Clerkship Year: What to Expect in 2nd year PA School
As a current PA student, you're likely already aware of the importance of clerkship in your education and future practice as a Physician Assistant. But for those who are still new to the concept, clerkship can be a bit confusing.
Here you'll gain a deep understanding of what clerkship is, why it's important for PA students, and what to expect during your clinical rotations.
From the purpose of clerkship to the benefits of completing clinical rotations, you'll learn everything you need to know to make the most of this exciting opportunity!
What is Clerkship in PA School?
Clinical clerkship, also known as clinical rotations, is a critical component of PA school education.
During clerkship, PA students spend time working in various clinical settings and specialties for several weeks at a time, under the supervision of licensed healthcare providers (usually a PA preceptor or MD preceptor).
Clinical clerkship is different from traditional PA school education, which typically consists of classroom-based learning and simulations.
During clerkship, PA students are expected to actively participate in patient care, from taking patient histories to performing physical exams and developing treatment plans. This hands-on experience is essential for building confidence and competence in patient care, which are critical for success as a PA.
Clerkship provides PA students with the opportunity to apply what they've learned in the classroom to real-world patient care situations.
Benefits of Clinical Rotations:
The purpose of clerkship in PA school is to provide students with the opportunity to apply the knowledge and skills they've learned in the classroom to real-world patient care situations.
Hands-on patient care experience: During clerkship, PA students have the opportunity to gain hands-on experience with patient care in a variety of clinical settings. This hands-on experience is critical for building confidence and competence in patient care, which are essential for success as a PA.
Exposure to different specialties and patient populations: Clinical clerkship provides PA students with exposure to different specialties and patient populations, which is crucial for preparing them for their future careers as healthcare providers. This exposure helps PA students to develop a well-rounded understanding of the healthcare system and the different needs of patients.
Learning about how PAs function within the health care team: clerkship allows PA students to work with licensed healthcare providers, which can help them to gain a better understanding of the day-to-day responsibilities of a PA and how they interact with other allied health.
Networking opportunities: Clerkship provides PA students with the opportunity to network with licensed healthcare providers, including physicians, PAs, and nurses. These connections can be valuable throughout their careers as PAs. Preceptors can become future references during the job hunt.
Improved clinical reasoning skills: Clinical clerkship provides PA students with the opportunity to apply their knowledge and skills to real-world patient care situations, which can help to improve their clinical reasoning skills. This improved understanding of patient care can help PA students to make better decisions in their future careers as healthcare providers.
Core and Elective Rotations
Clinical clerks in PA school complete core elective rotations in a variety of specialties and clinical settings.
The specific specialties and clinical settings may vary from program to program.
Core Rotations can typically include:
Family Medicine: In family medicine rotations, PA students have the opportunity to work with patients of all ages and with a wide range of medical conditions. This provides PA students with a well-rounded understanding of primary care and the healthcare system.
Pediatrics: Pediatrics rotations provide PA students with the opportunity to work with children and their families.
Internal Medicine: PA students have the opportunity to work with patients who have complex medical conditions and chronic diseases. This rotation provides PA students with exposure to the diagnosis and management of a wide range of medical conditions, including cardiovascular disease, endocrine disorders, gastroenterological conditions, respiratory disorders, and more.
Psychiatry: PA students have the opportunity to work with patients who have mental health conditions and disorders. This rotation provides PA students with exposure to the diagnosis and management of a wide range of mental health conditions, including depression, anxiety, bipolar disorder, and schizophrenia.
Surgery: Surgery rotations provide PA students with the opportunity to work work with patients undergoing surgical procedures. They work alongside surgical providers, participating in pre-op, intra-operative, and post-operative care.
Emergency Medicine: Emergency medicine rotations provide PA students with the opportunity to work in fast-paced emergency departments and see a wide range of medical conditions.
Women's Health: Women's health rotations provide PA students with the opportunity to work with patients in the obstetrics and gynecology setting.
Examples of Elective Rotations:
Cardiology
Dermatology
Gastroenterology
High Risk Obstetrics/Maternal Fetal Medicine
Neurology
Neurosurgery
Orthopaedic Surgery
Respirology
Travel Medicine (Pre-pandemic, some PA students did international electives in the Himalayas or other countries).
Urology
Vascular Surgery
Typical Schedule for a PA Clerk during Clinical Rotations
PA Clerkship schedule is a lot like having a full time job. Your schedule as a second year PA student will often mimic what a practicing PA would be working.
For example in a Family Medicine/ambulatory setting, hours could be Monday to Friday, 9 am to 5 pm.
If working in Emergency Medicine, you may have rotating 8 hour shifts of either 8 am to 4 pm, 4 pm to midnight, or midnight to 8 am, 4 days ago.
In General Surgery, you may have a schedule of 6 am to 2 pm, with 1 call shift each week that requires you to be on-call overnight.
Expectations and Responsibilities of PA Clerks
As a PA student, you can expect to be exposed to a wide range of medical conditions and patient populations during your clerkship rotations. You will work alongside physicians, PAs and other healthcare professionals to provide high-quality patient care, and you will be responsible for using your knowledge and skills to make a positive impact on the lives of your patients.
Some of the specific responsibilities you may have during your clerkship include:
taking medical histories
performing physical exams
developing and implementing treatment plans,
presenting patients to attending physicians/PA preceptors
assisting with procedures or during surgery
You may also be responsible for:
Documenting patient care in electronic medical records
Communicating with other members of the healthcare team
Educating patients and their families about their health conditions and treatment options.
In order to be successful during clerkship, it's important to be organized, efficient, and professional. You should be prepared to work long hours, as well as to be flexible and adaptable as patient needs and demands change. You should also be able to effectively communicate with patients and other healthcare professionals, and to collaborate with others to provide the best possible care.
Finally, it's important to remember that clerkship is an opportunity for you to grow and develop as a clinician. You should be willing to ask questions, seek feedback, and learn from your experiences. With the right attitude and approach, clerkship can be a rewarding and fulfilling part of your PA education.
Dressing for Clerkship Rotations
Dressing appropriately for clerkship rotations is an important aspect of preparing for and participating in clinical experiences.
As a PA student, you are expected to dress professionally and follow the dress code guidelines set by the clinical site.
Here are a few tips to keep in mind when dressing for clerkship rotations:
Wear scrubs: Most clinical rotations require students to wear scrubs. This is for practical reasons, such as the need for easy movement and quick access to patient information. It is also a way of maintaining a professional image and showing respect for patients and healthcare providers.
Dress appropriately for the setting: For rotations in specialty areas such as surgery, students may need to wear additional protective gear, such as a gown, cap, mask, and gloves.
Comfortable footwear: Make sure to wear comfortable and supportive footwear, as you may be on your feet for long periods of time during rotations.
It's always a good idea to check with the clinical site before your rotation to see if they have any specific dress code requirements.
Equipment and Tools for Clerkship
As a PA student in clerkship, there are a few essential tools and equipment that you'll need to bring with you to each rotation.
Here's a list of items you should consider having on hand:
ID badge: You'll need to wear a photo ID badge during clerkship rotations for identification and security purposes. You’ll often get this before the rotation starts or on your first day. Make sure to wear this everyday.
Stethoscope: A good quality stethoscope is an essential tool for taking vitals, listening to heart and lung sounds, and more.
Notebook: You'll want to take notes during your rotations, so bring a notebook and extra pens.
Medical reference books: Medical reference books such as a drug guide and a medical dictionary can be helpful during clerkship.
Penlight: You'll need a penlight to perform eye exams, check pupils, and more. (Family Medicine, Neuro, Emerg)
Reflex Hammer (Neurology, Physiatry, other MSK specialties)
End-of-Rotation Exams
End of Rotation (EOR) exams are designed to assess a student's knowledge and skills gained during a specific clerkship rotation.
Not all PA programs have it (for example UofT PA students have EOR exams, McMaster PA students do not).
Logging your Clinical Encounters
PA programs here in Canada require you to log all of your clinical encounters and specify what you did, using an app like e*Value. It can be overwhelming to delay putting this off, we recommend entering the your clinical encounters at the end of each day.
Tips to make the most of your Clerkship Experience
You’re only a PA student once, and the opportunity to do clinical rotations in all of these different areas of medicine won’t come again.
So what can you do to make the most of your time during clerkship, and build a strong foundation for your future career as a PA?
Set clear goals and objectives for your clerkship rotation: Before you start your clerkship rotation, take some time to think about what you hope to get out of the experience. What areas do you want to focus on? What skills do you want to develop? What do you hope to gain out of this experience? Having clear goals in mind will help you stay focused and make the most of your time in clerkship.
Be Prepared: Make sure you understand the expectations and requirements of each clerkship rotation, and come prepared with the necessary materials and equipment. This includes having a well-organized reference manual, a stethoscope, and any other tools you may need.
Do Background Reading before starting: Do some background reading to ensure that you are well-prepared for the experience. You can read course material from first year. Research the specialty including common conditions, treatments, and procedures. Familizer yourself with clinical practice guidelines or common practices.
Read around cases everyday: viewing and researching medical cases that are related to the patients you are seeing during your clerkship rotation. This can involve reviewing the medical literature, guidelines, and protocols related to the patients' conditions, as well as talking to the attending physicians, PA preceptors and other members of the healthcare team about the cases. This will help deepen your understanding, and reinforce what you have already learned.
Build Relationships: Building relationships with your attending physicians and other members of the healthcare team can be incredibly valuable. Take time to learn about the role each provider plays in the health care team, as you will likely be working with these clincians int he future. Not only will these relationships help you learn and grow as a clinician, but they may also lead to professional opportunities in the future.
Keep a Learning Log: Keeping a log or journal of your clerkship experiences can help you reflect on what you have learned, identify areas for growth, and track your progress. This log can then later be used to formulate a cover letter and focused resume when you apply to jobs as a new PA grad!
Get Involved in Patient Care: Participate in patient care as much as possible, and take advantage of opportunities to lead patient evaluations and treatments. This will help you build your clinical skills and develop your clinical reasoning.
Attend Grand Rounds or Teaching Rounds: Grand rounds are a great way to learn about a wide range of medical conditions and treatments. Attend as many as you can, and take advantage of the opportunity to ask questions and learn from experienced healthcare professionals.
Advocate for your owln learning: Advocating for your learning in clerkship means taking an active role in your own education and ensuring that you are getting the most out of your clerkship experience. Make sure that your supervising physician knows what your goals and objectives are, and ask for opportunities to work on specific cases or procedures that will help you achieve those goals. This may mean asking for learning opportunities (e.g. can I go ahead and take the history of the patient? Can I do this procedure with your supervision after I watch you do it?).
Ask questions and seek feedback: Don't be afraid to ask questions and seek feedback from your supervising physician and other members of the healthcare team. This will help you better understand the cases you are working on and learn from your experiences.
It’s okay to ask questions during Clerkship!
Asking questions during clerkship is an important part of the learning process and helps you gain a deeper understanding of the patients, the healthcare team, and the specialty you are rotating in.
The clerkship experience is an opportunity to learn, so don't be afraid to ask questions and seek clarification.
Here are some tips to help you ask effective questions during clerkship:
Be Prepared: Before asking questions, make sure you have done your background reading and have a solid understanding of the patient's condition, the treatments and interventions being used, and the healthcare team's roles and responsibilities.
Be Respectful: When asking questions, be respectful of the time and expertise of the healthcare team. Try to avoid interrupting them and be mindful of their workload and responsibilities.
Be Specific: Be specific when asking questions. Ask about specific aspects of the patient's condition, treatments, or interventions. This will help ensure that you receive a clear and concise answer.
Listen and Clarify: Listen carefully to the answers you receive and ask follow-up questions if necessary. If you don't understand something, ask for clarification.
Ask Open-Ended Questions: Ask open-ended questions that encourage discussion and allow the healthcare team to share their expertise. This will give you a deeper understanding of the patient's condition and the treatments and interventions being used.
What is “pimping” and should I be concerned?
"Pimping" is a term used in medical education to refer to a teaching technique where an educator tests a student's knowledge by asking a series of questions on a particular subject. This term is often used in clerkship, where students are expected to have a solid understanding of the patient cases they are working on.
During pimping, the educator will ask the student a series of questions related to a patient's case, including questions about the relevant anatomy and pathophysiology: patient's history, diagnosis, treatments, and prognosis.
Examples of Pimping Questions I received during my Surgery Rotation:
What are the 9 layers of the abdominal wall?
What are the potential complications of ERCP?
What are the risks and benefits of this procedure and how would you discuss them with the patient?
Work-Life Balance in Clerkship Year
Maintaining work-life balance during clerkship can be a challenge, but it is important for both your well-being and your success as a PA student. Here are a few tips that can help:
Plan ahead: Make a schedule that balances your clerkship responsibilities with your personal life, and stick to it as much as possible. This will help you stay organized and avoid feeling overwhelmed.
Make the most of your downtime: Clerkship can be demanding and intense, but it's important to make the most of your downtime as well. Use your free time to review what you've learned, read around your cases, or work on other projects that will help you grow as a clinician.
Stay organized: Keeping track of your notes, patient information, and schedules can be a challenge during clerkship. Consider using a notebook or digital tools to keep track of what you've learned and stay organized.
Make the most of your downtime: Clerkship can be demanding and intense, but it's important to make the most of your downtime as well. Use your free time to review what you've learned, read around your cases, or work on other projects that will help you grow as a clinician.
Get enough sleep: During clerkship, it can be tempting to stay up late and work, but getting enough sleep is crucial for both your physical and mental health. Make sure to get at least 7-8 hours of sleep each night.
Stay organized: Keeping track of your notes, patient information, and schedules can be a challenge during clerkship. Consider using a notebook or digital tools to keep track of what you've learned and stay organized.
Traveling & Accomodations for Clerkship
Depending on the PA program you attend, your clinical rotations may be centralized in a specific area (e.g. McMaster PA Students doing rotations in Hamilton and GTA area) or cover a broader geographic area (e.g. Manitoba MPAS and UofT’s PA program with the North-South Swap).
Most PA programs recommend having and driving a car for convenience in 2nd year PA school for clinical rotations.
Arrange for your own transportation and housing: If the site is far from home, you may need to arrange for transportation and housing during your clerkship rotation.
Plan ahead: If you know where your rotations will be ahead of time, make arrangements for travel and accommodations as early as possible. This will help ensure that you have a comfortable and convenient place to stay during your clerkship rotation.
Connect with other PA students: Your classmates may have already done the research on housing options close to a hospital or clinic for the city you are doing your clerkship rotation.
Final Notes
Clerkship is an exciting and challenging time in PA school, providing you with the opportunity to grow as a clinician and develop the skills and knowledge you need to succeed in your future career!
