Author: Elizabeth Massey, MHS-PAS, PA-C, EMTP
Former Associate Director of Clinical Education of Physician Assistant Studies
Editor: Elizabeth Moran, MSN, RN, CPNP
COVID-19 has changed the way we live, work, eat, socialize, give and receive healthcare. During these unprecedented times, APRN and PA student clinical rotations have also been severely impacted by COVID-19. When the pandemic rapidly surged in the US in Spring 2020, outpatient clinics and elective procedures came to a screeching halt — along with student clinical rotations. Retrospectively, APRN and PA educators, practitioners, and students could not have anticipated the challenges and barriers to completion of training that this would cause.
Now, as re-opening, and then re-closures, cautiously take shape across the US, APP programs are looking at how to adapt to this new world. Below are 7 Strategies PA and APRN programs can employ to help ready their students with clinical rotations and beyond. These strategies not only benefit PA and APRN program educators, but can also guide APP applicants when choosing a program. Current Physician Assistant and Nurse Practitioners students should query their programs on these strategies to help relieve the inevitable worry that COVID-19 has cast on their futures as providers.
4 Strategies for APRN and PA Students and Educators to Navigate Clinicals
- Ensure all clinical students have been appropriately fitted for an N-95 mask and make sure each student is supplied with at least one mask before going out on rotations. Some facilities require the students to have appropriate PPE before they can rotate, and due to shortages, many appreciate it if students come prepared. Applying students and current students should ask their program who will be incurring this cost. Will the appropriate fitting be scheduled and paid for by the school, or will this be the student’s responsibility? Correct N-95 fit is an OSHA requirement for those taking care of COVID-19 confirmed or suspected patients. Academic programs and clinical institutions have the duty to ensure student learners are safe.
- Have a discussion with the students about potential COVID-19 testing and quarantining prior to certain rotations. Some clinics and hospitals require negative COVID-19 tests prior to start and/or have a quarantining protocol. There are currently rapid tests and PCR tests available. Consult with your facility for requirements.
- Focus on more rural areas for finding clinical rotations. Individually run clinics and rural hospitals may be more likely to accept students as there is often less bureaucratic red tape than at larger institutions. With the right precautions, hospitals and clinics can work to optimize the safety of staff, students, and patients, while still granting learning opportunities for students and lending a hand to providers.
- Discuss the possibility of telemedicine rotations with potential preceptors. Telemedicine is now a skill that is important for students to develop as it is being frequently used to evaluate and diagnose patients. These discussions could also decrease housing costs for clinical students, as students could complete some of their clinical rotations remotely. Telemedicine calls can be conducted as a 3-way virtual call for the patient, preceptor, and student all to partake in. This often works best for Behavioral Health rotations, especially as many psych providers have exclusively switched to virtual visits.
3 Strategies for APRN and PA Students and Educators During the Didactic year
- Train and make sure students are comfortable with telemedicine. First, use telemedicine as a reminder to students about the power of listening and taking a good history in any clinical visit. Then, teach learners how to evaluate patients via video. For example, instruct the student on how to assess anemia in a patient via video, such as asking the patient to pull down the lower eyelid to assess for pallor. The skills students learn to aid in their clinical assessments virtually will also help them in rotations. Ultimately, telemedicine will expand their knowledge, critical thinking abilities, listening and communication skills, which will all be important as telemedicine continues to be a growing industry moving forward.
- Put more emphasis on ICD 10 coding during the didactic year. Why? Clinical students must be exposed to a minimum amount of different types of patients to meet graduation requirements. Benchmarks can vary per program for PA students and are monitored by the ARC-PA. When students are more familiar with billing/coding, they can input more appropriate patient contacts during each rotation, regardless of the tracking system the program uses. For example, when a student codes for both pregnancy AND anxiety it can help to meet minimum requirements for both Women and Behavioral health rotations. In September 2020, ARC- PA updated their standards to include ICD 10 coding. This has a downstream benefit, preparing students to bill as clinicians which will benefit employers and help the providers protect their licenses because overcoding and undercoding both constitute medical fraud.
- Ensure appropriate staffing for all portions of the program, including didactic and clinical learning. All are vulnerable to COVID-19, regardless of appropriate protection. One sick person adds a lot of work to other colleagues’ plates, even if equally divided. More clinicians than ever are feeling burned out from all the changes COVID-19 has brought to both our personal and professional lives. The burnout is not isolated to those practicing clinically, but academically as well. Heavy redundancy with regards to clinical preceptors, as well as academic staff and faculty, can help share the burden and reduce the mental fatigue the pandemic has caused.
Occupational Safety and Health Administration (2020, April), United States Department of Labor, Temporary Enforcement Guidance – Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak, Retrieved from
Accreditation and Review Commission on Education for Physician Assistant, Inc., (2020, November) Accreditation Standards for Physician Assistant Education© Fifth Edition, Retrieved from http://www.arc-pa.org/wp-content/uploads/2020/10/Standards-5th-Ed-September-2020.pdf
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Elizabeth Massey has been a practicing PA in Georgia since 2012. In addition to her primary focus in Emergency Medicine, Ms. Massey has also worked in Family Practice and Urgent Care. Beyond her clinical work, she has worked as a mentor, preceptor, and instructor to PA and pre-PA students. Her academic work includes work as Associate Director of Clinical Education and she continues to work as an adjunct instructor. Ms. Massey is a passionate advocate for educational equality. She earned her undergraduate degree from the University of Central Florida and worked as a first responder after college, both as an EMT and later as a Paramedic. Ms. Massey enjoys outdoor activities with her husband and their son. She is a DIY enthusiast and loves to write about her projects, medicine and family on her blog at pamoments.com