Developing and Maintaining Clinical Sites

Developing and Maintaining Clinical Sites

Developing and securing a clinical rotation site is one of the greatest challenge new PA program directors must overcome. PA program directors can only ensure the success of their PA program by maintaining and securing enough clinical rotation sites to accommodate the number of students they are provisionally accredited for. Let’s look specifically to the 5thEdition ARC-PA Standard regarding these requirements:


B3.01 The program must secure clinical sites and preceptors in sufficient numbers to allow all students to meet the program’s learning outcomes for supervised clinical practice experience.


New PA program directors often ask how many clinical sites/slots they will need to obtain to achieve provisional accreditation. And with the growing number of PA programs, finding sites can become increasingly difficult—as well as maintaining them. Let’s consider how to successfully develop and maintain the required number of clinical sites.



Step 1: Determine how many clinical sites are required

The first step in developing and maintaining clinical sites is figuring out how many clinical sites will be required for your PA program. In fact, the number of clinical sites your PA program needs depends on the number of students your program intends to enroll each year. Each program is required to establish clinical rotations in each of the following areas:

  • Internal Medicine

  • Family Medicine

  • Pediatrics

  • Surgery

  • Emergency Medicine

  • Psychiatry

  • Women’s Health


In addition, most PA programs choose to incorporate one or two electives into their PA curriculum.


As your PA program works to determine the correct number of clinical sites needed, remember clinical preceptors are likely to go on vacation, attend at least one conference per year, and/or are unable to precept at some point during the year. With this in mind, your PA program must incorporate a “cushion” when developing clinical rotation slots.


Example: A PA program is petitioning the commission to matriculate 20 students per year with 8 clinical rotations. A safe cushion would include 2-5 extra slots per rotation. In this case, the formula is 20 students x 8 rotations + (2 slots x 8 clinical rotations)=176 slots.



Step 2: Gather relevant information

After determining the number of clinical sites your PA program needs and before starting development, Massey & Martin, LLC recommends gathering important, relevant information that inform your next steps.


Consider the following questions:

  • Will your university compensate preceptors for their time?

  • Are other PA programs providing payment for clinical sites?

  • If so, how much are they paying?

  • If not, are you able to find out?


We recommend finding out early on whether or not your institution will provide compensation because this will determine your course of action. If your university does plan to provide compensation, use this as a selling point to obtain clinical sites. However, if the university will not be providing compensation, you will need to determine how to proceed.


  • Other questions to consider:

  • How many PA programs are within your state?

  • How close are each of these programs to your institution?

  • Does a gentleman’s agreement exist concerning the utilization of clinical sites in a state that has other existing PA programs?

  • Does a PA coalition exist within your state?


In fact, Massey & Martin, LLC encourages you to consider establishing a collaborative, state-wide PA coalition. This will prove beneficial in your pursuit of securing clinical sites, as well as provide an opportunity to develop relationships with other PA directors who find themselves facing similar challenges. (North and South Carolina, for example, have established these types of groups.)


Final questions to consider:

  • Are preceptors given a clinical faculty position as an incentive?

  • Will preceptors have access to the university’s medical library?

  • Is there a tax incentive for clinical preceptors?

  • Do you know other PA program directors within your state?

  • Are other PA programs sharing any clinical sites?


Step 3: Determine which demographic areas will be targeted

After gathering enough information to figure out your next steps, it’s time to determine which demographic areas to target. PA programs that have used the little blue book have found it to play a vital role in the development of their clinical rotation sites. This book provides physician names, addresses, specialties, and phone numbers. Massey & Martin, LLC recommends using this information to send out mass letters to physicians, inviting them to participate in becoming a preceptor. After, develop a spreadsheet to maintain a visual of your goals and monitor your progress.




Step 4: Utilize your resources

Next, consider various tools you can use to develop and maintain your clinical sites. We’ve included a few suggestions, and we encourage you to consider what unique resources you may have.


Gather email addresses

Search your state board of medicine’s website to find if any physicians’ email addresses are available. You can expedite the entire process of maintaining clinical sites by obtaining enough email addresses. Send an email with the cover letter and all the required documents; interested physicians will easily return the documents within the same day.


Use social media to expand your reach

Another great resource for developing clinical sites is social media; its unlimited connections provide you an opportunity to get in front of a lot of people easily. For instance, LinkedIn is a great tool to help you locate physician assistants in your area. Writing them a simple message, posting across various social media platforms, or writing a blog can guide you to identify medical providers who may be willing to become a preceptor.


Find your local Physician Assistant association

Each state has their own local Physician Assistant association. Massey & Martin, LLC recommends finding out about your state’s organization, then reaching out to the president of the group. Ask them if you can speak at the next meeting about your developing PA program. If your PA program is already established, consider reaching out to alumni; previous students often show appreciation by becoming a preceptor to help PA programs.


Establish an advisory board

Another valuable resources that may result in an increase of clinical sites is an advisory board. Consider establishing your own advisory board, arranging to meet twice a year. Call local hospitals where you intend to send students.


Remember, obtaining hospital clinical affiliation agreements may take up to six months. Start making phone calls early to identify who is responsible for processing the clinical affiliation agreements; don’t be discouraged if this means making several calls. The department may be medical staffing, medical educators, or clinical educators. The name will vary for each hospital.



Step 5: Schedule follow up appointments

We don’t recommend making cold calls in this process; they are seldom successful, wasting time and energy. Instead, schedule follow-up appointments with clinics that have shown interest, asked questions, or need a nudge to complete the paperwork.


When visiting these sites, bring a business card, candy, or some kind of preceptor gift. Put together a program folder with all the required documents, clinical preceptor manual, and clinical year syllabus. Follow up within one week after you visit, asking if there are any additional questions and when you can expect the paperwork to be returned.


Step 6: Keep information organized

Meanwhile, assign your administrative assistant to prepare hanging files for clinical documents, dividing them into different sections:

  • Internal Medicine

  • Family Medicine

  • Pediatrics

  • Surgery

  • Emergency Medicine

  • Psychiatry

  • Women’s Health

  • Electives

  • Hospitals/Clinics


Each preceptor can then be filed into its appropriate section. Required documentation includes:

  • Preceptor Clinical Affiliation agreement

  • Letter of Intent

  • Preceptor CV

  • Preceptor Fact Sheet

  • Initial site visit form

  • Request for Availability form

  • Board of Medicine license verification

  • Number of students per year designated

  • Email

  • Phone

  • Office manager

  • Address of practice


Finally, assign your administrative assistant to transfer clinical site/slot data from your Excel spreadsheet to the ARC-PA Appendix 12. This high level of organization is vital to your clinical site development success.



Conclusion

If your PA Program doesn’t obtain enough clinical sites to accommodate the number of students you are petitioning the commission for provisional accreditation, you will not be able to move forward. Establishing clinical sites is an important piece of the entire development of your PA Program. Thus, it’s important to start planning and working early; when your university decides to start a Physician Assistant program, immediately begin looking where you will target clinical sites geographically.


Keep in mind, the 5thEdition ARC-PA Standard A1.10 clearly states administration must support the program in securing clinical sites and preceptors sufficient in number to allow all the students to meet the PA program’s learning outcomes for supervised clinical practice experiences. All required rotations must be located within the United States. The PA program director needs to meet with administration regularly to ensure the PA program receives adequate support while securing clinical sites. Minutes must be documented to provide evidence of compliance.


Finally, clinical site development needs to be a top priority. All faculty and staff should be involved to some degree. Each week, specific specialties and demographic areas need to be the focus. Begin by sending out a minimum of 100 enticing letters/email to prospective preceptors weekly. Get creative, be informative, and stay concise. If compensation will be provided, state it in the cover letter. Start with a letter of interest, ask if you can come to speak with the doctor, and, most importantly, get organized.

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