MPAS Student Supervision in Clinical Activities

The purpose of the MPAS Student Supervision in Clinical Activities is to establish standards regarding the supervision of Master of Physician Assistant (MPAS) students participating in Clinical Activities.

Patient safety and wellbeing must be the primary concern in determining the degree of supervision required. Both supervisors and PA Trainees must adhere to appropriate ethical and professional boundaries. Supervising physicians should recognize and mitigate systemic barriers that may affect the learning experiences of students. Supervisors should actively model culturally safe and inclusive behaviours, and ensure all students have equitable access to meaningful clinical experiences and feedback.

PA students function as supervised clinical trainees and do not hold independent practice authority. Their clinical participation is determined by demonstrated competence and direct supervisory oversight.

PA students in their role as supervised clinical trainees, also known as PA Trainees, abide by the following principles:

• No independent authority to practice
• All clinical activity occurs under supervision
• Progressive entrustment in history-taking, exam, and clinical reasoning based on demonstrated competence.
• No independent prescribing authority
• Orders may be drafted after discussion but must be reviewed and authenticated prior to implementation 

See the MPAS Order and Prescription Writing Policy for further information regarding PA Trainee order writing and prescribing.

PA Trainee: A student in their second year of the MPAS program, who is completing clinical rotations - a core part of their educational program - as a supervised clinical trainee.

Designated Preceptor: The clinical supervisor who is ultimately responsible for the supervision of an MPAS student in a particular practice or service, usually a licensed physician or licensed/certified Physician Assistant. The designated preceptor oversees the student’s clinical learning experiences and assessments. If applicable, they oversee any student engagement with other MD faculty, PAs, residents, or other health care providers. Designated Preceptors may be:

1. Licensed/Certified Physician Assistant
2. Licensed Physician
3. Most responsible physician: the medical staff member deemed most responsible for a given patient’s (or group of patients’) care; also referred to as ‘attending physician’.
4. Consultant physician: a physician involved in the care of a patient on a consultation basis.
5. The on-call physician for a particular practice or specialty.

Supervisor: Any individual, including a supervising physician, a licensed/certified physician assistant, MD faculty, nurse practitioner, resident, or other non-physician health care provider who may be involved in teaching and supervising a physician assistant student during specific clinical learning experiences.

 

This policy applies to all second-year students enrolled in the Master of Physician Assistant Studies (MPAS) program at the University of Saskatchewan, irrespective of the geographically distributed site/campus to which they are currently assigned. This policy also pertains to all supervising physicians, practicing physician assistants, residents, and non-physician health care providers entrusted with MPAS Student supervision at all University of Saskatchewan campuses & learning sites, and Saskatchewan Health Authority (SHA) sites.

PA students (PA Trainees) function as supervised clinical trainees and do not hold independent practice authority. Their clinical participation is determined by demonstrated competence and direct supervisory oversight.

Direct in-person supervision is always required for PA students. As students progress through training and demonstrate increasing competence, the degree of supervisor intervention in their clinical activities may be reduced; however, supervision must always be adjusted to the clinical situation, and patient safety.

 

1.0 Expectations of the MPAS Program

The MPAS program must provide an environment in which MPAS learners are supported to gain experience and develop competency.

The MPAS Program will support clinical supervision of physician assistant students as an integral part of patient care and will ensure that appropriate preceptors are identified and trained. The MPAS Program

will work with clinical departments and clinical affiliates as needed to promote safe and effective clinical supervision and promptly address any identified instances when appropriate supervision was not provided.

The MPAS Program will support development and dissemination of policies regarding PA Trainee Clinical learning to Designated Preceptors and offer professional development to support safe and effective clinical learning experiences.

2.0 Expectations of the Designated Preceptor

Designated preceptors must be available at all times to MPAS Students under their supervision. Whether this availability requires on-site presence by the designated preceptor will be governed by the situation as well as applicable site and program specific policies and procedures.

The designated preceptor performs several roles when supervising a Physician Assistant Trainee on clinical rotation, including to:

• Promote and model professional conduct and culturally safe, inclusive behaviour at all times;
• Follow and support the Practice Standards of the College of Physicians & Surgeons of Saskatchewan;
• Identify issues relating to such matters as: conflict of interest, mistreatment, discrimination or harassment, and physician assistant student safety. The designated preceptor should be familiar with University, College, and Program-specific policies relating to these issues. When issues arise, the designated preceptor should provide support and direction.
• Support PA Trainees to perform procedures appropriate to their level of training under direct supervision (of the designated preceptor or supervisor), following appropriate instruction and demonstrated competence.
• Ensure that all individuals who may be supervising physician assistant students are oriented to the role of the Physician Assistant, supervision expectations and other teaching responsibilities; ensure that any clinical activities supervised by a non-physician health professional are within the scope of practice of the supervising health professional, and that this supervisor has explicitly accepted delegated responsibility from the designated preceptor for overseeing the physician assistant student’s participation in those specific activities. (Note: this is not intended to imply that the many opportunities for informal interactions between physician assistant students and other health professionals in the clinical setting necessarily comprise instances of clinical supervision by those professionals);
• Ensure appropriate supervision coverage (on-site or on-call) that supports student learning and patient safety;

2.1 Expectations of the Designated Preceptor: Student Orientation and Assessment

The designated preceptor is expected to provide the physician assistant student who they are supervising with appropriate orientation to their clinical experience as well as assessment of their performance, including:

• Ensuring the PA Trainee understands their role, responsibilities, and expectations about performance, learning objectives, and communication, in the orientation process at the beginning of each clinical rotation. The designated preceptor must ensure the student is informed of what to do and who to call across the spectrum of clinical assignments and rotations;

Conflict of Interest:

• If a conflict of interest with a supervisor is identified, avoid assessing that student and promptly inform relevant MPAS team members to adjust supervision as required;

Assessment:

A primary responsibility of designated preceptors includes providing the PA Trainee with ongoing, constructive feedback including informal and formal assessments. Designated preceptors should:

• Provide timely ongoing verbal and written feedback to physician assistant students including completion of relevant clinical assessments such as entrustable professional activity (EPA) feedback forms;
• Complete any required midpoint performance assessments and end-of-rotation performance assessments in a timely manner. When possible, initial feedback should be provided in person, followed by timely completion of the necessary written (narrative) feedback and other related documents.

Refer to the MPAS Assessment Policy and Course Syllabi for further detail.

Safety:

A primary responsibility of designated preceptors and all other supervisors includes ensuring physician assistant student and patient safety during clinical experiences and rotations:

• Be aware of the physician assistant student’s educational objectives and, in clinical rotations, the required clinical encounters for the period during which the student is working with them;
• Consider the PA Trainee’s level of training and ensure the student is competent in each task before delegating that task;
• Strive to create an atmosphere in which PA Trainees feel comfortable seeking assistance and disclosing lack of sufficient experience, skills, or knowledge to deal with a particular situation. Open and supportive communication along with prompt responses to requests for help are essential in encouraging students to express concerns or need for assistance;
• Contribute to a supportive learning environment through engaging all team members, including PA Trainees, in a respectful and inclusive manner;
• Promptly address and/or report concerns in the learning environment including any concerns of mistreatment, discrimination, or harassment;
• Provide equitable access to clinical learning opportunities, mentorship, and feedback;
• Respond in a timely fashion when paged by the student and be available to return to the site in an emergency; recognize when a student is unable to provide safe patient care because of the number and/or complexity of patients assigned as well as because of student stress and/or fatigue, and intervene immediately to support both the student and the care of the patients that have been assigned to the student;
• Adhere to the MPAS Clinical Work Hours and Call Policy;
• Confirm student clinical findings, review management plans, and adhere to the MPAS Order and Prescription Writing Policy.
• Make necessary modifications to the patient care plan managed by the physician assistant student;
• Ensure that patients are informed of the PA Trainee’s status as a physician assistant student.

3.0 Expectations of Physician Assistant Students

Physician Assistant students play a role in ensuring appropriate supervision during clinical experiences / rotations. The PA Trainee must ensure that their preceptor and/or supervisor is either onsite or available for direct consultation, as investigation or management plans cannot be commenced without preceptor and/or supervisor counter-sign, in accordance with the MPAS Order and Prescription Writing Policy.

PA Trainees must:

• Maintain a respectful relationship with their preceptor(s) and/or supervisors, and always display professional conduct with peers, non-physician health care providers, staff, coworkers, patients, and members of the public.
• Exercise caution and recognize limits of their knowledge and skills, and seek support to ensure safe provision of patient care;
• Inform their supervisor if they cannot care for the assigned patients because of the number and/or complexity of the patients assigned, or because of stress and/or fatigue to ensure patient safety;
• Review clinical findings, presumptive diagnoses, and proposed care plans with their Designated Preceptor or supervisor in a timely manner;
• Promptly inform their designated preceptor or supervisor when a patient’s condition deteriorates or when the diagnosis and/or management of the patient are in doubt;
  • In the event they are unable to reach the preceptor for timely guidance on urgent patient care needs, seek support from an alternative supervisor or practitioner until the designated preceptor can be contacted;
• Inform patients (or responsible family member) of their status as a physician assistant student and provide the name of the designated preceptor;
• Perform procedures appropriate to the level of training received and level of competence demonstrated, under direct supervision of the designed preceptor or supervisor, following appropriate instruction.
• Inform the MPAS program when they believe they have inadequate supervision, and/or the Designated Preceptor is not responding to their reasonable requests for assistance in the care of assigned patients. MPAS Students may report concerns to the Rotation Coordinator and/or the Director of Faculty and Clinical Placements.
• Complete an evaluation at the end of a clinical rotation or clinical learning experience, providing feedback in a constructive manner.

If a conflict of interest with a preceptor is identified, promptly inform relevant MPAS team members to allow adjustment of supervision as required.

4.0 Expectations of the Master of Physician Assistant Studies Program

1. Ensure appropriate communication occurs about the role of PA Trainees in provision of clinical care to patients and the expectations for physician assistant student supervision by Designated preceptors.
2. Ensure students are aware of policies around disclosure of their trainee status to patients.
3. Ensure there are appropriate mechanisms and clear expectations around appropriate communication of patient information for call and post-call coverage and sign over.
4. If a designated preceptor fails to provide adequate supervision to students, the MPAS Director of Faculty and Clinical Placements, in consultation with the MPAS Academic Program Director and the Rotation Coordinator may:
   1. Meet with the supervising physician to address any concerns and discuss potential solutions. A new designated preceptor may be provided to the PA Trainee if required.
   2. Provide faculty development training to support the designated preceptor to achieve their supervisory role duties.

 

The Academic Director of the MPAS program is responsible for providing oversight to the overall administration of the MPAS Student Supervision in Clinical Activities Policy.

The Director of Faculty and Clinical Placements of the MPAS program and the Manager of the MPAS program, with assistance from the MPAS Office, are responsible for the implementation, monitoring, maintenance, and evaluation of the MPAS Student Supervision in Clinical Activities policy. This includes the development and stewardship of the standard operating procedures associated with this policy.

Instances or concerns of non-compliance with the MPAS Student Supervision in Clinical Activities Policy should be brought to the attention of the Academic Director or the Director of Faculty and Clinical Placements of the MPAS program.

Program Manager, Master of Physician Assistant Studies (MPAS) Program