Abilities

Students must be able to learn through a variety of modalities including, but not limited to, classroom instruction; small group, team and collaborative activities; individual study; preparation and presentation of reports; and use computer technology. Students must have the mental capacity to assimilate and learn a large amount of complex, technical and detailed information in order to formulate diagnostic and therapeutic plans.

Technical Standard V: Behavioral and Social Attributes

Students must have the emotional stability to function effectively under stress and to adapt to an environment that may change rapidly, without warning, and/or in unpredictable ways. They must accept responsibility for learning, exercising good judgment, and promptly completing all responsibilities attendant to the diagnosis and care of patients. They must understand the legal and ethical standards of the medical profession. Students must be able to work effectively, respectfully and professionally as part of the healthcare team, and to interact with patients, their families, and health care personnel in a courteous, professional, and respectful manner. Students must be able to contribute to collaborative, constructive learning environments; accept constructive feedback from others; and take personal responsibility for making appropriate positive changes.

Technical Standard VI: Ethical and Legal Standards

Students must be able to understand the basis and content of both general and medical ethics. The student must possess attributes that include compassion, empathy, altruism, integrity, responsibility, and tolerance. Student must be able to recognize limitations in their knowledge, skills and abilities and to seek appropriate assistance with their identified limitations. Students whose performance is impaired by abuse of alcohol or other substances are not suitable candidates for admission, promotion, or graduation. In addition, should the student be convicted of any felony offense while in the PCA program, they agree to immediately notify the program as to the nature of the conviction. Failure to disclosure prior or new offenses can lead to disciplinary action that may include dismissal. Students must meet the legal standards to be licensed as a physician assistant in the State of California.

Adapted from Stanford School of Medicine Technical Non-Academic Standard, http://med.stanford.edu/md/admission/technical _standards.html, Accessed May 20, 2009

Process for Requesting Accommodations, Americans with Disabilities Act

Prior to matriculation students must

• Read and sign a statement that they are able to fulfill the Technical Standards
• Undergo a physical assessment and provide a document from their licensed medical provider stating that the student is able to fulfill the Technical Standards

Students with special needs or those who feel they may not meet the Technical Standards are urged to contact the Director of Admissions to determine whether they can meet the requirements with or without reasonable accommodations. Revealing a disability is voluntary; however, such disclosure is necessary before any accommodations may be made in the learning environment or in the Program’s procedures. Information about disabilities is handled in a confidential manner. Foothill College provides services for students who have been admitted to the PCA program and who have questions regarding accommodations for an established disability or evaluation of a potential disability. Students will be referred to

Margo Dobbins, DRC Coordinator will coordinate reasonable accommodations for students with documented disabilities in compliance with the Americans with Disabilities Act. Contact Ms. Dobbins at (650) 949-7038 or by email: DobbinsMargo@foothill.edu
More information is available at http://www.foothill.edu/al/drc.php

Requests for accommodations require program and institutional approval, which can be a lengthy process, including meetings between student, Program Director and DRC Coordinator. A student who intends to seek accommodations must submit notice of that intent in writing to Director of Student Affairs, Fred Tovar ftovar@stanford.edu

Deadline for submitting this written notice is June 1, 2012.

Occasionally a student develops or discovers a disability after enrollment in program courses. In this case it is the student’s responsibility to alert the PCA Program as soon as that disability is suspected or identified so that appropriate evaluation and discussion of accommodations can occur. If at any time the student develops a condition that would negatively impact health and safety of the student, program faculty, staff, other students or patients then the Program has the right and obligation to suspend the student form all or part of program activities until the condition can be evaluated.

Student Employment Policies

• Students are discouraged from seeking or maintaining employment while enrolled in the PCA program.
• Students may not work for the PCA program. The Program may hire work-study students, but PCA students cannot hold these positions.
• During preceptorship experiences, students must not be used to substitute for clinical or administrative staff at clinic sites (paid or unpaid).
• Students with specific prior knowledge, experiences and skills may assist faculty in didactic and laboratory sessions to share their knowledge and skills.

Class Visitors

Adults may be permitted to visit Stanford or Foothill College sites under the guidance and prior approval of the Director of Student Affairs. Applicants, accepted students and others may visit classes for short periods of time on an intermittent basis. Given the nature of the training program, some classroom events are not suitable for visitors. In general minor children (including children of students) are not allowed as visitors. Rare exceptions may be granted with prior approval.

Advanced Placement

The program does not offer advanced placement.

Articulations with Other Institutions

The PCA program maintains cooperative arrangements with a number of educational and service institutions throughout California.

Foothill College provides academic credit for all course work in the program and awards an Associate of Science (AS) for students who apply for the degree.

The PCA program offers an articulation with San Jose State University’s Department of Health Sciences for a Bachelor of Science (BS) degree.

The PCA program offers an articulation with St. Francis University’s Physician Assistant Program for a Masters of Medical Science (MMS) degree.

Information about these options can be obtained by contacting Lucinda Hirahoka Hirahoka@stanford.edu or Fred Tovar ftovar@stanford.edu Deadline:

Students must indicate their desire to seek the St. Francis MMS by the end of Quarter 1.

REGISTRATION, ENROLLMENT, and FEES

Foothill College General Registration Information

To register for Foothill College classes, follow the telephone registration instructions or online registration instructions published in the Foothill Schedule of Classes available online at www.fhda.edu. Please note: online information is subject to change. Students are encouraged to check the Web site frequently. For more information, call the Admissions & Records Office at (650) 949-7325.

Enrollment

Students are enrolled as Foothill Community College students. The PCA program follows the Foothill Academic Calendar published online at www.fhda.edu. Though students are enrolled in Foothill College courses, didactic coursework and skills training take place primarily at the Stanford campus or Foothill Middlefield campus, provided by PCA program faculty, School of Medicine faculty, community clinicians and educators. At graduation students receive a Certificate of Clinical Proficiency from the Stanford School of Medicine. Completion of the PCA program courses qualifies the student for an AS degree through Foothill College.

Student Fees and Expenses

The fees listed below reflect the seven quarters for the academic year 2011-13. If a student extends beyond the customary seven quarters, or requires remedial enrichment courses during enrollment, additional fees will be assessed.

Estimated Costs for Academic Year: 2011-2013
California Resident
Foothill College Enrollment fees
$17/unit x 21units (Quarter 0 and Quarter 1)		$     357
$ 24/unit x 77.5 units (new state fee starts Quarter 2-7)		$  1,860
Foothill Student Fees		$     328
Stanford University School of Medicine Certification Fees*
$ 6,750/quarter x 7 quarters		$ 47,250
Total Educational fees:		$ 49,795
Books & medical equipment		$   2,200
Home computer or laptop  with email & internet access		$   1,500
Fee for required online logging software		$        90
Total California Resident Cost:		$ 53,585

*Certification fee is established by Stanford University School of Medicine and applies to the quarterly certification process conducted by the Primary Care Associate Program.

Non-California Resident
Foothill College Enrollment fees
Quarter 0-7 $119/unit x 98.5 units		$  11,721.50
Foothill Student Fees		$     328
Stanford University School of Medicine Certification Fees*
$ 6,750/quarter x 7 quarters		$ 47,250
Total Educational fees:		$ 59,299.50
Books & medical equipment		$   2,200
Home computer or laptop  with email & internet access		$   1,500
Fee for required online logging software		$        90
Total Non-California Resident Cost:		$ 63,089.50

Living expenses vary among individuals and are excluded from this table. These figures are provided for planning purposes only, and are subject to change. Fees typically are increased for the second fall quarter of the program.

The following estimates pertain to expenses required by the PCA Program and by various agencies for certification and licensure:

Graduation Costs not covered by the program	Approx.  $100
PANCE fee	Approx.  $450
Licensure fee – California Medical Board	Approx.  $200
DEA Application	Approx.  $400
Background check	Approx     $60
Health Clearances	varies

Refund of Fees

Foothill College tuition fees may be refunded under certain circumstances. The specific policy is listed in the quarterly Foothill College Schedule of Classes. Any questions concerning tuition and fees should be directed to the Foothill College Admissions and records Office. Foothill College policy on tuition and fee refunds please see http://www.foothill.edu/reg/fees.php.

The Stanford certification fee may be refunded if the student withdraws from the course within the first month of the quarter.

FINANCIAL AID

Students should begin planning their financial strategy before applying to the PCA program. Presentations on financial aid from representatives of Foothill College are included during Orientation. Information is available at Foothill Financial Aid http://www.foothill.edu/aid/

National Health Service Corps (NHSC)

Primary care providers who join the Corps receive up to $170,000 in loan repayment for completing a five-year service commitment. The NHSC offers loan repayment support with an initial award of up to $60,000 for two years of full-time service. After the initial two-year commitment, providers may be eligible to receive additional support in exchange for continued service; up to $170,000 for five years of service. With continued service beyond five years, clinicians may be able to pay off all their student loans. Students pursuing a degree in qualified health professions can receive a scholarship now and serve later. Scholarships for tuition, fees, a monthly stipend, and other reasonable educational expenses are available for up to four years. Students who receive scholarships can choose their primary care specialty. They then serve at least two years at a NHSC-approved site in a high-need area. Please go to the NHSC web page for more information
National Health Service Corp: http://nhsc.hrsa.gov/

Other Sources of Financial Aid Information

Students are encouraged to seek additional sources of public and private sector money, as well as pursue those sources listed here. Students are strongly encouraged to apply for the Cal Grant C, as former students have had success in obtaining this grant. A listing of many potential money sources can be found in the following publications:

• Mathes & Dixon, The College Blue Book; Scholarships, Fellowships, Grants & Loans, 17th Ed.
• Feingold and Feingold, Scholarships, Fellowships, & Loans, Volume VI
• Cassidy and Alves, The Scholarship Book
• Schlachter, Directory of Financial Aids for Minorities and Directory of Financial Aids for Women

Web resources include:

• http://www.guaranteed-scholarships.com/ lists and describes scholarships offered by individual colleges and universities to all enrolled students meeting the specific criteria.
• http://www.get-recruited.com/ offers students a chance to be recruited by, and perhaps be offered scholarships to attend, colleges, universities and graduate schools throughout the United States. This great service is absolutely free.
• http://www.college-scholarships.com/ is an all-purpose college and scholarship information site which includes links to nine free internet scholarship search data bases, links to college websites and online applications, college admissions office email address and (mostly toll free) phone numbers, ACT and SAT prep information, and much, much more. The site has been the recipient of more than 25 internet awards and receives more than 150,000 visits each month.
• Fastweb (www.fastweb.com) is a way to find money for college. Search 600,000 scholarships worth over $1 billion. Get expert tips on financial aid, careers.

All four sites allow students and educators to sign up for a free email newsletter offering information on college admission, scholarships and financial aid, careers, college life, and other important subjects of interest to students, counselors, parents, and teachers.

Another good source for scholarship information can be found at SuperCollege.com.

STUDENT HEALTH and WELLNESS

Health Insurance

1. Access to basic health care services is available through Foothill College Health Services (see below).
2. Students who are injured while performing educational functions (such as receiving a needle-stick injury in clinic) are covered by workman’s compensation for evaluation and treatment of the injury (see below for policy and protocol for injuries and exposure to bloodborne pathogens).
3. Students must assume financial responsibility for any other health care cost beyond 1&2
4. Any student that suffers illness, accident or injury must provide medical clearance to the Student Progress Committee in order to continue/resume students activities
5.  Although health insurance is not required by Foothill College, the PCA program strongly encourages students to enroll in a health plan that will cover them during the program. Lack of health insurance can delay a student in getting care for a medical problem, which may delay the student’s academic progress.
6. Principal faculty including the medical director and the program director do not provide health care for students, except in an emergency situation when other health care providers are not available.

Foothill College Health Services
Location:         New Campus Center, Room 2126
 
Hours:             Monday – Friday 8:30 AM–1 PM and 2–4:30 PM
                         (closed for lunch between 1 & 2 p.m.)

Contact:          Phone: (650) 949-7243
                         Fax: (650) 949-7160
                         http://www.foothill.edu/health/index.php

Clinic services include links to:

Acupressure Massage	Meningitis
Alcohol & Other Drugs	Nutrition
Breast Cancer Awareness	Planned Parenthood
Get the Gardasil Vaccine	Smoking Cessation
HIV/AIDS Information	Living Violence-Free
Immunizations	Psychological Services

Information on Injuries and Exposures to Bloodborne Pathogens

If a student is injured while attending class or at their preceptorship, Foothill College procedures will be followed.

For any serious injury: render appropriate first aid and seek immediate assistance from the nearest medical facility. Call 911 if appropriate.

For a less serious injury

• Render appropriate first aid
• Contact Foothill College Health Services as soon as possible: (650) 949-7243
• The Health Counseling and Services office will assist with appropriate documentation that must be completed even if the student is treated at another health care facility.
• In the event of bloodborne pathogen exposure seek care from the nearest occupational health care facility; often the local emergency room is the resource.

In the Stanford area, students who experience an occupational injury, environmental hazard or exposure to bloodborne pathogens will be referred by Foothill College Health Services to:

Nova Care Occupational Health
20289 Steven’s Creek Boulevard
Cupertino, CA 95014    
(408) 996-8656

In the event of exposure to blood or body fluid, the following emergency procedures should be followed (left column). If students are unsure whether a significant exposure to bloodborne pathogens has occurred, or if their treating facility has questions regarding the latest in post-exposure protocols, resources are listed below (right column).

Students please note:

Medical Providers please note

If you experienced a needle-stick or sharps injury or were exposed to the blood or other body fluid of a patient during the course of your training, immediately follow these steps: Wash needle sticks and cuts with soap and water. Flush splashes to the nose, mouth, or skin with water. Irrigate eyes with clean water, saline, or sterile irrigants. Report the incident to your supervisor. Report the incident to PCAP Program Director. Immediately seek medical treatment.

If you have questions about appropriate medical treatment for occupational exposures, 24 hour assistance is available from the Clinicians' Post Exposure Prophylaxis Hotline (PEPline) at 1-888-448-4911 http://www.nccc.ucsf.edu/about_nccc/pepline/ CDC recommendations for the management of occupational exposures to blood & body fluids MMWR Recommendations and Reports, Volume 54, Number RR-9, Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis www.cdc.gov/mmwr/PDF/rr/rr5409.pdf MMWR Recommendations and Reports, Volume 50, Number RR-11, Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf

ACADEMIC ADVISEMENT

Faculty Advisors

Soon after acceptance into the program students are assigned a Faculty Advisor who

• Coordinates the approval process for primary preceptor sites and rotations
• Provides guidance on problem-solving in all areas of program activity, including didactic, preceptorship, personal adjustment and professionalism
• Meets with the student at least once each quarter to maintain contact and provide ongoing support
• Helps with preceptor and clinical rotation needs

Each student is required to meet with his/her faculty advisor at the beginning of the first quarter and in each quarter subsequently. Students with academic difficulties, issues of poor professionalism or delayed progress may be required to meet with their faculty advisor more frequently. Faculty advisors utilize an Advisory Form (see Appendix V) to record issues discussed with students that may require further action or intervention.

Faculty advisors have regular office hours to meet with students. While the program maintains an “open door” policy, appointments with the faculty advisor are strongly advised, since faculty members have variable schedules.

Student Liaison

The PCA program appoints a Student Liaison who is available to provide guidance and information to students. The Student Liaison is a principal faculty member who helps the student understands the PCA program and Foothill College policies and student options when faced with Program decisions on course failure, delay, deceleration or dismissal. The current Student Liaison is Ron Garcia, PhD.

Student Resources

One of the recurring areas of confusion for PCAP students is regarding their official student identity. PCAP students are not enrolled as Stanford University students, and thus do not have access to Stanford facilities except as noted below. PCAP students by registration and payment of Foothill course and activity fees have access to all features of student life at Foothill College.

Housing

Housing is not available on the Stanford campus. Students are responsible for arranging their housing during didactic and clinical phases of the curriculum. Local newspapers can be helpful, as well as discussing housing strategies with senior PCAP students.

Transportation and Parking

Stanford is linked to local train and bus systems (Caltrain, VTA, SamTrans) and has the Marguerite, a convenient free campus-wide shuttle system. The PCA program sponsors students who wish to drive and park on campus, enabling them to buy an annual parking pass. More information is available at http://transportation.stanford.edu

Student Areas

Stanford School of Medicine has limited areas for student use and none dedicated for exclusive use by PCAP students. Students are expected to share common areas and lounges and behave in a considerate and professional manner. PCAP students may use

• lounge room M202 in the Alway building
• study rooms in the CCSR basement (rooms 0235-0247)
• Lane Library
• Fleishman labs (rooms 208-218)

A bulletin board for posting information is located in the hall near Always M104.

Athletic Facilities/Swimming Center at the Stanford Campus

PCAP students are not permitted to use any of the athletic or swimming facilities. A number of shower facilities are available; consult senior PCAP students or faculty advisors.

Library Resources

The Lane Library provides a full-service learning environment including study areas and access to texts, periodicals and on-line resources. SUNet registration allows students online access to electronic copies of many of the core textbooks as well as downloadable tools useful in clinic practice. Refer to www.lane.stanford.edu

Coursework

PCAP student access to Coursework is sponsored through their SUNet ID.

Copy Machines

Students are not allowed to use the copy or fax machines in the Program office. Copy machines are available throughout campus and in the Lane Library.

Stanford Bookstore

519 Lausen Mall
Main Campus
Phone 650-329-1217
Fax 650-322-1936
Email Stanford@bkstr.com

Health and Safety Portfolio

Students accepted into the PCA program are required to complete important health and safety clearances before matriculating into core program activities. These clearances are based on current Centers for Disease Control Recommendations for health professionals, and guidelines current for Stanford Medical Center. Students are expected to maintain and update their portfolio of these and other clearances throughout their PCA program enrollment. Most of these clearances are initiated and fulfilled by meeting requirements of PCA50: Orientation to Primary Care Associate Program. The syllabus and requirements for this pre-matriculation course are reviewed at Orientation and posted on Coursework. Briefly the PCA 50 requirements include

• Statement of completion of primary vaccine series
• Recent update of Tdap
• Dates of Hepatitis B immunization (completed series of 3 or in progress)
• Proof by blood test of immunity to
  • Measles (Rubeola)
  • Mumps
  • Rubella
  • Varicella
  • Hepatitis B
• Screening for Tuberculosis infection by Quantiferon Gold blood test
• Current BLS/CPR (American Heart Association approved)
• Medical clearance from personal medical provider, guided by Technical Standards
• HealthStream training modules that instruct on issues of health, safety and professionalism

Failure to complete these by the deadlines posted in the PCA 50 syllabus may result in course failure and delay in matriculation to core program activities. Other clearances (such as N95 respirator fit testing and ACLS training) will be organized by the program in later quarters.
 
Students will be asked to provide appropriate documentation, and sign releases that allow the PCA program to share their health and safety information with clinics, hospitals and other facilities where students train.

Student Contract

As soon as students establish communications with the program (completing their SUNet & Coursework activation) they will be provided with an electronic copy of the current Student Manual. A hard-copy signature page will be distributed that lists agreements between each student and the PCA program regarding important aspects of student training. Each student must

• sign that s/he has read and understood the Student Manual
• return the original signed copy of the signature page to the PCA program by the deadline in the PCA 50 syllabus
• acknowledge that the signed document is a contract between the PCA program and the student assuring that each party will abide by the policies and procedures outlined in the Student Manual

Students are not allowed to matriculate to core courses of the PCA program without signing the contract. If a student has questions regarding the contract s/he is encouraged to contact the Program Director.

ATTENDANCE POLICIES

Overview

• Attendance is required in all scheduled lectures, seminars, and workshops
• Attendance includes the issue of tardiness, which should be avoided
• Students are responsible for notifying the program when they will be absent from class or clinic
• All notifications must be in writing. Email is sufficient.
• Students must submit the notification to the appropriate person(s) in a timely manner (see below)
• Notification must include the reason for absence, such as family emergency, illness, personal business. In some cases there may be a health, safety or legal issue that must be cleared before student is allowed to return to class or clinic.
• Students are expected to remediate the absence and fulfill all course requirements on time for the quarter, including cumulative clinic days.

Absence from campus-based lectures and events
If a student anticipates missing any required program event such as lecture, workshops, seminars or a test the student must

• Contact Fred Tovar ftovar@stanford.edu as soon as possible (telephone first and follow-up in writing with email or fax)
• Provide exact time and date(s) of expected absence
• State briefly the reason for absence
• State expected return date
• Provide plans for making up any missed activity
• Discuss with Fred Tovar any impact the absence may have on enrollment or payment of required fees

Fred Tovar will discuss the absence with the course director and, where applicable, lecturers, workshop/seminar leaders, faculty advisors.

• If a health, safety or legal issue is involved the Student Progress Committee will discuss what needs to be resolved before the student is allowed to return.
• If a student’s absence will affect his/her ability to complete on time that quarter’s course requirements, the issue will be referred to SPC.

• Course instructors or group leaders may impose a make-up assignment. The student must complete all make-up assignments that may be generated by his/her absence. The course director or group leader will set the deadline.
• A student who fails to complete assignments on time will be referred to SPC.

• A student who misses a written test is expected to take a make-up test within the same week as originally scheduled. The course director will set the make-up test date.
• The make-up test will be equivalent (but not necessarily identical) to the original.

• SPC will be notified if a student does not take the make-up test within the week.
• Due to program resources, performance tests such as OSCEs, technical skills demonstrations or practicums are offered only at certain times and there may be significant delay before a make-up exam can be arranged. Students should be aware that this delay can result in a grade of “Incomplete” for the course, which may have an impact on financial aid and qualification for certain rotations.
• SPC will review student attendance; frequent or excessive absences, including tardiness, may result in sanctions.

Absence from Clinical Preceptorship

In order for a student to make adequate clinical progress students must meet minimum requirements per quarter for attending clinic or fulfilling rotational days. (See preceptorship syllabi for quarter requirements). It is the obligation of each student to manage his or her time in order to meet those requirements. Each student will negotiate a plan with his/her preceptor and site visitor and faculty advisor for fulfillment of clinical days and rotations. The student must contact the Clinical Coordinator regarding absences that may impact student progress. Any plan for addressing those absences must be reviewed and approved by the Clinical Coordinator.

A student who is unable to meet the clinical attendance and performance requirements for the quarter is not making satisfactory progress and may earn a not-passing grade for the quarter. A student must contact his/her site visitor and faculty advisor as soon as s/he is aware of any absences that may impact completion of the quarter clinical requirements. If the site visitor and faculty advisor, in consultation with the Clinical Coordinator, cannot make a satisfactory intervention then the issue will be referred to the Student Progress Committee for resolution.  

PROFESSIONALISM

Professional Behavior Standards

Students enrolled in the PCA Program must develop, demonstrate and adhere to standards of professional behavior consistent with the principles of the PA profession, medical ethics, and state and federal laws. Student progress in meeting professionalism goals is evaluated throughout the student’s training. Each quarter, principal faculty will complete an evaluation form addressing the various aspects of the student’s demonstrated professionalism and adherence to policies of behavior. Such evaluation includes informal observation of behavior in classroom, interactions with peers, faculty and staff, participation in seminars/practice groups, and conduct in clinical and administrative settings. Lapses of professionalism will be addressed by use of the Advisory Form (see Appendix V). Students showing repeated or serious lapses of expected professional behavior at any time during their training will be referred to the Student Progress Committee,

The PCA program incorporates guidance from three sources in defining goals for professional behavior of its students:

• Foothill College
• Stanford School of Medicine
• PCAP guidelines, including AAPA guidelines for ethical behavior

Foothill College Policies

The PCAP student is expected to

• Comply with the Academic Honor Code (see Appendix I)
• Comply with the Student Conduct Policy (see Appendix II)
• Register, enroll and pay required fees on time. Failure to enroll and pay fees results in termination of malpractice coverage, and the student will not be allowed to participate in preceptorship or other clinical activities.
• If the student has financial difficulties that jeopardize enrollment status, the student must contact the Director of Student Affairs immediately

Students who fail to adhere to the Foothill College Policies are referred to SPC.

Stanford University Policies

The PCAP student is expected to

• Adhere to the Stanford Fundamental Standard on behavior (see Appendix III)
• Respect the posted guidelines for usage of classrooms and campus resources
• Contact the Director of Student Affairs and the Program Director when planning
• any extracurricular activity on the Stanford campus
• any activities with the medical students on the Stanford campus
• any invitation to outside agencies (such as representatives of equipment or pharmaceutical products)
• Follow Cardinal Clinic guidelines when participating at Cardinal clinics

 PCA Program Policies

The PCAP student is expected to:

• Adhere to all policies within this Student Manual
• Comply with state and federal laws. A student who is arrested or convicted of a misdemeanor and/or felony offense during the program must inform his/her faculty advisor in writing as soon as possible.
• Notify the PCA program and Foothill College if making a change in name, mailing address, email address, telephone number or emergency contact information.
• Maintain communication with the Program by checking email messages at least once daily and responding promptly
• If requesting accommodations under the “Americans with Disabilities Act,” notify the Program with specific request and appropriate documentation by the posted deadline, or as soon as the student suspects a disability
• Adhere to Guidelines for Ethical Conduct for the Physician Assistant Profession
• In addition to the behaviors identified in the Foothill College Academic Honor Code, refrain from the following cheating behaviors*
1. Copying from another student during an examination
2. Copying from a “crib sheet” during an examination
3. Permitting another student to look at your answer sheet during an examination
4. Asking another student for answers to an examination question
5. Marking two answers on a computer sheet when directions call for one choice
6. Taking an examination for another student
7. Asking another student for the questions on an examination that s/he had taken
8. Previewing an examination from a “test file” when the teacher does not permit students to keep examination copies and does not know that such a file exists
9. Memorizing a block of questions on an examination so that the questions could be used in a test file or used by others
10. Copying another student’s SOAP note, H&P or other written assignment and presenting it as original work
11. Copying a paper from a file or from a purchased paper and presenting it as original work
12. Using material from another student’s paper without bibliographic reference
13. Faking the results of a laboratory experiment or project
14. Basing an “article report” on an abstract rather than reading the assigned article
15. Claiming authorship or participation in a group paper or presentation when you made no contribution

*adapted from:  Danielsen RD et al. The Culture of Cheating: From the Classroom to the Exam Room. Journal of Physician Assistant Education. 2006, Vol 17, #1, pg 24.

PCAP Didactic Behavior Policies

With respect to the program’s didactic curriculum, the student is required to:

• Attend all classes, seminar, practice groups, workshops. The typical class day is 9 AM to 5 PM. Some evening or weekend classes may be scheduled.
• Be punctual
• Comply with the following rule: students may not use laptop computers or other devices that allow online access, texting or other communication modes during lecture or groups, unless approved by the lecturer/leader.
• Follow house-rules regarding appropriate behavior in the classroom
• Behave with respect, compassion, maturity and integrity toward peers, faculty, administrative staff and guest presenters
• Follow reasonable community standards for dress and grooming while on campus.
• Follow dress and grooming guidelines below when in any clinical setting.
• Give and accept constructive feedback from peers, faculty and supervisors
• Submit all required assignments (written and verbal presentations) on time
• Notify the Director of Student Affairs by phone or email of any absence (Fred Tovar ftovar@stanford.edu or 650-725-5342)

PCAP Clinical Behavior Policies

With respect to the program’s preceptorship curriculum, the student is required to:

• Attend all supervised clinical activities as required by the Program and its designated clinical preceptors
• Comply with the Dress & Grooming Standards for Clinical Settings (see below) Comply with state and federal laws and regulations regarding the delivery of health care services

• Maintain student enrollment, which confers malpractice insurance. Refrain from participating in supervised clinical practice unless student enrollment is current.
• Demonstrate sensitivity and responsiveness to each patient, and the influence of culture, age, gender and abilities in each patient interaction
• Give and accept constructive feedback from peers, site visitors, preceptors and other health professionals
• Behave with respect, compassion, maturity and integrity to peers, faculty, site visitors, preceptors, staff, patients and families
• Behave according to the ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices
• Function within legal and clinically appropriate limits for the PA student role
• Always identify oneself to patients, families and other health professionals as a PA student
• Submit all required assignments on time
• Maintain accurate and current Daily Patient Contact logs in the E*Value electronic tracking system during their preceptorships.

PCAP Dress & Grooming Standards for Clinical Settings
(adapted from the Dress Code of Stanford Medical Center)

General

Female Students:  Dresses, pant or skirts outfits suitable for a clinical environment and worn with appropriate shoes and hosiery/socks. Shoes must be clean and in good condition. Long white coat required, unless waived in specific clinical settings.

Male Students:  Shirts and trousers suitable for an office/clinic environment with appropriate shoes and socks. Tie optional. Long white coat required, unless waived in specific clinical settings. Shoes must be clean and in good condition.

All Students:  A clean, professional appearance is expected and includes clean nails and a hairstyle that does not interfere with duties. Jewelry is acceptable if it does not interfere with work duties. Perfume/cologne is discouraged, but if worn should be mild and unnoticeable to others. Make-up should be conservative.
No blue denim jeans, hats, caps, tank tops, shorts, spandex wear, sweats, flip-flops, cutoffs or skintight leggings. Midriff, chest and back must be covered. Scrubs should be worn only in designated areas. Tattoos and piercings may be viewed by preceptors and facility personnel as unprofessional and my limit the students clinic options.

Hospital settings may have more specific requirements about dress and grooming. Questions about dress and grooming should be directed to the Program Director or the Medical Director.

Name badges with photo identification as a PA student must be worn and visible at all times.

PROBLEM SOLVING & CONFLICT RESOLUTION

Learning and practicing medicine involves working with a wide variety of people. Conflicts and misunderstanding can occur. The danger in allowing conflicts to remain unresolved is that they detract from the educational environment and from learning.

The following process for resolving problems and conflicts does not apply to disputes about

• test or assignment scores
• preceptor evaluations
• course grades
• Student Progress Committee decisions

The procedures for disputing these are described elsewhere in this Manual. In addition, issues of discrimination and harassment are addressed by a different process (see below).

Conflict Resolution

The PCA program expects students in conflict to

• communicate directly and in a timely fashion with the other person(s) about the issue or problem
• seek a reasonable understanding or resolution
• if unable to reach resolution, "agree to disagree" 

If a conflict arises between students, student and preceptor, or student and faculty member, PCAP committee or staff member that is not amenable to direct communication, students should seek help. PCA program faculty and staff representatives identified below can act as mediators and assist with problem solving and conflict resolution. Whenever PCAP personnel are asked to act as mediators they must fill out an Advisory Form documenting the meeting (see Appendix V).
Foothill College has established a complaints and grievance procedure for students who believe they have been treated unfairly. However, the student must make a good-faith effort to follow the PCA program conflict resolution process prior to going to the next step of accessing Foothill College.

Failure to follow the conflict resolution process may be cited as an example of poor professionalism.

Guidelines below indicate usual areas where conflict or problems arise, and suggestions for resources for help. The student is directed to ask for assistance in the order presented, with the faculty advisor often being the initial contact.

Personal Issues

• Faculty advisor  (the advisor may be able to help resolve the issue, or provide information and referral to other resources)
• Director of Student Affairs
• Site visitor (especially if the issue involves preceptorship)
• Any other faculty member whom the student feels may be helpful.
• For health or psychological issues the student should contact Foothill College services described in this Manual

Financial Issues:  Fred Tovar, Director of Student Affairs

Didactic Course Issues

• Faculty advisor
• Course director (posted in each course syllabus)
• Coordinator of group, workshop or lecture series
• Medical Director (who oversees curriculum content)
• Program Director

Preceptorship Issues

• Site visitor
• Faculty advisor
• Clinical Coordinator

Student Progress Committee (SPC)

• Student Liaison should be contacted if a student has a conflict with an SPC decision

A student who disagrees with a decision made by SPC should follow the conflict resolution process described below. The student should

• first seek a meeting the Student Liaison to clarify policy and procedures
• ask  for a meeting with the SPC to request a clarification, discussion or reconsideration of a decision
• be prepared to submit new or additional information to support his or her cause.

If the conflict cannot be resolved then the student may wish to pursue the grievance process described below.

Discrimination and Harassment

Stanford University requires all PCA program faculty and staff to receive training and regular updates on policies and procedures related to discrimination and harassment. Students receive training during the Orientation course via HealthStream training modules. The PCA program follows the Foothill College guidelines regarding the policies and procedures for processing student grievances and allegations of discrimination and harassment. If a student believes s/he is experiencing discrimination and/or harassment, students are not required to try to resolve the issue through the conflict resolution process above. A grievance procedure has been defined by Foothill College to protect student rights, described here http://www.foothill.edu/services/studentright.php. A student should immediately contact their faculty advisor and Program Director when there is an issue of discrimination or harassment.

Disciplinary Actions

Disciplinary action will result from repeated minor lapses and/or any significant lapse in professional behavior. Disciplinary action may include written documentation in the student’s permanent file, official reprimand, suspension, and/or dismissal.

Official Reprimand formally recognizes a violation of any policy, core value or expected behavior outlined in this Manual and Appendix I-IV, and directs the student to avoid future infractions.

Suspension is defined as exclusion from a didactic and/or clinical setting. Suspension may be enacted by the Student Progress Committee (SPC) for any of the following:

• Behavior which jeopardizes the health or well-being of peers, supervisors, staff, instructors and/or patients.
• Violation of any policy, core value or expected behavior outlined in this Manual and Appendix I-IV which has the potential for negative consequences and harm, and which requires further Program inquiry.
• Failure to enroll and pay fees in a timely manner. Students who are not officially enrolled do not have medical liability insurance and are suspended from preceptorships and some classroom events.
• Failure to maintain appropriate communication with the program.
• Failure to complete assignments and evaluations in a timely manner. In this case the purpose of suspension would be to ensure that the student focuses his/her time on correcting the lapse or late assignments and become current in all expectations. Penalties for lateness may apply.

Additionally, preceptors, site visitors and faculty have the right to immediately suspend a student from clinic or hospital if the student is acting in a manner that is unsafe or unethical. The person initiating the suspension must report the events to the Chair of SPC and Program Director as soon as possible. SPC will investigate and determine an appropriate disposition, which may include resolution, sanctions or dismissal. See section regarding illness or injury that impacts student’s progress.

Dismissal may result from violations of a variety of PCA program policies, including behavioral and academic. See below for the policy and procedure for dismissal.

GRADING & TESTING POLICIES & PROCEDURES

Academic Performance Standards

Standards of acceptable performance for didactic courses and preceptorship are summarized in course syllabi and/or course manuals and are reviewed verbally at the course introduction and quarter overview.

Grades

The program assigns course grades, based on criteria identified at the beginning of each quarter or course. The minimum passing grade for each course is a “C” (70.0%). The program does not “round up” examination or course grades to the next whole number. In some circumstances the PCA program employs a standardized “curve” to calculate letter grades. This curve does not change the 70% minimum to pass, and is usually created to recognize, for example, that 86% in a challenging course may deserve a grade of “A”.

Some courses include components that must be passed in order to pass the course, regardless of the overall course average. These components are identified in individual course syllabi.

Students must earn a “C” or better in all courses to stay in good academic standing.

The “Incomplete” grade is available only by SPC designation for situations where the student does not attain quarter goals. The grade of Incomplete is not automatic; the grade is given only following SPC review. A student who receives an “Incomplete” in a course must satisfactorily progress in all required activities by the deadline designated by SPC. Failure to make satisfactory progress in all requirements may result in an “F” in that course, which may result in dismissal. An “Incomplete” grade automatically changes to an “F” grade if not successfully made up in one year.

Each student is assigned a code word identifier in order to post grades and other group announcements confidentially. Scores are posted as soon as possible after each examination and at the conclusion of each quarter.

Didactic Course Testing and Grades

Students are given regular, meaningful feedback on their academic progress through various assessments tools. Depending on the course, quizzes, midterms and final exams may be a multiple choice written or electronic exam, performance check-off, OSCE, practicum, reflection paper, written SOAP note or oral presentation. Content tested is based on instructional objectives posted in syllabi and unit goals and objectives, and include material from lectures and reading from required texts. The minimum passing grade for each quiz & final examination is 70.0%. Please consult individual course syllabi for specifics of testing and assignment of grades.

Preceptorship Evaluation and Grades

Students are given regular, meaningful feedback on their performance in supervised clinical practice (primary care preceptorships and hospital-based rotations). Depending on the preceptorship, site visits observation, preceptor evaluations, multiple choice written or electronic exam, practicum examinations and written assignments (including write-ups of patient cases) are utilized to evaluate students’ clinical knowledge, skills and behavior in the clinical setting. The minimum passing grade for each Preceptorship course examination is 70.0%; if a Likert scale 1 through 5 is used, the minimum passing score is 3 for each section of the Preceptor evaluation form.

Required Progress

Students are required to demonstrate steady, adequate progress in each course in fulfillment of instructional goals and learning outcomes (see course syllabi for specifics.) Students not making adequate progress will be referred to the SPC. Failure to make progress may be grounds for delay, deceleration or dismissal.

Dispute of Test Results and Evaluations

Written Exams

At the conclusion of each written quiz or test, students submit their score sheets and keep the examination. The correct answers are posted soon after the conclusion of the exam. Within seven (7) calendar days following the exam, students may submit a written request for consideration of an alternative answer to the course coordinator. A request must include a rationale and reference from a text from the program book list and/or other Program course materials. References to texts and web-sites that are not on the Program book list will not be accepted.

The request is submitted to a Test Committee, which consists of the course coordinator, and two other principal faculty members. The Test Committee will generate a response within four (4) calendar days. If the request is granted, the student’s test score will be changed and (if applicable, the course grade).

The Test Committee’s decision concludes the review of didactic course test items.

Standardized Performance Exams

Students will receive copies of their score sheets for performance exams such as OSCEs, technical skills check-off, and practicum examinations as soon as possible after the testing event. In general, Practicum and OSCE scores will be posted within seven (7) working days after the testing days are concluded. A student with a failing Practicum score can review their examination by phone or in person with the Practicum Coordinator or designee at an arranged time before the next class week. The student may submit a written request for a scoring change with a rationale and reference from a text from the program book list and/or other program course materials. References to texts and web-sites that are not on the program book list will not be accepted. The written request must be submitted within seven (7) working days after the student has had the opportunity to review their examination.

The Practicum Coordinator will refer disputed items to a Test Committee including the practicum or event coordinator and at least two other principal faculty members. The Test Committee will generate a response within four (4) calendar days. If the request is granted, the student’s Practicum score will be changed (and if applicable, the course grade).

The decision of the Test Committee concludes the review of disputed performance test items.

 

Preceptor Evaluations

Students must receive an end-of-course or end-of-rotation evaluation from the preceptor who provided the primary supervision of the student. However, any preceptor who supervised the student may be asked by the Program to submit an evaluation of the student. SPC may elicit an early evaluation from a preceptor if there is concern about a student’s clinical progress and performance. Students must receive notice of their preceptorship evaluation scores within seven (7) days of receipt by the Program. If a student does not agree with the score or comments on the preceptor evaluation s/he should first discuss the concern with his/her site visitor who will seek clarification from the preceptor. If concern remains unresolved the student must submit a written request to the Clinical Coordinator within seven (7) working days outlining the cause of concern. The Clinical Coordinator will direct the investigation of the evaluation and send the information to the Student Progress Committee for resolution. SPC will generate a response within four (4) calendar days of their meeting, which may include accepting the evaluation as is, or developing a remediation plan. The decision of SPC concludes the review of the disputed preceptor evaluation. Students who disagree with SPC decisions may seek an appeal, described below in Appealing and Grieving Program Decisions.

ACADEMIC PROGRESS POLICIES

Definition of Satisfactory Academic Progress

Students are required to perform at the “C” or higher level in all courses to maintain satisfactory PCA program academic progress. Students with grades below “C” are reviewed by the Student Progress Committee.

A student must maintain a GPA of 2.0 each quarter to remain in good academic standing and to graduate from the PCA program.

Note:  Students enrolled in the St. Francis MMS option must maintain minimum course grades of “C” in order to continue with the MMS option.  

Academic Advisement

During a course

Each time a student fails a graded assignment or does not meet Program expectations (deadlines, professionalism or technical standards) s/he must meet with his/her Faculty Advisor or designee and complete an Advisory Form (see Appendix V). This process provides an opportunity for feedback and remediation of problems. At the meeting the student and advisor

• Review the failed exam, assignment or other area of concern
• Review study habits and test taking skills
• Review student understanding of Program policies and expectations
• Address personal, financial or other issues that interfere with performance
• Develop a plan for correcting deficiencies
• Complete a document that summarizes the meeting and plan for success.

SPC reviews all completed Advisory Forms and directs additional interventions, if indicated. A student’s failure to follow through on the plan created by the academic advisory may result in disciplinary action.

End of Course

A student who fails to achieve a minimum grade of “C” in a course and achieve minimum competency requirements must meet with his/her Faculty Advisor or designee to complete an Advisory Form. The Student Progress committee will review the form and meet with the student to discuss the course grade and the student’s insight into causes. See Course Failure, below.

PCA Program Probation

The PCA Program has internal rules regarding academic probation that are stricter than Foothill College rules (see Appendix I). Remediating a course failure is not automatic (see below). For students who do not achieve the minimum competency requirements posted in the course syllabus The Student Progress Committee determines if a student shall be placed on probation and offered remediation of a course grade. The probation lasts for the remediation period, which may vary, depending on the deficit to be corrected. A student will be placed on probation for the following quarter if the student does not achieve minimum competency in any course, assuming that the student is allowed by SPC to continue in the program and remediate the grade. If the student is able to successfully remediate the course grade or grades, the student returns to good academic standing. Probation may affect a student’s eligibility for financial aid.

A student whose progress is delayed for academic reasons beyond seven (7) quarters is placed on probation until the student graduates or is dismissed.

Course Failure

A student fails a course if s/he does not achieve the minimum competency requirements posted in the course syllabus. Each course has a number of components that measure competency

• Scored testing:  70% is the minimum passing score. Students must achieve BOTH an overall cumulative average of 70% and 70% on any final exam for the course
• Skills check-off: students must achieve benchmarks of skill, such as satisfactorily demonstrating ability to perform phlebotomy, scrub and gown for the OR, etc.
• Preceptor evaluations: students must meet minimum standards in all aspect of the written evaluation
• Days, MCRs, procedures, papers, assignments: students must fulfill minimum requirements
• Professionalism: students must demonstrate adherence to and development of professional manner during each course. Failure to do so could result in course failure.

Students must demonstrate competence in all coursework in order to progress in the program. Failure to earn a minimum of a “C” grade in any course may be grounds for dismissal from the program.

Remediation

Performance During a Course

Students who do not demonstrate minimum competency and who are not making regular progress within a course are identified by the Academic Advisory process. SPC directs their remediation. Remediation may include review of failed assignments (one-on-one or in large group), direction for change in student study habits or help with problems, referral to Foothill College for evaluation for learning disability, or other referrals as deemed useful. Individual tutoring is not available during a course.

 

End of Course Performance

When a student does not achieve minimum competency in determining a final course grade, an advisory form is completed (see above and Appendix V) and sent to SPC for review and action. Each student’s situation is given careful and individual discussion regarding whether and how the course grade can be remediated. The following are general guidelines for what may be remediable:

• Quarter 1-7: Failure to achieve minimum competency in one or two didactic courses in any quarter, limited to a total of 5 units.

  Example 1: student does not meet course goals for Basic Science and Pharmacology courses in Quarter 1. The unit total of those courses is 5 units and may be subject to remediation.

   

  Example 2: A student does not meet course goals for Anatomy/Physiology and Pharmacology in Quarter 1. The unit total of those courses is 9 units and is thus not subject to remediation, and would be grounds for dismissal.

   

  Example 3: A student does not meet course goals for Core Medicine (6 units) in quarter 1. The unit total is greater than 5untis and thus not subject to remediation, and would be grounds for dismissal.

• Quarter 3-7: Failure to achieve minimum competency in a preceptorship (which is more than 5 units), as long as the student achieves course goals for all other courses that quarter.

  Example 1: in Quarter 4 a student does not achieve course goals for Preceptorship II (6 units). The student passes all other courses that quarter. The Preceptorship II may be subject to remediation.

   

  Example 2: In Quarter 4 student does achieve course goals for both Preceptorship II (6 units) and Core Medicine IV (5 units). These are not subject to remediation and would be grounds for dismissal.

• Limit: A limit of no more than 2 courses of any kind may be remediated during the entire arc of the student’s PCA enrollment (a “three strikes” policy).
• Other: If SPC determines that courses are not remediable (such as change in the student’s ability to fulfill Technical Standards) then the student may be dismissed.

If SPC determines that a course can be remediated, the student receives a grade of “Incomplete” for the course. An individual educational plan will be created for the student. This plan is a formal agreement between the student and the Program and must be signed by student and Chair of SPC. The plan will include

• Identification of the student’s progress problem
• The student’s explanation of the problem
• Faculty identification of the deficiencies and factors related to the outcome
• Identification of remedial activities
• Timeline to complete the activities
• Identification of required level of performance to complete the remedial activities
• Plan for monitoring the activities
• A plan for enrollment in subsequent quarter courses will be created

The Program reserves the right to revisit and amend the contract if new information evolves during the remediation. In this case the student will be informed in writing of the reason for the changes and will be asked to sign the amendment.

Remediating a course requires enrollment in an enrichment course that may include self-study, tutoring, extra assignments and re-testing. If a student requires tutoring or assistance beyond what the program can reasonably provide the student must assume the cost of that service. Didactic courses must be successfully remediated by week 4 of the subsequent quarter. In the event of a not achieving minimum competency in a preceptorship or rotation the remediation is to repeat the entire event, which may vary in length from 4 weeks to 12 weeks in duration. Students should realize that remediation incurs additional course fees and possibility for delay in graduation.

If the student fails to achieve minimum competency in goals of the enrichment course intended to remediate the grade of “Incomplete” then the student is not making progress and may be dismissed. If the student achieves minimum competency requirements for the enrichment course then the “Incomplete” is changed to a “C” and the student receives a grade in the enrichment course that reflects the requirements of its syllabus.

Deceleration and Leave of Absence Policy

Deceleration is defined as the loss of a student from the entering cohort, who remains matriculated in the PCA program.
Deceleration may come about through one of two mechanisms:

• The Student Progress Committee believes there is some serious deficit in Technical Standard that requires significant time to remediate. SPC declares the student in violation of Technical Standards and makes the decision to decelerate the student. SPC develops a plan of independent study and remediation so that the student can return with a future cohort of students.
• The student requests deceleration, offering reasonable explanation and proof that a deficit can be remediated during time before re-entry.

In both cases the student would be reassigned to a new class. Due to Foothill College policies and PCA course descriptions, students may not repeat courses for credit; credit earned in courses for which the student has achieved a passing grade would be retained. Student would audit all courses and participate fully to demonstrate retained competency (see competency policy below).
SPC determines the appropriateness of deceleration and, if granted, develops an individual contract with the decelerated student.

Leave of absence refers to a disruption in a student’s academic progress often due to life events such as medical, personal, or family issues that preclude continuing. A leave of absence may be short and remediable without deceleration, or it may extend one quarter or more. A student may petition SPC in writing for leave of absence. The request must include

• reasons for the request
• the amount of leave time desired
• student’s plans to address the difficulties during time away from the program

If the reason for the request is based on difficulties in academic performance, the student must state his/her perceptions of causes of poor performance in the request and plans to improve performance. If the reason for the request is based on medical necessity the student will be required to submit a physician’s letter documenting ability to return to full participation in the program. If the student is requesting accommodations for his/her return to the program those are subject to Program approval, following referral and assessment by the Foothill Disability Resource Center.
 
If the SPC grants permission, SPC will set the terms of the period of absence and criteria for returning, and the student must demonstrate current competency, as determined by the SPC, before resuming progress in the appropriate quarter. (See Current Competency Requirements below.) If a student does not agree with the terms set by SPC he/she should refer to the process outlined below for appeal of SPC decision.

Current Competency Policy

The SPC may require a student to demonstrate current competency in didactic and/or preceptorship courses if the student is delayed. The SPC writes a contract with the student that may include the following:

• The student participates in all courses, seminars and practice groups that the student has previously enrolled in and passed, in an audit status.
• The student takes quizzes and exams as they are offered during the class weeks
• The student must pass (with a 70% minimum score) all pertinent final examinations (written and skills performance). If the student does not pass the required examination on the first attempt, the matter will be referred to the Student Program Committee and may result in the student’s dismissal.
• The student must repeat any designated required curricular components, eg. orientation to surgical gowning and scrubbing.
• Allowing the student to retain credit for already completed requirements such as clinic days, rotations, required procedures and MCRs will be assessed on an individual basis by SPC.
• The student may be required to enroll and pay tuition for an enrichment course,

If the student successfully completes all stipulations of the contract, the student resumes normal progress in the quarter in which the disruption in progress occurred.

Dismissal
A student may be dismissed from the program for any of the following:

• Cumulative GPA less than 2.0 at any time
• Violation of Foothill Academic integrity (see Appendix I)
• Violation of Foothill College Student Conduct policy (see Appendix II)
• Violation of the Program’s standards of Professionalism
• Unable to meet requirements of PCAP Technical Standards

Dismissal from the Program does not preclude the student from applying for enrollment in other courses/programs at Foothill College.

Dismissal Process

1. The student receives written notice from the Chair of SPC that cause is present to consider dismissal from the Program (see list above)
2. Student is referred to the Student Liaison for guidance in understanding program policy, procedures and student options
3. The student meets with his/her Faculty Advisor to complete a written summary of what contributed to the event or events that are cause for dismissal
4. The written summary is forwarded to SPC, along with any other documents that the student wishes SPC to consider in mitigation of dismissal
5. The Chair of the SPC convenes a meeting of the committee to review and discuss relevant documents. The student is invited to present his/her information and requests.
6. If the student does not elect to attend the meeting, the deliberation and decision will move forward without him/her present.
7. Following this meeting, the SPC will render a decision regarding the student’s status in the program.
8. The decision will be communicated to the student verbally, followed by written letter, delivered by certified mail.
9. Failure to receive the certified letter does not alter the outcome of the process or the validity of the decision.
10. If the student pursues an appeal related to this decision, the student will not be permitted to remain enrolled and attend classes during the appeals process.

Appealing and Grieving Program Decisions

Appeal

A student who disagrees with an SPC or other Program decision may pursue an internal PCAP appeal process that may be considered a form of conflict resolution. The Student Liaison provides guidance and information during the process.

Within 7 calendar days of the SPC or Program decision the student may request an additional meeting with to request clarification, discussion or reconsideration of a decision. The student should be prepared to submit new or additional information to help
support his or her cause.

Grievance

If the student is not satisfied after the additional meeting he/she may petition the Program Director to initiate a review based on grievance of program action, described below. The student has 7 calendar days to contact the Program Director to initiate the petition for review. During the review the original SPC decision remains in force.

A grievance is a specific term used to describe a situation where the student feels the Program has subjected the student to an unfair decision or action. The rights protected under this procedure include, but are not limited to, those guaranteed by the established rules and regulations of the Foothill DeAnza Community College District, Foothill College, the Education Code of the State of California, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and Title VII of the Civil Rights Acts of 1964. For a student in the PCA Program, this procedure described below will be applicable and stand in place of any grievance or appeal procedure of Foothill College to contest such act, unless the Program refers the student to a Foothill College procedure.

The purpose of this procedure is to provide a prompt and equitable means of resolving student grievances. This procedure is for student grievances only. This procedure shall be available to any student who reasonably believes a PCA Program decision or action has adversely affected his or her status, rights or privileges as a student. The procedures shall include grievances regarding:

1. Course grades, to the extent permitted by Education Code Section 76224(a), which provides: “When grades are given for any course of instruction taught in a community college District, the grade given to each student shall be the grade determined by the instructor of the course and the determination of the student's grade by the instructor, in the absence of mistake, fraud, bad faith, or incompetence, shall be final.”
2. Act or threat of intimidation or harassment. These procedures do not apply to sexual harassment or illegal discrimination.
3. Act or threat of physical aggression.
4. Arbitrary action or imposition of sanctionswithout proper regard to academic due process specified in the College procedures, unrelated to disciplinary actions.
5. The exercise of rights of free expressionprotected by state and federal constitutions and Education Code Section 76120.

Additional circumstances:

6. Sexual harassment. Complaints of sexual harassment should be addressed to the Director of Student Affairs, Fred Tovar. Unresolved complaints can be directed to the Dean of Student Affairs and Activities at Foothill College or the Dean of Student Development and EOPS at De Anza College.
7.  Illegal discrimination. Complaints of discrimination on the basis of race, color, national or ethnic origin, age, gender, sexual orientation, marital status, or physical or mental disability should be addressed to the Director of Student Affairs, Fred Tovar. Unresolved complaints can be directed to the Dean of Student Affairs and Activities at Foothill College or the Dean of Student Development and EOPS at De Anza College.

As noted earlier in the Manual, issues of harassment and discrimination that occur during the course of student conflict are handled by reference to Foothill College guidance. The grievance here refers to student who feels an SPC decision involves discrimination or harassment.

In summary, a student may bring a grievance of a program decision only on the basis that he/she has been subject to one or more of the above 7 complaints of unfair or illegal treatment.

DEFINITIONS
Grievant. A student alleging that a college decision or action has adversely affected his or her status, rights or privileges as a student.

Party. The student, or any persons claimed to have been responsible for the student's alleged grievance, together with their representatives.

Program. The Primary Care Associate Program.

Program Director. The Program’s Director or his/her designated representative
Student Progress Committee (SPC). A designated group of program faculty and staff who monitor and assess student academic performance and professional behavior.

Faculty Advisor. A member of the Program faculty assigned to each student.

Student. A person currently enrolled in the Program.

Respondent. Any person claimed by a grievant to be responsible for the alleged grievance.

Work Day. A workday shall mean days during which the program is in session. This includes classroom and clinical days (may include a Saturday and/or Sunday) as noted in the Program calendar.

Student Grievance Process

Initial Actions
A student who believes that he or she has been treated unfairly by a Program action must make a reasonable, good faith attempt to resolve the matter on an informal basis. Any appropriate administrator, faculty member, or staff member may be invited to participate and assist in achieving an amicable resolution, as described in the section on Conflict Resolution. Asking SPC for a second meeting to discuss dismissal or other decision is an example of good faith attempt to resolve the matter.

Grievance Process
If the student is not satisfied with the results of the good faith attempt and/or the student believes that s/he has been treated unfairly by the Program, the student may file a grievance. The action being grieved must arise from items (1-7) listed above. The Student Liaison is available for guidance. A grievance is not valid which pertains to complaints about a Program policy of general application to all students.

The student may submit a written grievance of the incident or action to the Program Director within 7 calendar days of the incident, event or notification of program action that the student believes to be unfair. The grievance must include:

1. Statement of action being grieved
2. Inclusion of pertinent documents
3. List of the relevant parties involved
4. Description of the initial good faith Conflict Resolution Process and the outcome of the Process
5. Statement of desired outcome of the student’s grievance

The Program Director may seek a meeting with the individuals involved, review documentation, and/or request additional information. The Program Director, upon review of the relevant documents and within 14 calendar days, will determine an appropriate disposition of the grievance and inform the student by phone, email and in writing

Appeal of Grievance Disposition

A student may wish to appeal the Program Director’s disposition of the grievance, which requires a formal hearing with representatives from PCA Program, Foothill College, Stanford School of Medicine and others as outlined below.

Formal Hearing
The student may initiate a formal hearing through a written request to the Program Director. The request should state the action that the student is appealing, and the reasons for the appeal. This written request must be submitted within 30 days of the conclusion of the original grievance process or within 30 days of the original action which the student believes was unfair, whichever occurs first.
The Program Director assembles a hearing panel consisting of at least three of the following:

• one academic dean or another representative from Foothill College
• one dean from the Stanford School of Medicine Office of Student Affairs, or designee
• one practicing physician assistant or nurse practitioner Program graduate
• one community-based physician who is familiar with the Program and its operations

The Program Director appoints one of the members as Chair of the hearing panel.
The Chair shall establish the procedures for the hearing and assure that the student:

• is allowed to inspect and copy his or her entire Program student academic file including any materials relating to the action being contested
• is permitted an advisor or support person (excluding PCA program personnel or attorney)at the hearing; the advisor may not participate directly in the hearing
• has the right to be present during the presentation of findings, but not the deliberations
• has the opportunity to respond
• has the opportunity to question any individuals who present pertinent findings during the hearing
• has the opportunity to present supporting documents and individuals, including the opportunity to present his/her version of the situation.

A representative of the Program will also have the opportunity to present documents and statements to the hearing panel. This may include a statement from the Student Progress Committee. The findings and outcome of the hearing panel will be communicated to the student and the Program Director in writing. The decision is final and concludes the Appeal of Grievance disposition process.

STUDENT RECORDS

Student Access to Education Records

Student records are considered to be confidential in compliance with the Family Education rights & Privacy Act, also called FERPA (Section 438, Public Law 93380). PCAs student are NOT allowed access to other students’ records, which are kept in the Program offices in locked cabinets.
 
The Act requires educational institutions to provide student access to official education records directly related to the student. Consult the Foothill College Student Handbook for details about student access to their educational records.

Transcripts

Students’ grades are posted at the close of each quarter and a grade report is provided by Foothill College following each quarter.

Student and graduate official transcripts are maintained by the Foothill College Registrar and by the PCA Program in secure files in the Program office.

Permanent Records

Foothill College maintains the student’s official transcript permanently. The PCA Program maintains permanently a copy of the student’s admissions materials, official transcript, pertinent evaluations and correspondence, summative evaluation, and copies of communication with licensing agencies, credentialing agencies and potential employers. The Program serves as the graduate’s point of contact for information/documentation and verification required by institutions, state medical boards and employers.

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