Preceptor Orientation Handbook

Tips, Tools, and Guidance for Physician Assistant Preceptors

Trine University
College of Health Professions
Master of Physician Assistant Program
Starr Newman PA-C, Director of Clinical Education
1819 Carew Street; Fort Wayne, IN 46805
260-702-8064
[email protected]
Acknowledgments
PAEA would like to give a special thank you to the 2021 Director of Clinical Education Workshop faculty
who revamped this handbook, building upon the previous work of the 2011 Clinical Education
Committee:
● Mitzi D’Aquila (University of Southern California)
● Laura Gerstner (Campbell University)
● Susan McDiarmid (Westfield State University)
● Elana Min (Northwestern University)
● Amanda Moloney-Johns (University of Utah)
● Bobbie Morici (DeSales University)
● Starr Newman (Trine University)
● Craig Myers (Case Western Reserve University)
● Lisa Tshuma (A.T. Still University)

Thank you to the 2011 Clinical Education Committee for their initial work on this document and for
sharing their program materials:
● Patrick Enking
● Jerry Glavaz
● Rosana Gonzales-Colaso
● Carol Gorney
● Amanda Moloney-Johns
● Thomas Parish
● Jack Percelay
● Jacqueline Sivahop
● Michel Statler
● Jeanette Smith (Editorial Support)

We would also like to thank Daytheon Sturges and the PAEA Diversity, Equity, and Inclusion Mission
Advancement Commission for reviewing the diversity and inclusion strategies added in this latest
version of the handbook.

PAEA Staff Contributors

● Karen Hills (Chief, Educational Development)
● Christine Vucinich (Instructional Specialist)
● Elizabeth Alesbury (Editorial Support)
Table of Contents

Introduction 1
General Goals of the Clinical Year 1
Core Competencies for New Physician Assistant Graduates 1
Definition of the Preceptor Role 2
Preceptor Responsibilities 2
The Preceptor−Student Relationship 3
Orientation and Communicating Student Expectations 3
Preparing Staff 4
Supervision of the PA Student 4
Informed Patient Consent Regarding Student Involvement in Patient Care 5
Documentation 5
Medicare Policy 5
Prescription Writing 6
Expected Progression of PA Student 6
Student Evaluation 6
Feedback to Students 7
Student Responsibilities 7
Standards of Professional Conduct 7
Specific Program Policies 8
Diversity and Inclusion Strategies 8
The Preceptor−Program Relationship 9
Liability Insurance 9
Preceptor Development Resources 10
Introduction
We would like to take this opportunity to express our sincere gratitude to you, our
preceptors, for your contributions and dedication to this program and our physician assistant
(PA) students. The clinical experiences that the student gains in your practice are vital to
student success in our program. The clinical setting synthesizes concepts and applications of
principles for quality health care delivery. You, as a clinical preceptor, are the key to
successful learning experiences in the clinical setting. Working closely with you, the PA
student learns from your expertise, advice, and example. The student progressively develops
and strengthens the skills and clinical judgment necessary to become a practicing PA through
your supervision. Thank you for your commitment to PA education.

General Goals of the Clinical Year

The clinical year takes students from the theoretical classroom setting to an active, hands-on
learning environment to prepare them for a lifetime of continued refinement of skills and
expanded knowledge as a practicing PA. To this end, the goals of the clinical year include:
● Apply didactic medical knowledge and skills to supervised clinical practice
● Advance clinical reasoning and problem-solving skills
● Expand and strengthen the medical fund of knowledge
● Perfect the art of history-taking and physical examination skills
● Refine oral presentation and written documentation skills
● Broaden understanding of the PA role in health systems and healthcare delivery
● Apply principles of diversity and inclusion to patient-centered care
● Develop interpersonal skills and professionalism necessary to function as part of a
medical team
● Experience a wide variety of patient demographics, types of patient encounters, and
clinical settings representative of the breadth and depth of PA scope of practice
● Prepare for the Physician Assistant National Certifying Exam

Core Competencies for New Physician Assistant Graduates

“Core Competencies for New Physician Assistant Graduates” identify the knowledge, skills, attitudes,
and behaviors that all PA students should be able to demonstrate by the end of their PA training
program. There are 47 specific competencies related to knowledge, abilities, or skills that are
measurable and observable. These competencies are tailored explicitly for PAs entering practice for
the first time and were developed using the “Competencies for the PA Profession” foundation.

The Core Competencies for New Physician Assistant Graduates are organized using the following eight
domains:
1. Patient-centered practice knowledge
2. Society and population health
3. Health literacy and communication
4. Interprofessional collaborative practice and leadership
5. Professional and legal aspects of health care
6. Health care finance and systems
7. Cultural humility
8. Self-assessment and ongoing professional development

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More details are available on the PAEA website:
https://paeaonline.org/our-work/current-issues/core-competencies

Definition of Preceptor Role

The preceptor is an integral part of the teaching program, serving as a role model for the student.
Through guidance and teaching, they help students improve skills in history-taking, physical
examination, effective communication, physical diagnosis, accurate and succinct documentation,
reporting, problem assessment, and plan development, including coordination of care. Additionally,
by providing feedback, preceptors are a vital resource as students develop and progress.

Preceptor Responsibilities
Preceptor responsibilities include, but are not limited to, the following:
● Orient, assess each student at the onset of the rotation with the practice/site policies
and procedures, including safety and emergency policies and procedures.
● Review the expectations and objectives for the rotation.
● Provide ongoing and timely feedback to the student regarding clinical performance,
clinical knowledge, skills, attitudes, behaviors, and critical thinking skills.
● Supervise, demonstrate, teach, and observe clinical activities to aid in the
development of clinical skills and professionalism and to ensure high-quality patient
care.
● Delegate increasing levels of responsibility based on a student’s experience and
expertise.
● Participate in the evaluation of clinical skills and medical knowledge base through the
following mechanisms:
o Direct supervision, observation, and teaching in the clinical setting
o Immediate evaluation of presentations (including both oral and written)
o Assignment of outside readings and research to promote further learning
● Demonstrate cultural humility in all interactions with patients, families, health care
teams, and systems.
● Dialogue with faculty during site visits to evaluate student progress and assist the
learning process.
● Review and add supplementary documentation to student notes to evaluate the
student’s clinical reasoning and documentation skills.
● Demonstrate an ethical approach to the care of patients by serving as a role model
for the student.
● Complete and return the student evaluation forms to assess performance and
improvement throughout the supervised clinical experience.
● Promptly notify the PA program of any circumstances that might interfere with
student safety or wellness or accomplishing the above goals or diminish the overall
experience.

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The Preceptor−Student Relationship
The preceptor should maintain a professional relationship with the PA student in the clinical
setting at all times and adhere to appropriate professional boundaries. Social activities and
personal relationships outside the professional learning environment should be appropriate
and carefully selected to avoid putting the student or preceptor in a compromising situation.
Contact through web-based social networking platforms (e.g., Facebook, Instagram) should be
avoided until the student fully matriculates through the educational program or completes the
rotation where the supervision is occurring. Please consult the Director of Clinical Education
regarding specific school or university policies.

Orientation and Communicating Student Expectations

Orientation of the student to the rotation site serves several purposes. Orientation facilitates
a quicker transition in allowing the student to become a member of the medical team. It also
establishes a feeling of enthusiasm and belonging to the team as well as helping students
develop the functional capability to work more efficiently.

On the first day of the rotation (or, when possible, before the rotation), the student should
take care of any administrative needs, including obtaining a name badge and computer
password and completing any necessary paperwork, EMR training, and additional site-specific
HIPAA training, if needed. The preceptor should provide an orientation to emergency/safety
procedures and preparedness, including, but not limited to the facility emergency plan,
emergency evacuation routes, location of emergency eyewashes and other emergency
equipment, and contact details for emergency services.

Early in the clinical rotation, it is recommended that the preceptor and student formulate
mutual goals regarding what they hope to achieve during the rotation. The preceptor should
also communicate his or her expectations of the student during the rotation.

Expectations can include:

● Hours
● Interactions with office and professional staff
● General attendance
● Call schedules
● Overnight and weekend schedules
● Participation during rounds and conferences
● Expectations for clinical care, patient interaction, and procedures
● Oral presentations
● Written documentation
● Assignments
● Anything else that the preceptor thinks is necessary

Students are expected to communicate with preceptors any special scheduling needs that
they might have during the rotation, particularly when they might be out of the clinical
setting for personal reasons or program-required educational activities. Please consult the
Director of Clinical Education regarding specific school or university attendance policies.

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Many sites find it helpful to create a written orientation manual to be given to the student
before the first day of the rotation. A manual helps the students quickly become more
efficient. Creating such a site-specific orientation/policy manual can be delegated to the
students that you host, with each “subsequent” student adding to a document that you, as
the preceptor, maintain and edit.

Preparing Staff
The staff of an office or clinic has a key role in ensuring that each student has a successful
rotation. Helping the student learn about office, clinic, or ward routines and the location of
critical resources helps them become functional and confident. Students, like their
preceptors, depend on staff for patient scheduling and assistance during a patient's visit.
Students should have conversations with staff about expectations and make sure they
understand office policies and procedures for making appointments, retrieving medical
records, bringing patients into examination rooms, ordering tests, retrieving test results, and
charting.

Preceptors should not assume that receptionists, schedulers, and nursing staff automatically
know the student’s role. The preceptor should inform the staff about how the student is
expected to interact with them and patients. Consider having a meeting or creating a memo
with/for staff in advance of the student’s arrival to discuss the:
● Student’s name
● Student’s daily schedule
● Student's expected role in patient care and what they are permitted to do with and
without the preceptor present in the room
● Anticipated impact of the student on office operation (i.e., Will fewer patients be
scheduled? Will the preceptor be busier? etc.)
● Process for how patients will be scheduled for the student

Supervision of the PA Student

During a student’s time at the clinic or hospital, the preceptor must be available for
supervision, consultation, and teaching or designate an alternate preceptor. Educational
continuity should be maintained when using multiple preceptors. Although the supervising
preceptor might not be with a student during every shift, it is essential to assign students to
a Physician (MD/DO), a Physician Assistant (PA), a Nurse Practitioner (NP) or a Certified
Nurse Midwife (CNM) who will serve as the student's preceptor for any given time interval.
Sharing preceptorship duties exposes students to important variations in practice style and
feedback, which can help learners develop the professional personality that best fits them. If
supervision is not available, students may be given an assignment or spend time with
ancillary staff (x-ray, lab, physical therapy, etc.), as these experiences can be valuable. The
preceptor should be always aware of the student’s assigned activities.

Students are not employees of the hospitals or clinics and, therefore, work entirely under the
preceptor’s supervision. Students are not to substitute for paid clinicians, clerical staff, or
other workers at the clinical sites. On each rotation, it is the student’s responsibility to ensure
that the supervising physician or preceptor sees all of the student’s patients. The preceptor

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can provide direct supervision of technical skills with gradually increased autonomy in
accordance with the PA student’s demonstrated level of expertise. However, every patient
must be seen, and every procedure evaluated before patient discharge. The preceptor must
document the involvement of the PA student in the care of the patient in all aspects of the
visit. The preceptor must also specifically document that the student was supervised during
the entirety of the patient visit. Laws for Medicare patients are slightly different in terms of
what a student is able to document, and this is explained further in the following
“Documentation” section. The PA student will not be allowed to see, treat, or discharge a
patient without evaluation by the preceptor.

Informed Patient Consent Regarding Student Involvement in Patient Care

The patients are essential partners in the education of PA students. All efforts will be made
to observe strict confidentiality, respect patient privacy and dignity, and honor their
preferences regarding treatment. All students must complete HIPAA training before their
clinical year. However, patients must be informed that a PA student will participate in their
care, and their consent must be obtained. Consent is given through standardized forms at
admission or on a person-by-person basis. The students should be clearly identified as PA
students and must also verbally identify themselves as such. If the patient requests a
physician, PA, or other licensed clinician and refuses the PA student’s services, the request
must be honored. Patients must know that they will see their regular provider, and they
should have an explicit opportunity to decline student involvement.

Documentation
If allowed by the preceptor and/or facility, PA students may enter information in the medical
record. Preceptors should clearly understand how different payers view student notes
related to documentation of services provided for reimbursement purposes. Any questions
regarding this issue should be directed to the Director of Clinical Education. Students are
reminded that the medical record is a legal document. All medical entries must be identified
as “student” and must include the PA student’s signature with the designation “PA-S.” The
preceptor cannot bill for the services of a student. Preceptors are required to document the
services they provide as well as review and edit all student documentation. Students' notes
are legal and are contributory to the medical record.

Additionally, writing a brief note that communicates effectively is a critical skill that PA
students should develop. The preceptor must document the involvement of the PA student in
the care of the patient in all aspects of the visit. The preceptor must also specifically
document that the student was supervised during the entirety of the patient visit.

The introduction of EMRs (electronic medical records) can present obstacles for students if
they lack a password or are not fully trained in using a specific institution’s EMR system. In
these cases, students are encouraged to handwrite a note and review it with their preceptors
for feedback whenever possible.

Medicare Policy
CMS no longer requires that clinicians serving as preceptors re-perform student-provided
documentation. As of January 1, 2020, preceptors can now verify (sign and date) student

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documentation. This makes the role of preceptor significantly easier as they are able to spend
more time teaching and less time documenting. Students also benefit from increased experience
with electronic health records, better preparing them for practice.

All physician, PA, and nurse practitioner preceptors are allowed to verify medical record
documentation provided by PA students. It is important to note that there are no restrictions on
the verification of student-provided documentation based on the profession (i.e., a preceptor
does not have to be a PA to verify the documentation of a PA student).
https://paeaonline.org/our-work/advocacy-for-pa-education/emerging-advocacy-issues

Prescription Writing
Students may write or input electronic prescribing information for the preceptor, but the preceptor
must sign/send all prescriptions. The student’s name is not to appear on the prescription. The
preceptor MUST log into the system under their password for clinical rotation sites that use electronic
prescriptions and personally sign and send them. Students should practice handwriting prescriptions
on clinical rotations where the opportunity to electronically input prescriptions is not available.

Expected Progression of PA student

PA students are trained to take detailed histories, perform physical examinations, give oral
presentations of findings, and develop differential diagnoses. As the year continues, they should be
able to develop an assessment and plan more effectively, though this will involve discussion with the
preceptor. If the preceptor deems it necessary, students initially may just observe patient encounters.
However, by the end of the first week, students should actively participate in evaluating patients. As
the preceptor feels more comfortable with the student’s skills and abilities, the student should
progressively increase supervised autonomy. If the preceptor thinks that a student is not performing
clinically at the expected level for where they are in their training, they are encouraged to address this
with the clinical program faculty early in the rotation.

Student Evaluation
The preceptor's evaluation of the student is especially important and typically serves as the
primary mechanism for feedback to the program regarding a student’s ability to meet the
learning outcomes for the rotation. Preceptors are encouraged to discuss the evaluation
with the students, focusing on strengths and opportunities for growth, and documentation
including specific comments regarding performance is strongly encouraged. Preceptors are
also encouraged to familiarize themselves with the program’s syllabus and evaluation tools
and reach out to the program with any questions. Considerations such as the timing of the
rotation (first versus last rotation) and improvement and receipt of feedback throughout the
rotation should be noted when completing evaluations.

Preceptors should consider performing brief end-of-rotation evaluations privately with

colleagues and staff to gain additional insight into the student's professionalism and
effectiveness, as health care team members’ comments are helpful contributions to student
evaluations. Additionally, staff feedback may enhance the student experience from one
rotation to another and can help to improve efficiency and flow while also maximizing
educational opportunities.

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Please contact the Director of Clinical Education for specific evaluation forms and policies
relating to the student handbook.

Feedback to Students
While students may have only one formal evaluation during the clinical rotation, they should
regularly receive positive and constructive feedback from their preceptors to help improve
their clinical performance.

Daily or weekly check-ins are recommended and can provide avenues to address any student
questions as well as encourage dialogue between student and preceptor.

Student Responsibilities
In addition to adhering to the standards of professional conduct outlined later in the handbook,
students are expected to perform the following during their clinical rotations:
• Obtain detailed histories, conduct physical exams, develop a differential diagnosis, formulate
an assessment and plan through discussion with the preceptor, give oral presentations, and
document findings.
• Assist or perform and interpret common lab results, diagnostics tests, or procedures.
• Complete any assignments, tasks, and presentations as assigned by their preceptor.
• Educate and counsel patients across the lifespan regarding health-related issues.
• Attend and engage in clinical rotations as scheduled in addition to grand rounds, lectures, and
conferences, if available to them.
• Demonstrate emotional resilience and stability, adaptability, and flexibility during the clinical
year.

Standards of Professional Conduct

As health care practitioners, PA students are required to conform to the highest standards of
ethical and professional conduct required of certified PAs in addition to their program-
defined standards. These may include, but are not limited to:
● Respecting flexibility
● Demonstrating academic integrity
● Being honest and trustworthy
● Demonstrating accountability
● Promoting cultural humility

The professional conduct of PA students is evaluated on an ongoing basis throughout the

professional phase (i.e., the didactic and clinical years) of the program. Violations of
standards of conduct are subject to disciplinary actions administered by the university and
the physician assistant program.

If preceptors are concerned about a student's professionalism, please contact the Director of Clinical
Education immediately.

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Specific Program Policies
Please see the MPAS Program Student Handbook for information on the following:
● Workers’ Compensation
● Substance use, including drugs and alcohol
● Professionalism
● HIPAA training
● Sharps-related injuries, including needlesticks
● Blood-borne pathogens training
● Immunization requirements
● Background checks
● Urine drug testing
● Sexual harassment and assault resources

The following link to the U.S. Department of Education's Office of Civil Rights (OCR) provides
information about federal laws that protect students against racial, sexual, or age
discrimination: http://www2.ed.gov/about/offices/list/ocr/know.html.

Diversity and Inclusion Strategies

PA education is committed to growing diversity and inclusion among its faculty, students, and
preceptors. A 2020 report from the NCCPA indicates that 80.8% of practicing PAs identify as white.i
Additionally, a Diversity Standard (A1.11) was added to the ARC-PA 5th Edition Standards. PA
programs continue to develop recruitment and retention efforts to support underserved populations.
Furthermore, it is important that students are provided with opportunities to demonstrate their
ability to understand and care for diverse patient populations. Clinical preceptors can contribute to
these efforts using some of the following strategies:

1. Recognize that students come from a variety of backgrounds with differences that contribute
to variations in habits, practices, beliefs, and/or values. ii
2. Encourage the PA student and preceptor to discuss personal biases and/or fears at the
beginning of the rotation and ongoing as needed.
3. At the beginning of the rotation, the preceptor should discuss any considerations unique to
the student's practice setting and patient population. Additionally, the preceptor may provide
the student with suggested resources for further research on the unique practice settings and
patient population.
4. Intentionally seek opportunities for students to care for patients with diverse backgrounds,
habits, practices, beliefs, and/or values.
5. Engage the student in dialogue about their encounters with diverse patients and team
members and provide formative feedback regarding their interactions and perceptions.
6. Encourage the student and preceptor to challenge their own beliefs and understand their
impact on their care of patients and development as a compassionate, inclusive learner.
7. Provide opportunities for the student to interact with community outreach activities as

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 available at the clinical site and in the local community.
8. Become a mentor for prospective PA students who are from underrepresented minority
groups.
9. Encourage students and preceptors to engage in conversations about health equity and social
determinants of health.

PAEA has available in the Digital Learning Hub a Diversity, Equity, and Inclusion Toolkit
(https://paea.edcast.com/pathways/diversity-equity-and-inclusion-toolkit) and best
practices guidelines. Ask your Director of Clinical Education to download and share this
resource if you do not have access.

The Preceptor−Program Relationship

The success of clinical training of PA students depends on maintaining good communication
among the student, the PA program clinical faculty and staff, and preceptors. All members of
the team should share their preferred contact information.

If a preceptor has a question or concern about a student, they should contact the Director of
Clinical Education or designee. Programs strive to maintain open faculty–colleague
relationships with their preceptors and believe that if problems arise during a rotation, by
notifying appropriate program personnel early, problems can be solved without unduly
burdening the preceptor. In addition, open communication and early troubleshooting may
help avoid a diminution in the educational experience.

Liability Insurance
Each PA student is fully covered for liability insurance by the PA program/university for any
clinical site with a fully executed and valid affiliation agreement. Students completing a formal
elective rotation with a preceptor or clinical site that might become an employer must
maintain a “student” role in the clinic and should not assume an employee’s responsibilities
until after completing the PA program and successful certification and licensure. This includes
appropriate routine supervision with the preceptor of record and within the scope of the
agreed-upon clinical experience. This relationship is vital in preserving the professional liability
coverage provided by the PA program/university and is critical to protect both the student
and the employer if a patient seeks legal action. Even more concerning is the occasional
opportunity or suggestion from a potential employer that a student participate in patient care
activities outside of the formal rotation assignment before PA program completion. While
these opportunities may be appealing and are seemingly benign, they must be avoided at all
costs, as the university’s liability coverage does not cover the student in these circumstances.

In addition, if a PA student is working in a paid position in a different healthcare-related

capacity at any time during their PA education, that individual is not permitted to assume the
role of a PA student while on duty as a paid employee. Even in a shadowing capacity, it is not
appropriate for a student to represent themselves or participate in the care of any patient
outside of the role for which they are being paid. Liability insurance will not cover any
student assuming the “PA student” role outside of an assigned clinical rotation.

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Preceptor Development Resources
PAEA’s Committee on Clinical Education created a set of one-pagers for preceptors to help
streamline and enhance this essential experience:
● Incorporating Students into Patient Care/Workflow
● The One-Minute Preceptor
● Ask-Tell-Ask Feedback Model
● SNAPPS: A Six-Step Learner-Centered Approach to Clinical Education
● Introducing/Orienting a PA Student to Your Practice
● Tailoring Clinical Teaching to an Individual Student

The one-pagers are available on the PAEA website: https://paeaonline.org/how-we-can-

help/faculty#clinical. They combine some of the committee's own resources with the best
precepting practices outlined in the literature.

Additional resources for preceptors can be found in the Preceptor Channel within the PAEA
Digital Learning Hub: https://paea.edcast.com/channel/preceptor-development Ask your
Director of Clinical Education to download and share these resources if you do not have
access.

i
National Commission on Certification of Physician Assistants, Inc. (2021). 2020 Statistical Profile of Certified Physician
Assistants: Annual Report. https://www.nccpa.net/wp-content/uploads/2021/07/Statistical-Profile-of-Certified-PAs-
2020.pdf.
ii
Accreditation Review Commission on Education for the Physician Assistant, Inc. (2019). Accreditation Standards for
Physician Assistant Education. 5th edition. http://www.arc-pa.org/wp-content/uploads/2021/03/Standards-5th-Ed-
March-2021.pdf.

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