Covering ARC-PA Standards & Supporting SCPEs with Aquifer Custom Courses
October 28, 2020

Perspectives | October 28, 2020

Virtual-patients-combined-with-real-patients

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 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:

  • Diagnostic Excellence 04: 10-year-old male with chronic abdominal pain
  • Family Medicine 03: 65-year-old woman with insomnia
  • Family Medicine 09: 50-year-old woman with palpitations
  • Geriatrics 04: 85-year-old woman with dementia
  • Geriatrics 05: 79-year-old woman with agitation
  • Geriatrics 06: 85-year-old woman with delirium
  • Geriatrics 07: 78-year-old man with depression
  • Geriatrics 10: 72-year-old man and sexuality in older adults
  • Internal Medicine 05: 55-year-old man with fatigue
  • Internal Medicine 26: 58-year-old man with altered mental status and experiencing homelessness
  • Family Medicine 01: 45-year-old woman wellness visit
  • Family Medicine 02: 55-year-old man wellness visit
  • Family Medicine 06: 57-year-old woman diabetes care visit
  • Family Medicine 08: 54-year-old man with elevated blood pressure
  • Family Medicine 10: 45-year-old man with low back pain
  • Family Medicine 15: 42-year-old man with right upper quadrant pain
  • Family Medicine 20: 28-year-old woman with abdominal pain
  • Family Medicine 22: 70-year-old male with new-onset unilateral weakness
  • Family Medicine 28: 58-year-old man with shortness of breath
  • Family Medicine 33: 28-year-old woman with dizziness
  • Pediatrics 02: Infant female well-child visits (2, 6, and 9 months)
  • Pediatrics 03: 3-year-old male well-child visit
  • Pediatrics 04: 8-year-old male well-child check
  • Pediatrics 06: 16-year-old male preparticipation evaluation
  • Pediatrics 11: 4-year-old male with fever and adenopathy
  • Pediatrics 13: 6-year-old female with chronic cough
  • Pediatrics 21: 6-year-old male with bruising
  • Pediatrics 22: 16-year-old female with abdominal pain
  • Pediatrics 23: 15-year-old female with lethargy and fever
  • Pediatrics 28: 18-month-old male with developmental delay
  • Internal Medicine 01: 49-year-old man with chest pain
  • Internal Medicine 04: 67-year-old woman with shortness of breath and lower-leg swelling
  • Internal Medicine 07: 28-year-old woman with lightheadedness
  • Internal Medicine 08: 55-year-old man with chronic disease management
  • Internal Medicine 12: 55-year-old man with lower abdominal pain
  • Internal Medicine 14: 18-year-old woman for pre-college physical
  • Internal Medicine 21: 78-year-old man with fever, lethargy, and anorexia
  • Internal Medicine 24: 52-year-old woman with headache, vomiting, and fever
  • Internal Medicine 25: 75-year-old woman with altered mental status
  • Internal Medicine 29: 55-year-old woman with fever and chills
  • Abdominal Aortic Aneurysms
  • Breast Cancer
  • Bowel Obstruction
  • Lung Cancer
  • Skin Cancer
  • Carotid Stenosis
  • Inguinal Hernia
  • Cholecystitis
  • Pyloric Stenosis
  • Hypercalcemia

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.