College of Nursing and Health Sciences

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University of Massachusetts College of Nursing and Health Sciences

Course Number: NU 615 DL Fall 2013 Course Title: Advanced Health Assessment (2 cr. didactic 1 cr. clinical 65 hrs) Credits: Three credits, 2 credits didactic; one credit clinical (65 hrs) Placement Core Pre requisite graduate course, in Post Master’s Certificate Prerequisites Pre req or concurrent Advanced Pathophysiology 614; Class: Weekly Wimba Sessions Tuesday 7:30 to 8:30 pm Margaret McAllister PhD, FNP-BC, FAANP Clinical Assoc. Professor [email protected]; H:508-785- 2951; office 617-287-8275 College of Nursing & Health Science 100 Morrissey Blvd Boston MA 02125 Faculty: Kathleen Ouzts PhD, ANP, ACNP, FNP-BC Lecturer H : 251-978-2457 F: 251-968-5092 16 Market Street, Orange Beach, AL 36561 Email: [email protected] Office Hrs: By appointment Wimba or phone with faculty Program Dir: Margaret McAllister Ph.D., RN, CS, FNP [email protected]

Blackboard Support number: 1-855-789-7053 or http://umb.echelp.org Kathleen Ouzts Phd, ANP, ACNP, FNP-BC Sec II Faculty Instructor [email protected] H:251-978-2457 F:251-968-5092 By appointment Wimba or phone with faculty Program Dir: Margaret McAllister Ph.D., FNP-BC, FAANP [email protected]

Course Description: The course focuses on the development of advanced practice nursing skills in health assessment for urban populations. Concepts, theories and research on human development, anticipatory guidance, prevention and early detection of risk factors and diseases are emphasized. Critical thinking, diagnostic reasoning and communication skills are developed through practice with case guided vignettes and simulated practice experiences specific to the student’s area of advanced practice nursing in the clinical laboratory setting with direct preceptor supervision and evaluation.

Course Objectives: Upon completion of the course, the learner will 1. Apply theoretical models in culture, nursing, and health promotion, to the process of advanced practice nursing care of diverse populations at risk. 2. Demonstrate advanced health assessment skills that are both age-appropriate and problem focused. 3. Interpret health assessment data and formulate a differential diagnosis. 1 | 615 Syllabus P a g e | 2

4. Apply evidence-based research to the early identification of individuals/populations at risk for common health problems.

Topical Outline

1. Advanced health assessment skills, critical thinking skill, diagnostic reasoning, into the comprehensive, acute/episodic, and chronic focused health care encounter. 2. Advanced assessment skills for diverse urban communities at risk for: violence, substance abuse, and bioterrorism. 3. Risk factors and disease prevention interventions for diverse urban populations at risk for: Obesity, sedentary life style, nutritional deficiencies, lead poisoning, mental illness, sexually transmitted diseases, and unintended pregnancy. 4. Assessment of Risk Factors and anticipatory guidance with school age children and their families e.g. vision and hearing screening, violence prevention, tuberculosis screening, dental and oral health, physical activity and exercise. 5. Assessment of Early Risk Factor and Disease Detection of Adolescents e.g. Injury prevention, prevention of sexually transmitted disease, and unwanted pregnancy, screening for substance abuse, intervention, and prevention. 6. Assessment, and Early Disease Detection, of Adults e.g. Breast examination and mammography screening, cervical cancer screening, testicular cancer screening, oral health care, HIV screening guidelines and referral, work place injury prevention. 7. Assessment and Early Disease Detection of Middle and Older Adults e.g. blood pressure screening, screening for hyperlipidemia, diabetes, screening for coronary artery disease and peripheral vascular disease, exercise and diet counseling, mammography screening, menopause counseling, and screening for neurosensorial losses and functional losses associated with aging. 8. Focused health history and physical examination guidelines for common chronic illnesses in adult populations: asthma, copd, hypertension, hyperlipidemia, and diabetes. 9. Legal and ethical issues of health care

Teaching Strategies Classroom modules, WIMBA presentations, online discussion and clinical experience/practice.

Methods of Evaluation /Percentage/points of Grade below 100 Points

SOAP notes (HEENT, cardiac or pulmonary and complete PE) 3 notes @ 5 pts./each 15 peer review of each colleague’s notes 3 x 1.7 5 WIMBA weekly attendance and participation 1 points x 10 10 Weekly logs for 65 Clinical Hours due by Tuesday AM 1 point/ wk. ** 10 Oral case presentations 2 cases x 2 points one before midterm and one after 8 Quizzes 2 points each x 6 quizzes x 2 pts . (12 questions each quiz) 12 Midterm exam weeks 1 through 6 Oct 22 : 7:30 – 9 pm EST 20 Final Exam weeks 6 through 13 Dec 10 7:30 -9 pm EST 20

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Clinical Preceptor Evaluations (Midterm/Final)submitted on time due week 7 and week 13 Oral Case Presentation evaluation will be assessed by preceptor and submitted to faculty at midterm and final. (All evaluations must be sent to faculty signed with your signature and that of the preceptor. Include self-addressed stamped envelope to return the faculty signed midterm to your home. The final evaluation on the same form must be sent again to faculty. Retain a copy for your files as well as a copy of your Google logs).

Quizzes will be at the end of Wimba session in weeks 2, 4, 5, 9, 10, 12 First Wimba is Tuesday Sept 10 at 7:30 First Quiz is Tuesday Sept 16th at 8:30 Midterm week 7 –730 – 9 pm EST 40 multiple choice questions Final Week 14 Tuesday 730 – 9 pm EST 9 - 40 question multiple choice Quizzes and exams will be given using Proctor Cam and administered at the end of each Wimba Discussion session each Tuesday 7:30-8:30; You will have 40 minutes for the 10 question Quiz generally beginning an 8:30 to 8:45. There is no make- up exam or quiz. *** Google logs, each of you will receive a link to your log, on umb email. Please retain the link and access the log only through the link. We will review what is expected on the weekly logs. At midterm and final the preceptor must review and sign off on your log to validate your time and patients you have seen.

Grades Letter grades will be given in accordance with the grading criteria indicated in The UMB Graduate Student Handbook. Students must earn a B- minimum of 80% to pass Graduate level course. Students in jeopardy of failing following any given exam are asked To discuss with the course instructor and will be notified of their risk of failure by mail. Final grades are points of, 94-101 =A, 90-93=A-, 87-89=B+, 84-86 = B, 80-83= B-, 77-79=C+, 74-76=C; INC grade = see below; W (withdrawal dates on university calendar at

Clinical Incomplete (INC) Option A grade of incomplete (INC) is not automatically awarded when a student fails to complete a course. Incomplete is only awarded when satisfactory work has been accomplished in the majority of the course and the student is unable to complete clinical course requirements due to extenuating life circumstances beyond his or her control. See UMB graduate and Undergraduate Handbook for policies regarding the incomplete (INC) grade. “The student must negotiate with and receive the approval of the course instructor in order to receive the grade of incomplete. A copy of the written agreement between the faculty member and the student, which specifies the work to be completed, and the deadline for completion must be on file with Department Graduate Program Director with a copy to the graduate student’s advisor. A student can only obtain credit for an INC IN A CLINICAL COURSE ALLOWING FOR TIME TO COMPLETE THE CLINICAL REQUIREMENTS by finishing the coursework before the end semester and achieving a passing grade on all clinical course work. Following such completed work an Inc for clinical practice time may be give for up to 30 days following the completion of the course work by agreement and contract on file with the faculty. Students cannot progress to any other clinical course while an INC remains on their transcript in a pre-requisite course.

Graduate students with an Incomplete in a pre-requisite course cannot progress to active enrollment in a subsequent course requiring that pre-requisite while an INC grade remains on her/his transcript. The INC form is available in clinical tools file. The form needs to be 3 | 615 Syllabus P a g e | 4 personalized (your plans for clinical completion to include clinical logs with google docs and keeping instructor informed of your progress) and expected completion date for 65 hour. Please keep me informed of your plans to request an INC for the clinical component of the course. Complete the form and mail hard copy by week 10 of course. An INC can only be acknowledged if you have done all the rest of the requirements for the course and have a passing grade in the course.

Exams Exams /Quizzes will be taken online on Blackboard and proctored remotely by ProctorCam. During the exam you will be monitored by a proctor via the webcam who will be observing you while you are taking the exam. While taking the proctored exam be sure that you do not download and copy and paste the exam into your computer, access internet sites in another window or use any other electronic devices. This will easily be recorded by ProctorCam and will constitute cheating

or the intention to do so.

Study groups are encouraged using Wimba or other online sources such as Google Hangouts or Google talk to meet virtually and discuss the content related to differentials.

Unless otherwise noted, the quizzes/exams will be available for the designated time outlined in the course syllabus below. Contact me via email if you have any schedule conflicts that cannot be resolved. Call my home or cell phone number if you have a technical problem during the exam that can’t be resolved with ProctorCam help desk (877-837-8127, they are open 9am-10pm east coast time). The exams are mostly multiple choices with a few brief written responses. Exams are based on required reading material and Wimba lecture discussion topics reviewed and stressed in the Wimba session.

You will need a webcam, microphone, computer with a solid Ethernet cable connection and the latest version of Adobe Flash Player (available at www.adobe.com). You will sign into the ProctorCam site and provide identity confirmation and room scan to insure there are no textbooks or notes in the vicinity. Close down any other windows on your computer prior to the exam as ProctorCam will monitor your on line activity. Once you have passed the check-in, you will be directed to Blackboard Learn to open the exam. Be sure to register and conduct the practice exam prior to our first exam (this is optional and not worth points towards your grade). Once you access the exam you will have 1 hour to complete the exam. After you start the exam you won’t be able to close it and return so make sure you have enough time to complete once you start. You can save your answers as you go or save at the end, which gives you the option of going back and changing answers. I will correct the exams by the end of the week they are given. You can check your score under the grades tab in the left column of the home page. Once the exam period has ended and all exams graded, you can access the exam to check the correct answers by clicking on the exam link again. I will consider challenges to any questions with evidence-based rationale. If more than 50% of the class gets any one question incorrect the question will be eliminated.

A Practice exam is available for you to take and will be available throughout the course. It is brief, only 1 simple question, and will allow you to check your connection to ProctorCam. I encourage you to go through this exam well before our first real exam on 9/17, though it is not mandatory and doesn't count towards your grade. You will need to sign into ProctorCam using the account information established from the invitation email you should have received. You will be given a password for the exam as part of the check in process. Please note that the on-line chat for ProctorCam is available from 9AM to 10PM EST. The following information is from ProctorCam.

Here are hints and tips that may help students as they go thru the practice session:

 This link provides screen shots / explanation on how the process works. We encourage students to take a few minutes to go through these slides - http://help.proctorcam.com/entries/21856683-how-to-test-on-proctorcam  The testing process is as follows: oClick Begin Check in to start oVerify Audio / Video is working oApplication will automatically Launch and will say Recording oFollow the checklist. Launch the Test page (which will open the UMB website) oNavigate and take test oAfter the test is submitted, go back to the ProctorCam window showing the video and click End Test (which will close the session/application)  Also, students can click and drag the application (when it launches) so it is not in the middle of the screen (recommend upper right hand side)

Students having problems or questions should not hesitate to reach out to us via the following ways. We can usually solve/explain things rather quickly:

 email us at [email protected]  use the on-line chat (located on the bottom right on the ProctorCam website) available 9am- 10pm EST.  call us at 877-837-8127

Disability Statement Any individual with a physical or mental impairment that substantially limits a person in some major life activity, and needs an accommodation, must provide documentation of this disability to the Director of the Ross Center for Disability Services. The Director of Disability Services will make a determination whether or not accommodations are needed. Once determination is made, the Director will consult with the faculty member on appropriate accommodations. A student with a documented disability is encouraged to register with Disability Services, (M/1/401) by visiting the Ross Center or calling (287-7430).

Academic Honesty The health professions have a code of ethics and standards for their members. It is the policy of the College of Nursing and Health Sciences that academic dishonesty or misconduct will not be

5 | 615 Syllabus P a g e | 6 tolerated. All human performance and fitness and nursing students should familiarize themselves with the policies on Academic Dishonesty and Student Misconduct described in the University and College of Nursing and Health Sciences Student Handbooks. Examples of academic dishonesty include but are not limited to cheating on exams, submitting written material that is the work of others, or seeking unauthorized use of computer files of a student or faculty member. Misconduct includes but is not limited to furnishing false or inaccurate information, disruptive conduct or threat, or damage to university property. Click on link below for Code of Student Conduct: http://www.umb.edu/student_affairs/code.html Students are also encouraged to review the Academic Integrity slides posted on the home page for this course as well as Module 6: Citations and Plagiarism, a free tutorial offered through the Healey Library: http://www.lib.umb.edu/node/1519. A resource for APA format & how to avoid plagiarism may be found at http://owl.english.purdue.edu/owl/resource/589/01/

Required Texts Cash, J., & Glass, J. (Eds.). (2010). Family practice guidelines. (2nd ed.). New York, NY: Springer. ISBN-13: 978-0826118127. Clinical reference book contains patient education guidelines and management guidelines for you to take to clinical. The focus of this course is learning how to make a differential diagnosis based on data but learning as you go on how to manage patients is a good thing.

Bickley, L. S. (2013). Pocket guide to physical examination and history taking. 7th ed. Lippincott Williams and Wilkins ISBN 978 4511 7322 ( take to clinical learn to consult and learn abnormals and how to describe them)

Center for Disease Control (2013) Adult Immunization Schedule: http://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html download and print

Clinical Preventive Task Force: 2012 http://www.ahrq.gov/professionals/clinicians- providers/guidelines-recommendations/guide/index.html (download content from this cite to support your Soap notes and learn all screening guidelines.) (Important assessment tool and way to learn the required immunizations for adults, there is also a make -up schedule posted)

Desai, S. (2009). The Clinician’s guide to laboratory medicine. Houston: MD2B. ISBN 978- 097-255-6187. (If you have Beckerman’s, than can be used.) Bakerman’s is older but explains much in detail and useful book to have. Consult as needed to learn and look up labs.

Rhoades, J. & Peterson. Advanced health assessment and diagnostic reasoning, Second Edition. Jones and Bartlett Publishing Company. ISBN: 9781449699628

Toy, E., Briscoe, D., & Britton, B. (2012). Case files family medicine. (3rd ed.). New York, NY: McGraw-Hill Medical. ISBN-13: 978-0071753951. (See case studies early in the term on different age groups cited in the appendix and noted in the syllabus in week 13.)

Video Loyola University Physical Assessment Series as required in weekly sessions: http://www.learnerstv.com/lectures.php?course=ltv032&cat=Medical ( these videos allow you to jump ahead and view contents related to experiences you are having. You can download them

into your iphone or mobile device.

 Equipment:  Stethoscope: High level 3 M Cardiology III Stethoscope a must have  Reflex hammer if none available in the agency  Access to otoscope and opthalmascope in agency.  High quality headset with microphone to connect to your computer. Purchase online or else where do not get an inexpensive set as it will not be conducive to good transmission of voice and audio

 Library Bar Code for online Access to Healey Library Students enrolled in a UMB online course are eligible to receive a barcode for access to Healey Library resources located at http://www.umb.edu/library/services/library_barcode/. UMB library is a rich and valuable academic online resource which will allow you to do most of your research work off-campus. To access most of the campus resources, you will need your barcode number found on the reverse of your student id card.

 If you don't have a student ID card or are unable to read the bar code number you can send an e-mail request to: [email protected]. Your request should include your first and last name, Social Security number (or student ID number), course name and number and semester. You will receive address of the library website. Barcode access terminates at the end of the semester. (Note: This service is available Monday – Friday 9 - 5 PM

Recommended Texts

 Chase, S. (2004). Clinical Judgment and Communication in Nurse Practitioner Practice. Philadelphia, PA: FA Davis. ISBN-13: 978-0-8036-0797-2  Bakerman, S., Bakerman, P., & Strausbauch, P. (2002). Bakerman’s ABCs of Interpretive laboratory Data (4th Ed.). Interpretive Data Laboratory, Inc. Also available from Skyscape for your phone purchase or on line use or subscription version available at: http://www.skyscape.com/estore/pro).ductdetail.aspx?productid=447

 Supplemental Texts

Hicks, R. W., & Seiber, D. C. (2011). The Comprehensive Health History and Physical Examination: A Lifespan Approach. Louisiana Advance Practice Education Associate, Inc. ISBN: 978-1-892418-17-3.

Kaufman, M. (2014). History and Physical Examination. Burlington, M: Jones & Bartlett Learning. ISBN: 978-1-4496-6026-0.

LeBlond, R., Brown, D.D., & DeGowin, R.L. (2008). Degowin’s Diagnostic Exam (9th Ed.). New York, NY: McGraw Hill. ISBN -10: 0071478981 | ISBN-13: 978-0071478984.

Matthew, A. M., (2000). Pocket PE: Physical Examination Study Cards. Philadelphia, PA: Lippincott Williams & Wilkins. ISBN 13: 9780781723695 (978-0-7817-2369-5) ISBN: 0781723698 (0-7817-2369-8

Prabhu, F., & Bickley, L. (2007). Case Studies to Accompany Bates’ Guide to Physical Examination and History (9th Ed.). Philadelphia, PA: Lippincott Williams and Wilkins. ISBN: 0781792215 / 9780781792219  On line library access http: //www.lib/umb.edu/node/70  If you need an article not available in UMass library data bases: email reference @umb.edu for your request  http: //www.lib.umb.edu/references  Free medical journals on line  http://www.freemedicaljournals.com/  Comprehensive reference to learning lab and diagnostic testing http://www.medicine.ufl.edu/3rd_year_clerkship/online_learning_resources.asp US Department of Health and Human Services Division of Nursing (2002). Domains and competencies of the NP in specialty areas, Washington DC. US Department of Health and Human Services. http://www.nonpf.com/associations/10789/files/PrimaryCareComps02.pdf

Quest Lab selection and interpretation guidebook on line: http://viewer.zmags.com/publication/0bffc869#/0bffc869/14  hhttp://www.merckmedicus.com/pp/us/hcp/hcp_home.jsp  hhttp://webstore.lexi.com/Store/PDA-Software-for-Advanced-Practice-Nurses

Excellent online dermatology reference  hhttp://dermatlas.med.jhmi.edu/derm/

Antibiotic guide  hhttp://hopkins-abxguide.org/

 Sanford Guide to Antimicrobial Therapy 2013 www. sanfordguide .com

Comprehensive reference to learning lab and diagnostic tests:  http://www.medicine.ufl.edu/3rd_year_clerkship/online_learning_resources.asp

Free downloadable PDA program for differential dx  hhttp://books.mcgraw-hill.com/medical/diagnosaurus/index.html

Skyscape- lots of free (and those that cost $) medical apps/3 physical assessment apps  hhttp://www.skyscape.com/index/home.aspx

For evidenced based summaries http://www.cochrane.org/ Cochrane reviews http://www.tripdatabase.com/index.html Trip database

Recommended resources

Web Path Tutorials: http://library.med.utah.edu/WebPath/TUTORIAL/TUTORIAL.html#2

Healthy People 2020 - Improving the Health of Americans www.healthypeople.gov

Useful web links: http://www.aafp.org/afp.xml free app AFP by topic

Data Bases: Useful links: www.umb.edu - go to Academics, click on Library click on data bases go to proquest nursing journals or click on eReserves; Free medical journals on line: http://www.freemedicaljournals.com/ Pub med search: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed If you are in need of an article not available in UMass library databases email [email protected] for your request see: http://www.lib.umb.edu/reference/

Learning about Blackboard Learn If this is the first time you're using Blackboard, go to the Student User Guide available on the course home page. It is recommended that you use an Ethernet cable during WIMBA sessions instead or going wireless.

Clinical Experience Entrance into the Course Students entering NU615 are expected to be competent in the performance of undergraduate health assessment skills and are urged to review content in depth prior to starting this course. The health assessment clinical component should focus on general and patient symptom/complaint focused ROS, complete PE as needed and focused differential dx ; treatment plans are developed by the preceptor

Clinical Experience The clinical practice time is aimed at allowing the students the opportunity to learn more advanced physical exam techniques and to integrate findings with a differential dx approach. Each student is expected to practice taking a history and review of symptoms and performing a physical assessment on a variety of patients. In addition, practice of history taking and physical exam techniques outside of the clinical setting with families and friends allows you to compare and contrast normal findings across the life span.

Each student should have a high quality Littman cardiology grade stethoscope for laboratory practice. Students may also purchase other medical equipment, (tuning fork, reflex hammer, otoscope, etc.) as their needs dictate.

Recording Clinical Experience Google Docs A Google Excel spread sheet form will be provided to record your clinical experience on logs. The patient encounters are to be submitted weekly on the Google docs which you will share with your faculty. Dr. McAllister will send you a link to Google docs with the template. This link is the only way to reach your log. Retain it and use it to access the log.

Clinical Grades

Passing this course is contingent upon passing the clinical component with a level of competence as an average in all of the areas and completing clinical logs on Google Docs. Failure to complete and keep clinical logs up to date will lead to a mailed midsemester warning from the Graduate Program Director. At the midterm and final you are asked to share you log with your preceptor and ask her to sign digitally and date. Detailed description of NU615DL Advanced Health Assessment Course Overview for Preceptors & Students

NU615DL, Advanced Health Assessment, consists of both online education and a preceptored clinical experience. The course is conducted over 14 weeks (Monday 9 Sept, 2013 to Friday, Dec 13 2013). The on line course includes weekly tutorials, written assignments, participation in on line discussions, and on line attendance at two Wimba sessions. The clinical component requires 65 hours of preceptored clinical experience with written requirements of clinical logs and clinical evaluations. The clinical site and preceptors are chosen by the student and approved by the College of Nursing and Health Sciences, University of Massachusetts Boston. The approval process/contract negotiation involves communication with the student, the clinical site, and the faculty/staff at UMass ([email protected]). The working agreement process can take up to 4 weeks and must be completed before starting the clinical experience.

Clinical practice may begin only when written contract is approved and not before Monday 9 Sept, 2013 and must be completed by the Friday 13 Dec 2013. Approval for clinical sites is coordinated through Dr. Margaret McAllister. All questions re: the clinical contract should be addressed to [email protected]. No student may begin any clinical experience without knowing that a signed working agreement is in place.

The student is expected to be in the clinical setting for about 6 hours/week. Each week the assignments, readings, and files will be focus on the physical assessment skills for one or more systems. The focus of the student’s weekly clinical experience will, hopefully, coincide with the weekly course content. However, students should not do more than 12 hours/week without permission of the faculty. At the beginning of the semester, students will provide the course faculty with the dates and times of expected clinical experiences.

All students must wear an identification nametag. See the memo for ordering your name tag. Nametag includes: Your Name and credentials. (The order of credentials following your name is your highest degree: BSN, MSN, or PhD then RN or PNP-BC. Then any other certifications you may have). Adult/Geriatric Nurse Practitioner Student or Family Nurse Practitioner Student University of Massachusetts at Boston

1. Clinical Preparation a) Read the weekly assigned Rhoades textbook chapters. b) View slides posted in Blackboard (Note that slides are not taken from Rhoades but another text Kaufman et al which we believe is more detailed in content that you need

to know and provides an outline of the exam procedures. Rhoades a better job with the important abnormals you should know for each system. c) View pertinent web links to supplement the readings. d) View the health assessment videos and other interactive posts in Blackboard  Practice specific assessment skills prior to going to the clinical setting. Each week there is a specific focus to the physical assessment skills that you should seek out in the clinical setting. The clinical focus may need to be altered to meet the needs of the patient population and clinical setting. These anticipated skills are scheduled in the syllabus weekly reading assignments and are considered the objectives for the clinical competencies in health assessment to be mastered by the student.  These competencies should be a reference to both the student & preceptor to guide the focused health assessment competencies each week. The focus is each weeks reading, learning the common abnormals associated with the system or systems, descriptors for abnormals, and learning the differentials for the system such as what is the differential for cough in a 65 year old male with history of smoking? The underlying etiology of a diagnosis is based on your knowing the underlying pathophysiology of the acute or chronically presenting problem: based on the menomic VINDICATES V Vascular, I Infection; N Neoplastic, D Drugs/Toxins, I Inflammatory/Idiopathic, C Congenital, A Autoimmune,/allergy, T Trauma, E Endocrine/Environmental, S Something Else/pSychological; Also for better understanding of the process read and retain:  Baerheim A. The diagnostic process in general practice: has it a two-phase structure? Family Practice 2001; 18: 243–245. At http://fampra.oxfordjournals.org/content/18/3/243.full The historical / subjective questions we ask and the physical exams we conduct help us to test our hypothesis of the patients presenting complaint or reason for the visit.*****  Common problems that we see in primary care/ outpatient or urgent care setting are the focus of the course. Ask your preceptors to allow you to see /hear abnormal she/he finds and call you in as well with others in the practice that identify abnormal labs and physical exam findings.

2. Clinical Written Requirements: Demonstrate clinical proficiencies by performing specific evaluations, diagnostic reasoning and clinical decision making and formulation of plans of various medical problems with documentation of findings in the SOAP format. Demonstrate supporting evidence for your case soap note and critiques.

3. Subjective is the history obtained from the patient and or other significant others based on the reason for the visit, episodic/acute, chronic illness diagnosis or care, or comprehensive physical exam. History of the presenting illness see chapter in Rhoades, past medical history, social history, and occupational history family history all is subjective data. The objective focuses on the findings on vital signs, physical exam including vision screening if appropriate, peak flow measurement, blood pressure and description of physical exam findings ( pertinent negatives as well ) and any diagnostic tests or laboratory data found in the patients history that should be considered or done that day. The diagnosis is supported by the analysis of your subjective and objective data. Your plan may indicate additional diagnostic tests in collaboration with your preceptor, health teaching related to risk

factors, immunizations needed. At this time you are not recommending prescriptions as a means to manage the patient but may learn from the case to apply in future clinical experiences.

You must cite any evidence or guidelines that support the diagnosis and/or health promotion screening plan of care. This can include evidence for practice from readings, including published sources such as clinical guidelines, protocols, or consensus statements. Full citations of evidence using APA 6th (ed) format is required to support your soap note postings. Please follow the US Preventative Services Task Force (USPSTF) for ranking evidence about the effectiveness of screening guidelines.

 SOAP #1: Based on a patient presenting with a problem related to HEENT such as upper respiratory infection (URI), conjunctivitis or ear infection including health history and physical examination of head, neck, ears, nose, throat, and lungs, differential diagnosis and plan. Include citations and references from at least 2 sources including evidence based guidelines  The clinical preceptor will evaluate your performance of the physical exam components and sign off on your midterm clinical evaluation form indicating the date of the exam.  See the SOAP template and examples (located in the COURSE MATERIALS on Blackboard.  Post under SOAP #1 assignment on/before Tuesday Oct. 15, 2013.

 Peer review select a class mates note posted on the discussion board; Please review with attention to completeness, organization, and supporting evidence that is subjective and objective that leads to the diagnosis and or problem list for the patient. Make suggestions for further information needed either subjective or objective. One student per note for peer review due Oct 22.

 SOAP #2: Based on a patient presenting with a problem in the cardiopulmonary system such as bronchitis, cough, SOB or chest pain. Includes health history and PE of the HEENT, heart, lungs, abdomen and lower extremities. Include citations and references from at least 2 sources including evidence based guidelines.  Clinical preceptor will evaluate your performance of the physical exam components and document on your midterm/final clinical evaluation form.  See the SOAP template and examples (located in the COURSE MATERIALS on Blackboard  Post under SOAP #2 assignment on/before Tuesday Nov 12, 2013.

 Peer review select a class mates note posted on the discussion board; Please review with attention to completeness, organization, and supporting evidence that is subjective and objective that leads to the diagnosis and or problem list for the patient. Make suggestions for further information needed either subjective or objective. One student per note for peer review due Nov 21.

 SOAP #3: Complete History and Physical Exam Based on a patient presenting with a chief complaint related to a complete physical exam. Focus on health promotion, disease prevention and early detection and health maintenance. You are to document the CC, HPI for any active or current medical problems and history of screening tests and results, complete ROS and PMH including SH and FH ; a complete PE including a neuro and musculoskeletal exam, a differential diagnosis for any new complaints or changes in active medical problems and decision making for indications for any screening tests and plan. Include citations and references from at least 2 sources including evidence based guidelines

 Complete Physical Examination – the Clinical preceptor will evaluate the student’s performance of the physical exam and document on your final clinical evaluation form.  Documentation – use SOAP template.  Post under SOAP #3 assignment on/before Tuesday Dec, 3, 2013.

 Peer review select a class mates note posted on the discussion board; Please review with attention to completeness, organization, and supporting evidence that is subjective and objective that leads to the diagnosis and or problem list for the patient. Make suggestions for further information needed either subjective or objective. One student per note for peer review due Dec 10. .

a) Additional Course Requirements: 1. Attendance at all sessions of WIMBA, an online synchronous meeting, for students & faculty to discuss course content and for students to present a case orally related to content presented that week in readings, ppts and videos. The Wimba sessions will be held Weekly and are posted below, weekly quizzes or oral case presentations will follow the Wimba discussions. You will sign up for an opportunity to present a case orally to your faculty in 5 min. see below for dates. 2. WIMBA software is EMBEDDED IN BLACKBOARD. YOU SIMPLY NEED TO DO A BROWSER CHECK PRIOR TO THE SCHEDULED SESSIONS. WHEN YOU CLICK ON WIMBA FROM YOUR BLACKBOARD HOMEPAGE YOU WILL SEE DIRECTIONS TO DO A BROWSER CHECK, FOLLOW ALL DIRECTIONS ON THE SCREEN. BE SURE TO DO THIS AT LEAST ONE WEEK IN ADVANCE TO ASSURE YOU WILL BE CONNECTED. IF YOU HAVE PROBLEMS FOLLOW DIRECTIONS TO CONTACT BLACKBOARD HELP. You will need headphones. (Best Buy or Staples). 3. Exams - Achieving an average grade of 80 or better on all quizzes and exams. Successful completion of both the theoretical and clinical content is necessary to pass the course. 4. Written Assignments – Late assignments will not be accepted / graded unless arrangements are made with the instructor prior to the due date. All assignments must meet the same quality requirements that have been adopted for NU 615 at the University of Mass Boston. Please make a personal copy of all submitted assignments. Please place your name and course number on all pages submitted. Assignments will be graded within 14 days of due date.

5. Feedback - Email will be used to communicate with students to evaluate their progress. Students are expected to notify the course faculty if there are any problems with the clinical setting, submission of assignments, or the course structure. On all emails please use the subject line to provide your last name, NU615, and the topic of the email (e.g., Smith NU 615 working agreement not in place). I will respond to all emails within 48 hours to kathy or [email protected]. Otherwise, I check class emails on BlackBoard 2-x week (Mondays and Thursdays). You can also schedule a phone call with faculty. 6. Preceptors: Clinical preceptors are also acting as educators, mentors, role models and co-evaluators for students. Preceptors need to familiarize students with equipment (ophthalmoscope/otoscope, reflex hammer, etc) and the organization and personality of the practice setting. Since this is the first clinical experience for these advanced practice students, preceptors must be available to supervise the student/patient interaction by a combination of observing the student, reviewing the students presentation of the case, validating physical exam findings and providing direction for clinical decision making and treatment plans while at the same time fostering confidence in the student to be able to function independently after graduation from the program. Please send me your preceptor’s name/credentials/email by second week of course to my email address. 8. Course Evaluations: will be made available to you online. 9. Clinical Competency - If a preceptor has any concerns regarding the clinical competency of a student, the preceptor MUST notify the course faculty immediately. Each preceptor will be provided with the email and phone number of the course instructor. The student should not return to the clinical setting until the faculty has spoken to both the preceptor and the student to devise an appropriate plan. At any time if the student is considered unsafe or at risk of failing, the student may be asked not to return to the clinical setting by the agency director. At any time if the student is considered at risk for failing by virtue of poor performance or otherwise failing grades the student will receive a letter from the graduate program director advising them of their risk of failing and the need to develop of plan to achieve competency in collaboration with faculty and the student’s preceptor. A. Clinical grading (pass/fail) – Clinical grading is a combined decision of the course faculty and preceptor. Should there be any indecision about the clinical competency of the student, he/she may be asked to come to the University of Mass Boston in order to demonstrate clinical exam competence. The student will receive a grade of “Incomplete” until the final decision of a grade is made. B. Clinical mid-term & final evaluation - Midterm clinical evaluation due after 30 hours of clinical experience to the faculty by email and snail mail. Both students & preceptors must complete the midterm & final evaluation forms sign and date the form. The same clinical evaluation form is again signed and submitted by the faculty as final clinical evaluation no later than Friday December 13, 2013 (email and snail mail). This clinical evaluation form will go in your permanent record file so students are advised to keep a copy of the final evaluation form for themselves. Students must obtain a minimum grade of advanced beginner) in all domains by the final evaluation. If, at any time, preceptors have some doubt about the inability of the student to obtain a minimum of 3.0 in each domain, preceptors must contact the faculty immediately. Contact with faculty –faculty will be in touch with preceptors to discuss your progress). If preceptors

have any concerns/questions about a student, expectations of the course, etc. please contact the faculty by email. Do not wait until the mid-term or the final evaluation to bring up concerning issues. Students are also expected to report any of the same issues. b) Key Points in Review: Ultimately, to be successful in this course, the faculty needs to receive the following data: 1. Documentation of 65 hours of clinical practice via weekly Google logs using the link for access to the logs, no password will give you access to the logs. 2. Three well developed SOAP notes and critique review of a colleagues soap note with supporting evidence from guidance or other scientific journal article Attendance at all weekly seminar Wimba Sessions and completion of weekly quizzes and exams. 3. Documentation of successful performance of evaluation, risk evaluation a patient with a problem a HEENT problem, a cardiopulmonary problem and complete history and physical exam on the midterm or final clinical evaluation tool signed by the preceptor. 4. Midterm and final clinical evaluations graded and signed by both student and preceptor. A grade of 3 points must be obtained in all domains by the final evaluation in order to be successful in the course. 5. Situations may occur during the semester that are unplanned and change the course of your progress in the course. Your goal is to address the issue/issues with the course instructor via email as soon as possible and discuss the course assignments/due dates/plan of action. (e.g., your preceptor changes hours of clinical availability, work schedule conflicts, etc) As you can see by the course requirements, the University of Mass Boston is committed to ensure quality education to students enrolled in their courses, whether in the classroom or online. We know that this online clinical course may be a new and unique experience for most of you. I will be available to answer questions and assist you in completing the course. When students have successfully completed this course, the faculty, students and preceptors can feel confident in the physical assessment and history taking skills of the student. Clinical Objectives Week by Week

Week 1: Tues Sept 10, 2013 Orientation to Clinical Setting and Course Overview 1. Preparation- Come to the clinical setting with files listed below, and books on clinical guidelines such as Bates Pocket Book of Health Assessment and Cash and Glass, and a personal electronic device such as a smartphone or iPad to quickly access information. Be ready to be an active listener & participant in the clinical setting. If you have questions about education side effects consult Epocrates free edition on line or in your iPhone\e or android: https://online.epocrates.com/ 2. This first week: a) Read Roades & Peterson chapters 1-3 Interviewing, PE strategies, Documentation. b) View Video: http://www.youtube.com/watch?v=szNn1-N24qs&lr=1 c) http://www.youtube.com/watch?v=34D_6r_M6TM&lr=1 d) Review examples here of acute problem SOAP notes: http://www.fammed.wisc.edu/sites/default/files//webfm-uploads/documents/med- student/pcc/pds-example-soap-note-acute-problem.pdf

a) Clinical practice Google doc log e) Review “Leading Health Indicators”, Healthy People 2020”, www. healthypeople .gov Evaluation: Content from these chapters will be tested on first quiz week 2 Sept 17 Each week, read chapters and view videos prior to going to the clinical setting and practice the week’s “Clinical Competencies” so that you will be prepared to be an active participant & not just an observer. Note supplemental materials: f) Suggested reading: Chase chapter 1, 3, & 5. g) Videos of history taking: http://www.learnerstv.com/Free-Medical-Video-lectures- ltv501-Page1.htm 3. Clinical – a) Orientation to clinical setting by preceptor/staff. b) Review with the preceptor:  The Course Objectives and dates of SOAP notes and discuss expectations of student and preceptor request preceptor to sign off on your Google sheet at the midterm and final exam validating your attendance and your log of patients seen.  Weekly schedule of clinical competencies to focus on what is expected for the current & future weeks  The mid-term/final evaluation tool to help clarify student objectives. c) Review resources with the preceptor of clinical tools (stethoscope, tuning fork, reflex hammer, ophthalmoscope/otoscope, EHR etc. other tools such as peak flow meter, ekg machine.) d) Observation of the preceptor as he/she interacts with her patients, takes a history, etc. for the first day or two then begin doing histories and progress to doing the history and physical exam. e) Begin practicing focused health histories and review of systems. f) Look at next week skills (HEENT). You may begin to practice skills for the next week (working one week ahead as needed). 4. Assignment a) Google docs log on/before Tuesday am

Week 2: September 17 Preventive Secondary Prevention Screening, Diagnostic and Laboratory Testing a) Preparation – Lab content in Blackboard b) Learning modules on laboratory in Blackboard c) Wimba Seminar lecture discussion on laboratory Tues 7:30 pm d) CDV Guidelines at this web link: http://www.cdc.gov/nccdphp/dnpao/hwi/resources/preventative_screening.htm e) questions following the wimba seminar for 45 minutes. Assignments f) Quiz 1 on Week 1 content 12 multiple choice questions following Wimba lecture discussion on preventive screening and diagnostic testing. g) Google doc clinical log by Tuesday am from Week 1

Week 3: Tuesday September 24, 2013 HEENT 1. Preparation – Head, Neck, Eyes, Ears, Nose and Throat

a) Rhoades chapters 6, 7. 8 Content knowledge evaluated week 2 Sept 17 Quiz 2 b) Master content and maneuvers in this video: c) http://www.youtube.com/watch?v=PAor9WG7XF4&lr=1 and

d) http://www.youtube.com/watch?v=wPzCA9k8GRQ e) http://www.youtube.com/watch?v=NE_epHjNpfohttp://www.youtube.com/watch? v=NE_epHjNpfoPractice HEENT on pts/family members/volunteers f) View Head and Neck exam: http://videos.real.com/#v/92nh3j-head-and-neck-exam Become familiar with the ophthalmoscope and otoscope in clinical. http://www.youtube.com/watch?v=NE_epHjNpfo http://www.youtube.com/watch?v=8bf-e2nq76w Otoscope: http://www.youtube.com/watch?v=iIbaq15t1L0 Use the tuning fork to perform the Rinne and Weber tests. What do these tests mean? How do you describe the results? What does lateralize mean in the Weber test? What is a positive Rinne Test mean? 2. Assignments a) Complete clinical log on Google doc on/before Tuesday Sept 17 am. b) Post introduction on discussion board by Mon c) Wimba Content discussion seminar Session #2 Tues Sept 17, 2013 7:30 to 8:30 pm EST d) Oral case presentation six students following seminar 5 min each student

Week 4: Oct 1, 2013 Thorax and Breast 1. Preparation – Breast and Axillae pp. 348-367 a) Rhoades Chapter 13 Content evaluated b) Practice Assessment of the Breast c) View Videos: http://www.learnerstv.com/video/Free-video-Lecture-1088-Medical.htm d) Part 2: http://www.learnerstv.com/video/Free-video-Lecture-1089-Medical.htm e) Attend Wimba lecture discussion on breast axilla exam and differential diagnosis f) View video on examination of the Thorax mislabeled as throat: http://www.dnatube.com/video/9513/Examination-of-Throat-Part-1 g) Apply the recommendations for breast cancer screening to patients at risk and within the recommended age group. What is a hypoechoic mass ? h) Examine results of breast cancer reports see: http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page2\ i) http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-staging 2. Assignment a) Complete clinical log on Google doc on/before Tuesday am. b) Quiz 2 on content from week 2 and 3 content Labs and HEENT 40 min 12 question

Week 5: Tuesday Oct 8, 2013 Respiratory 1. Preparation – Thorax and Lungs a) Rhoades and Peterson chapter 9 supporting content in Blackboard b) Practice assessment of, Thorax & Lung exam c) Focus on Peak flow measurement and interpretation see Blackboard content d) Focus on x ray reading basic principles see Blackboard content e) Common problems of the thorax and lungs

f) View videos on respiratory part I and part 2 http://www.learnerstv.com/video/Free-video-Lecture-1114- Medical.htm g) Part 2 http://www.learnerstv.com/video/Free-video-Lecture-1115-Medical.htm h) Attend Wimba lecture discussion on pulmonary i) Quiz 3 on content covered in week 4 breast thorax and axilla 12 questions:40 min 2. Assignments a) Complete clinical log on prior week’s clinical in Google doc due on/before Tuesday am

Week 6: Tuesday Oct. 15 Cardi ovascular and Peripheral Vascular System a) Rhoades chapter 10 b) Master understanding of Hyperlipidemia case study 34 in Toy and Briscoe 1. Practice cardiac and PV assessments 2. Assignments a) SOAP #1 Blackboard: Tuesday October, 15 2013 peer evaluation due Tuesday Oct 22 b) Attend Wimba lecture discussion of Cardiovascular PVS, risk factors for hyperlipidemia View this video http://videos.real.com/v/6yxv0z-cardiovascular-examination accompanying notes to video are here: you must c) http://www.learnerstv.com/lecturenotes/lecturenotes.php?note=1&cat=Medicine d) Learn Ankle brachial index measurement in and assessment for venous thrombosis View videos: http://stanfordmedicine25.stanford.edu/the25/ankle.html#ABIvideo e) Analyze a screening EKG: content in video lectures: f) http://www.youtube.com/watch?v=1LyizJGWZvQ g) http://www.youtube.com/watch?v=URBREKIUALk h) http://www.youtube.com/watch?v=YsiNFaDtTYo i) Practice and know the components of history and physical the components of the exam for patients with hypertension and diabetes including the foot exam for diabetics http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2494620/pdf/1679.pdf see resource at this link http://www.hrsa.gov/hansensdisease/leap/ and watch video here: http://videos.real.com/v/9bm35v-dr-pelto-performing-a-comprehensive-diabetic-foot- exam-cdfe How to order free monofilaments: http://www.hrsa.gov/hansensdisease/leap/ j) Assignments k) Oral case presentations group 2 six – seven students following Wimba discussion. l) Complete clinical log on Google doc on/before Tuesday am

Week 7, Oct. 22 Neuro Mental status 1. Preparation – Mental Health and Nervous System a) Rhoades and Complete MidtermT exam in Blackboard 90 min 40 questions content in weeks 1 through 6; Exam will be available at 7:30 p.m. Oct 22. Wimba Session will follow exam completion at 9 pm p.m. b) Peterson chapter 4 and chapter 16, Appendix A 482 c) Attend Wimba discussion lecture on nervous system and mental health exam d) View video on neurological exam parts 1-5 http://www.learnerstv.com/lectures.php? course=ltv032&cat=Medical e) Mental status exam: http://www.learnerstv.com/video/Free-video-Lecture-2728- medical.htm 2. Assignments

 Complete clinical log on Google doc on/before Tuesday am  Complete peer review of colleague’s soap note from Week 6 due on Oct 24l

Week 8: Tues Oct 29 Musculoskeletal 1. Preparation - Muscoskeletal a) Rhoads and Peterson chapter 15 b) Attend Wimba lecture and discussion on MS system c) View upper extremity exam: http://www.learnerstv.com/video/Free-video-Lecture-1090- Medical.htm and part 2: http://www.learnerstv.com/video/Free-video-Lecture-1090- Medical.htm d) View; Lower extremity exams: http://www.learnerstv.com/video/Free-video-Lecture- 1093-Medical.htm e) Physical exam of the knee: http://www.learnerstv.com/video/Free-video-Lecture-1093- Medical.htm 2. Assignments a) Complete clinical log on Google doc on/before Tuesday am Oct 29 b) Complete peer evaluation of clinical note posted  Midterm Clinical Evaluation (after approximately 30 hours clinical)). Be sure to grade yourself, date, and sign the document (you and the preceptor). Send by snail mail or scan to your faculty member in this course, we must sign and return to you and you must retain and fill out again for the final.  Oral case presentations; group 1 six or seven students following wimba discussion lecture. Week 9: Tuesday Nov 5, 2013 Abdomen/Gastrointestinal 1. Preparation – Gastro intestinal a) Rhoades chapter 111 b) Practice assessment abdomen on friends and family c) Watch videos abd 1 http://www.learnerstv.com/video/Free-video-Lecture-1086- Medical.htm d) And 2 http://www.learnerstv.com/lecturenotes/lecturenotes.php?note=1&cat=Medicine e) View video on anus, and digital rectal exam: http://videos.real.com/#v/8il18i-digital- rectal-examination f) Apply knowledge of common problems based on symptoms and signs in four quadrants, flank and back g) Apply knowledge of common labs and diagnostic tests -x-rays ordered with common findings on history and physical exam 2. Assignments a) Google doc clinical log by Tuesday am b) Attend Wimba lecture on GI system c) Quiz 4 on content from week 7 and 8

Week 10: Tuesday Nov 12. 2013 Integumentary a) Preparation – Skin, Hair, & Nails b) Rhoades & Peterson Chapter 5 c) View videos: http://www.youtube.com/watch?v=YeEf4-S4eVU d) http://www.youtube.com/watch?v=GRNiS-MMdzw e) Skin Cancer: http://www.mayoclinic.com/health/melanoma/MM00657

20 | 615 Syllabus P a g e | 21 f) Excellent reference sheet related to skin history and physical exam and findings. https://www.crnbc.ca/Standards/CertifiedPractice/Documents/RemotePractice/743Integumen taryAssessmentAdultDST.pdf g) Melanoma: http://www.mayoclinic.com/health/melanoma/DS00575&slide=6 h) Squamous cell: http://www.mayoclinic.com/health/medical/IM00892 i) Basal Cell: http://www.mayoclinic.com/health/medical/IM00272 j) Assignments a) Soap #2 Tuesday Nov 12, 2013 b) Google doc clinical log by Tuesday am c) Attend Wimba lecture on integumentary system d) Oral case presentations group 2 following wimba lecture discussion

Week 11: Tuesday Nov 19, 2013 Female Exam and GU 1. Preparation – Pelvic examination: http://www.dnatube.com/video/8593/Tutorial-on-pelvic- examamination; bimanual exam: http://www.youtube.com/watch? v=WgOPaS86CJA&oref=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv %3DWgOPaS86CJA&has_verified=1 2. Rectovaginal exam: http://www.youtube.com/watch?v=NmJn8mXlNfA 3. reproductive model: http://www.dnatube.com/video/5166/Female-Reproductive-Model-- Pelvic-Organs-Surface-View; 4. see complete female exam parts 1-5 on this link: 5. http://www.learnerstv.com/lectures.php?course=ltv032&cat=Medical a) Rhoades female chap 13 b) Practice female assessment to sexuality/GU 6. Assignments a) Google doc clinical log by Tuesday am b) Attend Wimba lecture on GU system c) Quiz 5 on content from week 9 and 10; 12 questions d) Complete peer review of colleague’s soap note posted in Blackboard due on Nov 21.

Week 12: Tuesday Nov 26 Gentalia Male & complete exam a) Preparation – Lab tests commonly ordered for problems related to male GU b) Male GU exam video: http://www.dnatube.com/video/9164/Urological-Examination-for- Male c) Practice assessment putting it all together see male examination linked at this site d) Parts 1-4 http://www.learnerstv.com/lectures.php?course=ltv032&cat=Medical 1. Assignments a) Google doc clinical log by Tuesday b) Attend Wimba lecture on Male GU system c) Quiz 6 on content from week 11 and 12 female and male GU only on Nov 26 following Wimba

Week 13: Tuesday Dec 3, 2013 Lifespan review films on male and female complete exams above 1. Preparation- Life Span and MS changes a) Rhoades and Peterson Chapter 14

b) Toy and Briscoe case studies 11, 18, 29 c) Tanner’s Stages of development: http://www.youtube.com/watch?v=PanL62uquoA d) Scoliosis http://www.choc.org/video/index.cfm?vid=12 and resource page e) http://www.orthobullets.com/spine/2053/adolescent-idiopathic-scoliosis f) Attend Wimba Lecture on content related to this week’s readings g) No quiz this week content will be on the final exam. 2. Assignments a) Google doc clinical log by Tuesday am b) Attend Wimba lecture on Life span assessments c) Complete clinical log on Google doc on/before Tuesday am d) Soap #3 Tuesday Dec 3, 2013’ e) Peer Review of colleagues log due no later than Dec 10 th am. f) Exam #3 Tuesday Dec 10, 2013 7:30 pm weeks six through 13. 40 questions Final clinical log on Google doc by Fri December 13 g) Final clinical evaluation email and hard copy mailed by Fri Dec 20, 2013.

Course Dates

Sept 10 First Day of Class, Wimba 7L30 Sept 10, 20137:30 to 8:30 followed by selected weeks quizzes in Blackboard with Proctor Cam. Sept 17 Add drop deadline 100% refund Sept 17 Quiz 1 in Blackboard Sept 24 Add/change deadline 50% refund Oct 1 Quiz 2 Oct 8 Quiz 3 Oct 14 University closed Oct, 15 SOAP #1 Oct 22. Peer review of soap note 1 due; Oct 22 Midterm exam Blackboard 7:30 to 9 pm EST Nov 5 Quiz 4_ Nov 7 Pass/fail/withdrawal deadline Nov 11 University Closed Nov 12 SOAP #2 Nov 11 University closed Nov 19 Quiz 5 Nov 21______Peer review of soap note #2 _ Nov 26 Quiz 6_ Nov 26 INC form due Dec 3 SOAP #3 no quiz this week Dec 10 Peer review of soap note #3 due on Dec 10 Dec 10 Final exam in Blackboard 7:30 – 9 pm EST Dec 13 Final clinical evaluations and 65 clinical hours and cases logged on Google docs complete

Dates subject to change: but we hope they won’t good luck and enjoy learning.

23 | 615 Syllabus