By: Michele Zawora, MD, FAAFP | Program Director | Thomas Jefferson University Physician Assistant Program-Center City

We all know that every student will have a slightly different experience in each of their supervised clinical practice experiences (SCPEs), dependent upon specific caseload, seasonal variations, and location. At Thomas Jefferson University Physician Assistant Program – Center City, we’ve been using Aquifer cases to augment learning, build key communication skills, and supplement clinical experiences to meet ARC-PA standards.  

Matching Cases to SCPEs

Aquifer’s library offers a wide range of deep, detailed cases allowing you to select specific cases that you deem appropriate to meet your needs for student learning objectives. Aquifer’s Case Library (now known as the Content Library) feature allows you to search for specific diagnoses, clinical focus (i.e. diagnosis, management, etc), patient age, system, and more. After you’ve selected the cases that you find most useful for your topic or case setting, it’s easy to build a custom course to assign and track your students.

Our program uses Aquifer for four core SCPEs: Primary Care (Family Medicine), Pediatrics, Internal Medicine, and Behavioral Medicine. We also use WISE-MD for Surgery. While Aquifer does not have a specific course for psychiatry, there are many applicable cases within pediatrics, internal medicine, and family medicine that we use for our behavioral health course. At the end of the clinical year, students will have completed a minimum of 50 pre-selected virtual patient cases. 

Each year, we select ten cases that fit into each of these five SCPEs and assign them to the students as they enter the rotation. Last year, we changed the process of how we selected the cases, focusing on creating courses to include not only “must see” cases but also to help address certain ARC-PA standards and help to demonstrate competencies in evaluating and managing patients across the lifespan and in different types of clinical medicine: acute, emergent, preventive and chronic. Aquifer has a wide variety of both diagnoses and care settings, so it is easy to manage both of these requirements. 

ARC-PA Standards
B3.03 Supervised clinical practice experiences must enable all students to meet the program’s learning outcomes: 

a) for preventive, emergent, acute, and chronic patient encounters,
b)across the life span, to include infants, children, adolescents, adults, and the elderly,
c) for women’s health (to include prenatal and gynecologic care),
d) for conditions requiring surgical management, including pre-operative, intra-operative, postoperative care, and
e) for behavioral and mental health conditions.

Below, I’ve shared the Aquifer cases that we selected for our five SCPE custom courses and highlighted the ARC-PA standards we use Aquifer to support:

Building Clinical Communication Skills

Initially, we used Aquifer cases for self-directed learning, assigning cases for each specific rotation and setting a requirement for the minimum amount of time that students needed to spend on each case, which we verified using Aquifer’s reports. Now we’ve adapted our use of the cases to help address a common skill gap. We ask students to write a SOAP note for each case, which they submit for formative feedback and grading. This added exercise has helped to fill an important hole, as our faculty have noticed that as more clinical sites implement electronic health records, fewer students are writing formal notes in the clinical space–and those who do write notes are not always getting feedback from the preceptor about the quality and content of their notes. As entry-level PAs, our graduates will be expected to very quickly adapt to their new jobs and will need to write many notes for clinical care, continuity, and transitions of care that meet standards for compliance and reimbursement.

Feedback & Findings

Overall, we’ve found that Aquifer is a great tool to supplement our student learning, and can also be beneficial in further meeting specific ARC-PA standards. In the current times of COVID, Aquifer cases have become even more valuable, to allow the creation of hybrid SCPEs that offer virtual cases that are blended with in-person experiences. Student feedback has affirmed the usefulness of these cases to expand learning and reinforce knowledge and management strategies that they have learned in their didactic curriculum and experience in the SCPEs.

Share Your Perspectives

What has worked well for you and your students? Let us know—and share with your peers—by submitting a pearl.

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