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Midwestern UniversityArizona College of Optometry

External Rotation Student and Preceptor Manual

Academic Year 2014 - 2015

Midwestern University Arizona College of Optometry

19555 N. 59th Ave.Glendale, AZ 85308

Midwestern University External Rotation Manual

Revised June 10, 2014

Dear External Preceptors,

Thank you for serving as a preceptor for the 2014-2015 Arizona College of Optometry External Rotation Program. This manual is a guide to help ensure the most successful rotation you can offer.

We encourage students to be self-directed in their learning, take initiative and make the most of their time at your external rotation site, however they cannot do so without your guidance and direction. Please take the time to go over expectations, goals, and the schedule of activities on day one. The most favorable outcomes are dependent on open communication. We are here to assist you in any way we can.

Students are required to bring a prepared Professional Portfolio to your external rotation site. The portfolio will include an updated CV, emergency contact information, immunization record, CPR certification, certification of training for universal precautions, OSHA regulations, HIPAA regulations, and an anti-harassment and discrimination course, their goals for your rotation, and other confidential documents.

The External Rotation program plays an essential role in the preparation of students for entry into professional practice. We want to thank you again for your guidance and instruction of our students. We are so pleased to have you participate in this vital component of the educational process for tomorrow’s practicing optometrists. Feel free to contact us at any time during the rotation to discuss any student issues or concerns.

Best,

Alicia Feis, O.D.Assistant Director, Clinical Rotations [email protected]

Joshua C. Baker, O.D, M.S.Assistant Dean of Clinical [email protected] 623-806-7211

Victoria KimberlinClinic [email protected]

Lori KleinClinical Education [email protected]



mailto:[email protected]




623-806-7243

TABLE OF CONTENTS

Item Page Number

Mission Statements…………………………………………………………Arizona College of Optometry, External Rotation Program

4-5

External Rotation Program Overview………………………………… Course description and objectives

6

Calendar………………………………………………………………… 7

Clinical Conduct Policies ……………………………………………… Attendance, student attire, professionalism and incident reports

8-10

University and College Policies………………………………………… Alcohol/drug policies, criminal background checks, immunizations, rotation

training, special requirements, CPR training, liability insurance, counseling, disability/medical concerns, compensation, travel and lodging, communications, academic honesty, professional misconduct, concerns

11-18

Clinical Rotation Policies ……………………………………………… Student schedule, practice management, absences and time off, grading,

remediation, grade appeals, externship failure, extended program

19-25

Responsibilities of the Extern……………………………………………… Professional portfolio, rotation time line, program evaluations, patient activity log,

concerns

26-28

Responsibilities of the Site and the Preceptors…………………………… Student confidentiality, teaching, student evaluation, concerns, student

professionalism, dismissal or removal of an extern, communication and participation, training resources, adjunct status, housing, administrative responsibilities

29-34

Rotation Schedules ..........….……..……...………………………………35

Appendices…………………………………………………………………36-49

Appendix 1. Incident report formAppendices 2 & 3. Absence request formsAppendix 4. Grading formAppendix 5. Preceptor and site evaluation formAppendix 6. Patient logAppendix 7. Miscellaneous Tips On Teaching With A Student Intern



Important Numbers and Contact Information……………………………. 50

Mission Statement Arizona College of Optometry

The mission of Midwestern University Arizona College of Optometry (AZCOPT) is to educate future optometrists and residents in an interprofessional healthcare environment. The College fosters professional attitudes and behaviors that encourage lifelong learning and scholarship to serve the needs of the public and improve the health and well being of society.

The Goals of the Arizona College of Optometry are listed below.

Provide broad and innovative educational opportunities in the basic, visual, and clinical sciences

Plan and develop a diversity of clinical experiences to allow our students to enter the practice of optometry

Support and nurture an environment of intellectual inquiry and activity by students, residents, and faculty

Promote interprofessional educational programming to develop students’ appreciation of other health care professions

Ensure that students have a strong basic and vision science foundation Promote student involvement in community service Develop a high quality residency program Establish an Eye Institute that serves the eye/vision care needs of the community Provide lifelong learning activities and support services to the optometric profession and

the public Maintain the financial viability of the College



Mission StatementExternal Rotation Program

Arizona College of Optometry

The mission of the External Rotation Program of the Arizona College of Optometry (AZCOPT) is to support the missions of the College and the Clinical Program by expanding the educational and clinical experience of optometry students. This is accomplished by enabling students to provide optometric care to diverse patient populations in off-campus health care facilities.

The Goals of the AZCOPT External Rotation Program are listed below.

Provide clinical experiences which expose student clinicians to:o large numbers of patient encounters to allow the further development of diagnostic

and management skillso the provision of continuous services to individual patients over a longer time period o practice management issues related to reimbursement, quality assessment and

improvement, office management and practice development Place students in professional environments which foster development of values and

attitudes which enable the student to provide quality health care services that are of maximum value and benefit to patients

Provide guidance and support including, but not limited to preceptor training, site visits, and evaluation tools which will enable preceptors to maximize the value of the externship experience for students

Offer a variety of external rotation sites to each student to maximize educational benefit Assess student performance and activity at each external rotation site Maintain adequate documentation of externship program to insure that its quality and

effectiveness can be demonstrated to interested third parties Facilitate regular ongoing communication between external rotation site preceptors and the

Arizona College of Optometry to ensure continued high quality clinical education for optometry students



External Rotation Program Manual

This External Rotation Manual is intended to provide AZCOPT students and the external rotation site preceptors with specific information and policies related to the AZCOPT external rotation program. For information or polices not directly addressed in this manual, the reader is directed to the Midwestern University Eye Institute Manual or the Midwestern University College Catalog, both of which are available to site preceptors online at www.midwestern.edu

Overview of Rotation Requirements for Fourth Year StudentsClinical experiential sequences will vary depending upon the availability of affiliated external rotation sites, students’ preferences for rotation assignments, and the optimal rotation schedule that best meets the educational objectives of the External Rotation Program as determined by the Assistant Dean of Clinical Affairs and the Assistant Director, Clinical Rotations. The fourth professional year is comprised of a series of full time-clinical rotations or externships of approximately twelve weeks in duration.

1. Course DescriptionThe external rotation program is designed to provide the fourth-year optometry students with

three quarter-length rotations at off campus sites and one quarter at the Midwestern University Eye Institute (unless otherwise approved by the course director). The purpose of these rotations is to provide the student with the opportunity to be mentored and taught by outstanding practitioners in primary and/or secondary care optometry settings. The external rotation program is an essential and integral part of the curriculum, designed to contribute to the transformation of students into complete health care professionals who can apply scientific knowledge and clinical abilities for the benefit of patients. The student is expected to participate in patient care under the instruction and guidance of faculty and adjunct faculty, according to the highest standards of clinical, moral and ethical conduct.

2. Educational ObjectivesIt is expected that students’ cognitive, technical and analytical skills will continuously improve over the fourth-year experience. It is expected that their knowledge base will be broadened and deepened during the external rotations, and that interpersonal skills, attitudes and values will improve throughout the process. AZCOPT graduates are expected to have achieved entry-level competence that allows them to independently manage the most common eye and vision care needs of patients accurately and efficiently. Graduates are expected to manage conditions that may be outside entry-level competence through effective utilization of appropriate referral or consultation. In addition, the externship experience is intended to provide opportunities for students to interact within a practice or other health care institution in a manner that furthers their ability to establish themselves in a setting that is conducive to the provision of excellent services to patients and results in a satisfying and successful professional career.

External rotation sites are considered an extension of the College’s clinical program. Therefore, policies of the College will be enforced, when applicable and not in conflict with existing external rotation site policies. Preceptors should be familiar with these policies and assist in their enforcement.



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CalendarAlthough most external rotation sites generally follow the dates in the Rotation Calendar of the college, it is at the discretion of the external rotation site to determine what days are granted as holidays and days off. Externs SHOULD NOT ASSUME what days you will have off during the course of your rotation. You must communicate with your external preceptors about what days may be granted and what days you are expected to work. Recall that this is a clinical education program inserting itself into busy optometric practices and a full operation of the clinic is vital to the continuation of the practice as well as the program.

AZCOPT Rotation Schedule 2014-2015Rotation 1- Summer Quarter (May 26 – August 13, 2014) Rotation 2- Fall Quarter (August 18 – November 5, 2014)Rotation 3- Winter Quarter (November 10 – February 18, 2015)Rotation 4- Spring Quarter (February 23 – May 15, 2015) Clinic Make-up Days May 19-23, 2015

Midwestern University HolidaysThe student will be scheduled according to the regular work day and holiday schedule of the external rotation site. The following are Midwestern University holidays (no classes held). The external rotation site preceptor is not obligated to observe this schedule.

Independence Day-July 4, 2014Labor Day-September 1, 2014Thanksgiving Holidays-November 27-28, 2014Christmas Eve-December 24, 2014Christmas Holidays-December 25-26, 2014New Year’s Eve-December 31, 2014New Year’s Day-January 1, 2015Martin Luther King, Jr. Day-January 19, 2015Memorial Day- May 25, 2015

Class of 2015 Pre-Graduation ActivitiesStudents are expected to attend mandatory activities on campus in May 2015 prior to graduation. More information will be provided about the financial aid exit interviews, AZCOPT focus groups, AZCOPT Student Survey, Post-AZCOPT student survey, and AZCOPT lectures and debriefings at a later date.

Class of 2015 GraduationStudents will graduate at the Midwestern University campus in Glendale, Arizona on May 28, 2015.



Clinical Conduct PoliciesClinical service is a privilege. Each extern represents not only him/herself, but also the college and the profession. For these reasons the extern is expected to maintain high standards of conduct at all times.

Attendance Attendance is mandatory for all assigned clinic sessions. Students are responsible to report 15 minutes before the assigned clinic session starts unless specified by the preceptor. The extern will have their necessary equipment in their exam room and readily available before the appointment of their first patient. If possible the extern will review the patient records at least one day prior, in preparation for patient care.

Externs must remain in the assigned clinic at all times until all patients have been examined and the preceptor has released the student. All possible consideration will be made to complete the clinical assignments within the business day. If the student needs to leave the clinic during their shift, the student must obtain permission from the preceptor and notify the reception desk of his/her whereabouts.

Student AttireProfessional appearance and demeanor are critical to developing patient rapport and confidence. Adherence to the established dress code will be factored into the students’ midpoint and final grade in the area of professionalism. The following information outlines the dress code requirements observed at the Midwestern University Eye Institute. It is recommended that these requirements also be observed at external rotation sites, unless the site has its own specific requirements that may or may not conflict with AZCOPT requirements. The external rotation site has the ultimate authority over optometry student dress code.

Name TagsStudents must be identifiable by a name tag while on campus or external rotation sites. The name tag should be kept current and should be clearly visible. The external rotation site may also provide a name tag specific to that site.

Lab Jackets and CoatsAZCOPT-approved short white, long-sleeved student lab coats should be clean and pressed at all times and are required during patient care activities (unless otherwise approved). You may have to purchase a clinic coat without the AZCOPT logo, if required by the site. (Student is responsible for this cost). Clothing worn beneath the lab coat should be appropriate for a health care professional.

Proper Attire: common sense and a sense of professionalism should dictate daily attire. Be attentive to all aspects of your personal hygiene. Hair should be clean and well groomed. Long hair should be tied back. Dramatic

styles and wet hair are not appropriate. Beards should be well groomed. Jewelry should be kept to a minimum, with limited visible body piercings. Earrings

should be small and no longer than one inch below the lobe.



Clothing should fit and should be clean and pressed. Clothing that has unprofessional wording or images of any kind are not appropriate. T-shirts are not appropriate. Baggy “sagging” pants, halter tops, backless or midriff-baring tops, and fatigues are not considered appropriate. Sweatshirt material is not considered appropriate. Dresses and skirts should be no more than two inches above the knee and should be worn with appropriate hose and shoes. Mini-skirts or revealing necklines are not appropriate.

Tattoos should be covered. Perfume should not be worn in a patient care setting. Make-up should be kept light. Shoes should be appropriate. Open toe shoes are prohibited. Appropriate hosiery or

socks are to be worn at all times. Dress slacks, dress blouses or tailored shirts are appropriate. Ties are required.

Additional pins are limited to professional organizations only. (ie. AOA, AAO, COVD etc.) Industry-sponsored awards or logos are not appropriate.

Cell phones should be turned off or placed on “silent” mode and will be limited to emergencies only during external rotation hours. Appropriate clinical applications may be accessed to assist in patient care. Personal use during clinic encounters is inappropriate.

These guidelines are not all-inclusive. Students are expected to adhere to the spirit of the dress code. The Assistant Director, Clinical Rotations and/or the preceptor will make the final determination of whether a student is in compliance with these standards. An out of compliance student will be removed from patient care immediately, can be referred for professional ethics evaluation and will be considered as an unexcused absence.

ProfessionalismThe demonstration of professionalism is critical to the success of a healthcare professional. The development of the values and attitudes that are required of a professional occurs over a period of time and must begin early in a student’s education. In this way, professional behavior becomes an integral part of an individual. Professionalism is demonstrated by the student who:

Uses appropriate verbal and non-verbal communication Is punctual, appropriately attired and adheres to appropriate clinic policies and guidelines Is reliable, dependable and accountable for one’s actions Behaves in an ethical manner Produces quality work Accepts constructive criticism and modifies behavior, if necessary Is cooperative - i.e. non-argumentative; willing and helpful Is non-judgmental-student demonstrates an attitude of open-mindedness toward others and

situations; does not “stereotype” others or prejudge situations Communicates assertively - actively and appropriately engages in dialogue or discussion Is self-directed in undertaking tasks; self-motivated Is respectful-demonstrates regard for self, patients, peers, faculty, staff and university

property Is empathetic - demonstrates appreciation of others’ positions; attempts to identify with

others’ perspectives; demonstrates consideration towards others



Handles stress - remains calm, level-headed and composed in critical, stressful or difficult situations

Is an active learner - seeks knowledge; asks questions, searches for information and takes responsibility for one’s own learning

Is confident - acts and communicates in a self-assured manner, yet with modesty and humility

Follows through with responsibilities - if a task is left incomplete or a problem is not resolved, student seeks aid

Is diplomatic - is fair and tactful in all dealings with patients, peers, faculty and staff Demonstrates a desire to exceed expectations - goes “above and beyond the call of duty”,

attempts to exceed minimal standards and requirements for tasks assignments and responsibilities

Utilizes time efficiently - allocates and utilizes appropriate amounts of time to fulfill responsibilities; utilizes others’ time wisely

Understands and respects patient confidentiality and adheres to all HIPAA requirements

Incident Report (Please see Appendix 1 on page 36)Professional demeanor must be maintained at all times while in clinic and class. This includes attitude, work habits, patient communication, ethics, dress code, attendance, conduct, courtesy, respect, and Health Insurance Portability and Accountability Act (HIPAA) compliance. Any observed behavior not consistent with a professional demeanor will be documented using the Student Incident Report Form. Any significant documented behavior over the duration of the students’ fourth year rotation series not consistent with a professional demeanor will result in the following:

1st report: Written communication from Assistant Director, Clinical Rotations to the student outlining the infraction and a review of the professional conduct policy including repercussions for not adhering to the professional conduct policy.

2nd report: Meeting with the Assistant Director, Clinical Rotations. 3rd report: Meeting with the Assistant Director, Clinical Rotations and Assistant Dean of

Clinical Affairs. 4th report: Meeting with the AZCOPT Dean, referral to the Student Promotion and Graduation

Committee, failure of the course, and/or dismissal from the program.

An egregious unprofessional misconduct reported at any time may result in immediate failure of the course, and/or dismissal from the program regardless of whether any previous Student Incident Report has been filed.

Additionally, if a student receives a “needs improvement” (NI) on the professionalism and conduct portion of the student clinical grading form at the midterm evaluation, a meeting with the course director and/or the Assistant Dean of Clinical Affairs to discuss acceptable behaviors and the consequences of failure to meet the expectations for professional conduct. If a student receives a “needs improvement” (NI) on their final evaluation, a meeting with the AZCOPT Dean will be scheduled, as well as referral to Student Services, failure of the course, and/or dismissal from the program will result.



University and College Policies

Alcohol/Drug Policy and ProceduresA Drug-Free Workplace and Substance Abuse Policy and Procedure has been established for Midwestern University in order to appropriately serve the needs of faculty, staff, and students. This policy has been established to implement a drug-free workplace and academic environment consistent with federal and state law, including the terms and conditions whereby employees, students, volunteers, faculty, physicians, and other professionals may be disciplined for violation of these policies and tested for suspected use of an illegal drug or alcohol.

As part of the Drug-Free Workplace policy, entering students must sign and submit a statement to the Office of Student Services indicating that they are drug-free and that they agree to abide by Midwestern University’s Drug-Free Workplace and Substance Abuse Policy. The signing and submitting of this statement occurs as part of each new student’s Orientation Program the week prior to the onset of classes. The Dean of Students maintains these statements in the Office of Student Services. In addition, the Office of Student Services emails a copy of the current Drug-Free and Substance Abuse Policy annually to all students for their review.

Midwestern University maintains a drug-free environment consistent with the principles of the Federal Drug-Free Schools and Communities Act and the Drug-Free Workplace Act. All offers of employment and enrollment of students are conditional on students abiding by Midwestern University’s Drug-Free Workplace and Substance Policy. In addition, a student who is convicted of a state or federal offense involving the possession or sale of an illegal drug (a controlled substance as defined by the Controlled Substance Act and does not include alcohol and tobacco) that occurred while the student was enrolled in school and receiving Title IV aid, is not eligible for Title IV funds. For more detailed information concerning Title IV funds and convictions for the sale of illegal drug see the Student Financial Services section of the catalog.

The stated policies and procedures apply to all students of Midwestern University on campus, or at all facilities operated by the affiliated entities. The stated policies and procedures also apply to any student who is enrolled at another academic institution but rotating in a clinical service on the premises of a facility operated by MWU. The University reserves the right to evaluate any student if there is a reasonable cause to suspect that he/she is abusing or is under the influence of alcohol or illegal drugs/substances. A student is considered to be under the influence when his/her ability to perform usual tasks is diminished or impaired due to the apparent use of an illegal drug/substance, alcohol, or a combination thereof. Any student who attends a class or a clinical rotation under the influence of alcohol or who is suspected of abusing drugs will be required to undergo an immediate drug and/or alcohol screening in accordance with this policy. While the costs of these initial drug screenings are typically the responsibility of the appropriate college or the Office of the Dean of Students, transportation to an emergency room for those students who are exhibiting signs of physical/mental impairment will be the responsibility of the student.

If a student is found to have a positive drug screen and he/she is taking prescription drugs, he/she will be asked to provide documentation to both the University and/or the Medical Review Officer in the form of either a physician’s or pharmacist’s name and phone number where they can be contacted for verification. If however, the student is found to have a positive drug screen without documentation of a legitimate prescription, he/she will be subjected to disciplinary action, which Midwestern University External Rotation Manual


may include immediate suspension and/or medical leave. Although extreme cases may result in expulsion, it is the intention of Midwestern University to assist students with chemical dependencies by helping the student receive the appropriate counseling and treatment for his/her dependency.

Criminal Background ChecksDue to growing nationwide concerns regarding the suitability of today's health care providers, many hospitals, health care systems, clinics, physician offices, or pharmacies providing health care services require disclosure of an individual's criminal history. In addition, many state statutes also require disclosure of an individual's criminal history in order to apply for certain health professional certificates, registrations, and licenses. Existence of a criminal history may subject an individual to denial of an initial application for a certificate, registration, or license to practice in a clinical setting or result in the revocation or suspension of an existing certificate, registration, or license. In response to this growing trend, Midwestern University requires students to submit to criminal background checks.

It is the policy of Midwestern University that all accepted students must submit to a criminal background check prior to matriculation. In addition, students who remain enrolled must submit to a criminal background check as needed to remain eligible for continued participation and/or to participate in clinical rotations. In accordance with the laws of the State of Illinois, CCOM students are required to undergo fingerprinting as part of the criminal background check process. Students in other programs may also be required to undergo fingerprinting.

The criminal background check involves obtaining an authorization from a matriculating or current student that allows the University to obtain the student's individual criminal history. The results of the background check are reviewed by the Dean of Students to determine whether or not there is a record of misdemeanor and/or felony convictions. If there is a positive record, the Dean of Students will inform the appropriate Academic Dean and the Director of University Risk Management so the University can make a determination whether the criminal history will negatively impact the student's admission status or ability to complete the practical training/rotation requirements of the degree program.

Criminal background checks are conducted through Student Services as part of the initial student matriculation process and on an as-needed basis thereafter while a student is actively enrolled at Midwestern University.

1. All matriculating students must complete the Criminal Background Release and Consent Form to conduct the criminal background check. All newly admitted students who have submitted a matriculation deposit are provided with access to a copy of the University policy and the Criminal Background Release and Consent Form. By going to the Midwestern University website (http://www.midwestern.edu) and selecting MWUNET, the student can find the Student Handbook and consent form.

2. The Office of Student Services will contract with a professional service to conduct the criminal background check.

3. The Dean of Students will review all criminal background reports and determine whether or not a misdemeanor or felony conviction record exists. If a felony or misdemeanor



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conviction exists, the Dean of Students will conduct a criminal background investigation. The investigation may include any of the following components:

a. Request for additional detailed information about the positive criminal background check report. This may entail one or more meetings with the student.

b. Collection of additional data, e.g., Federal Bureau of Investigation fingerprints and report, concerning the positive criminal background check report.

Following the criminal background investigation, the Dean of Students, in consultation with the Academic Dean (or their designees), will determine whether or not the student should be disqualified from matriculation or continued enrollment. Criminal convictions will not automatically disqualify a student from enrollment or continued enrollment. The University will consider such factors as (but not limited to) the nature of the crime, the age of the individual at the time the crime was committed, length of time since the conviction, the nature of the clinical program and the relatedness of the conviction, and whether the University will be able to provide appropriate professional clinical training to the student.

4. Failure to disclose a conviction or material misrepresentation of information by an incoming or enrolled student is deemed to be falsification of the application and may result in denial of admission, matriculation and/or dismissal from the program and University. Students must disclose any misdemeanor or felony charge/conviction.

5. Failure of the student to present appropriate forms to the Office of Student Services for the purpose of conducting criminal background checks when requested will bar the student from initial matriculation and/or continued enrollment.

6. Students with a positive criminal background check are individually responsible for checking the licensing and certification requirements in any state where the student is interested in participating in a preceptorship, internship, clinic or other rotation to determine whether or not their conviction may be a barrier to participation.

7. Students are required to disclose to the Dean of Students and appropriate Academic Dean any arrests, criminal charges, or convictions against them during their entire period of enrollment as a student at Midwestern University. Such arrests, criminal charges, or convictions may negatively impact a student's ability to obtain and/or complete clinical rotations or preceptorships.

8. Midwestern University does not guarantee clinical rotations for students who have a history of felony or misdemeanor charges/convictions. In such cases, the University confidentially shares information about the student’s positive criminal background history with potential preceptors and practice site representatives as necessary and on a need-to-know basis. This may include releasing a copy of the original Criminal Background Check report for their review. This gives the preceptor and site representatives an opportunity to decide whether the student is acceptable to the site. For this reason, scheduling and completion of practical training/rotations and graduation may be delayed. In some instances, it will not be possible to arrange for practical training/rotations at specific sites.

a. If this information is known by the University prior to the student’s matriculation, the Dean of Students and/or Academic Dean (or their designee) will meet with the potential student to discuss the consequences of the positive criminal background investigation on the student’s ability to complete degree requirements so that appropriate action can be taken.



b. If this information is known by the University after the student’s matriculation, the Dean of Students and/or Academic Dean (or their designee) will meet with the student to discuss the consequences of the positive criminal background investigation on the student’s ability to start/resume practical training/rotations and the student’s ability to graduate so that appropriate action can be taken.

9. Records concerning a student’s positive criminal background check are stored in a confidential file in the Student Services Office and Office of the Academic Dean.

10. In the event that a student is assigned to a practical training/rotation site that requires a copy of the original Criminal Background Check report prior to a student’s placement at the site, the student’s criminal background check report and cover letter will be scanned into an encrypted password protected PDF file. The encrypted PDF file will be forwarded via email to the rotation site coordinator.

Immunization GuidelinesTo complete the matriculation process, all students must submit completed medical files documenting completion of a physical exam, immunizations, tuberculosis and titer blood testing. Specifically, all students must submit documented laboratory proof of the absence of tuberculosis and proof of immunizations against measles, mumps, rubella, varicella (chicken pox), diphtheria/tetanus/pertussis and hepatitis B. There may be some additional requirements depending on the student’s particular program, e.g., Veterinary Medicine students are also required to show documented laboratory proof of rabies vaccinations. In addition, all students in health professional degree programs are required to prove the efficacy of their immunizations through blood titers, to measure the level of circulating antibodies associated with these various diseases. Depending on the program, students may also be required to submit to a drug screen.

While enrolled, all students in health professional degree programs must submit annually documented laboratory proof of the absence of tuberculosis, must update diphtheria/ tetanus/ pertussis vaccination if necessary, and must receive an annual seasonal flu vaccination.

Cost for these requirements must be paid by the student, but may be built into the student’s financial aid budget. Rabies vaccinations are included in the cost of education for Veterinary Medicine students. Any reimbursement from an insurance plan is a matter between the student and his/her insurance carrier. Immunization clinics for some vaccination/ inoculations are provided on both campuses to assist students with their compliance requirements. Information on immunizations, titers, cost, and immunization clinics is provided through the Wellness Center (Downers Grove Campus) and the Office of Student Services (Glendale Campus).

Waiver of a University Immunization RequirementA student can request a waiver for a University immunization requirement from the Office of Student Services and their respective College Dean/Program Director, but the student must be aware that the requirements are established by affiliated rotation sites and Midwestern University. Failure to satisfy immunization requirements will compromise a student’s ability to participate at certain clinical rotations sites that require those immunizations. Moreover, procurement of alternate clinical experiences and/or clinical rotation sites that do not require immunizations may not always be possible. As a result, a student’s progression through their academic program is likely to be slowed as a result of



leaves of absence, a student’s anticipated graduation date is likely to be delayed, or the student may be unable to complete their respective clinical program and not graduate.

If a student’s clinical training is at a Midwestern University clinic, the student with an approved immunization waiver will be required to follow the patient contact restrictions stipulated by the University Office of Risk Management and the health professional degree program.

Record AccessStudents are required to keep a copy of all health information turned into the University. A student who wishes to inspect his/her original health and/or immunization file can do so through their online Student Portal, or to receive a copy of such record, the student is required to submit a written request to the Wellness Center on the Downers Grove Campus and the Dean of Students on the Glendale Campus. Requests for records will be honored no later than one week from the written request date. Inspection of a student’s original health record is made in front of the responsible administrator or designee. Students are allowed copies of their medical records. Students requesting multiple copies of their health and/or immunization records may be charged a copying fee.

On-Line Pre-External Rotation TrainingStudents are required to complete the following self-instructional, self-paced, (or independent study) on-line training via LawRoom before clinical experiences are assigned and renewed annually.

Universal Precautions Related to Bloodborne Pathogens HIPAA Privacy and Security OSHA Regulations in Illness and Injury Prevention Anti-Harassment and Discrimination

Students will be provided with all necessary login information and instructions by the Clinical Education Coordinator. A record of the students who completed the training is kept on file in the Clinical Education Coordinator’s office. Failure to complete all requirements as requested by the Clinical Education Coordinator may result in cancellation of the external rotation causing the student to be placed on an extended track requiring a late graduation date as well as additional tuition fees.

Special Requirements for RotationsClinical rotation sites may have additional requirements such as, but not limited to: corporate on-line training, urine drug screens, additional health requirements, and fingerprinting. Students will be notified in advance so that these requirements will be completed before the rotation starts. These costs will be at the student’s expense. Failure to complete all requirements as requested by the Clinical Education Coordinator may result in cancellation of the external rotation causing the student to be placed on an extended track requiring a late graduation date as well as additional tuition and fee charges.



CPR TrainingAll students, prior to the start of the clinical program, must become certified in Basic Life Support for Healthcare Providers (CPR & AED). A copy of the student’s Healthcare Provider certification card must be submitted to the Clinical Education Coordinator before the student will be allowed to begin their clinical experiences. Contact the Clinical Education Coordinator if your certification will expire during your rotation sequence. If the student does not have a current CPR card and does not complete CPR training when offered, the student must make his/her own arrangements at his/her own cost to become certified through the American Heart Association or another organization. Proof of certification must be submitted to the Clinical Education Coordinator at a minimum of one month prior to start of both the third and fourth academic year.

Liability InsuranceMidwestern University provides liability insurance for all students enrolled in the clinical rotation program. This insurance covers students only when they are participating in the optometry practice experiences in the United States as a part of the curriculum to satisfy graduation requirements.

CounselingMidwestern University provides confidential student counseling by an on-campus counselor to help students deal with a variety of non-academic and personal concerns. Short-term counseling is provided at no cost for all students who are currently enrolled in classes at Midwestern University. Students who present with long-term issues are referred to known off-campus specialists for assessment and treatment. All efforts are made to make referrals to providers on the student’s health insurance network so that the student does not incur additional costs.

To preserve confidentiality, appointments are made directly with the Student Counselor (623-572-3629). The counselor can be reached Monday through Friday during business hours to schedule an appointment; however accommodations in scheduling are flexible for students off-campus or on rotations. For those students who cannot be on-campus, the counselor can provide assistance via telephone.

If a student is failing a rotation or not performing well, the student is highly encouraged to seek academic counseling from the Assistant Dean of Clinical Affairs, 623-806-7211, Associate Dean of Academic Affairs, 623-572-3941, or the Dean, 623-572-3901.

Disability Statement or Medical ConcernsIf you require accommodation for reasons such as a disability, if you have emergency medical information (e.g. medication or food allergy), or if you need special arrangements in case the building must be evacuated, please notify the Clinical Education Coordinator. All requests for accommodations must be processed by the Midwestern University Dean of Students, following the guidelines outlined in the Midwestern University Student Handbook. Students should review any information regarding approved accommodations with their clinical preceptor on the first day of rotation.

CompensationStudents cannot receive payment, gifts, or rewards for any work for which they receive academic credit. There is no monetary compensation to students for participation in the external rotations.



Students are responsible for all transportation, housing, food and any other personal expenses associated with their rotations. In rare cases, site-specific housing may be provided for students.

Travel and Lodging It is the student’s responsibility to assure that he/she has made appropriate arrangements for lodging and transportation to /from clinical education/rotation/fieldwork sites throughout the curriculum. The University does not generally provide for the cost of transportation and lodging. Travel arrangements are the sole responsibility of the student. Students are not considered an agent or employee of the University and are not insured for any accidents or mishaps that may occur during any traveling that is done as part of the student’s professional program. Students are usually responsible for all expenses associated with clinical education, such as transportation, meals, housing, professional attire, laboratory fees, etc.

CommunicationsInternet access is available at some of the external rotation sites, but permission must be obtained from the preceptor prior to use. Such Internet use is to be limited to professional communication and the student’s current practice-related tasks. Internet access for personal use is available on-campus, public libraries, and other local Wi-Fi locations.

College faculty and administrators will use electronic means, in addition to regular mail, to communicate with students. This information may be important and/or time sensitive. Thus, the following are expectations of the College:

All students are required to check their University e-mail account on a daily basis. Official, “in writing” college and campus-wide communications are sent to students over e-mail. Students are responsible for information that is transmitted through this electronic medium (see Computer Code of Conduct in the MWU Student Handbook). The student University e-mail account is the only electronic mailing address recognized by the University. The University and its employees are not responsible for forwarding email to students at personal email accounts that are not held by the University. Information included in the student emails should follow the guidelines of appropriate professional conduct. (See Computer Code of Conduct and Appendix 4, Section 2, Subsections a and b under Grounds for Action: Academic and Professional Misconduct of the MWU Student Handbook).

Lack of access to electronic communication is not a valid excuse for failure to respond to a request, perform an assignment, or meet a deadline.

Academic HonestyAcademic honesty and integrity are expected of all students throughout their course of study at Midwestern University. Academic dishonesty includes, but is not limited to, intentional cheating, fabrication, plagiarism, and knowingly helping or attempting to help others be dishonest. Academic dishonesty lowers scholastic quality and defrauds those who will eventually depend upon your knowledge and integrity. Any violation of this code is considered to be a serious academic violation and may result in a reprimand, written warning, academic and/or disciplinary probation, suspension, or dismissal. Academic dishonesty constitutes a breach of academic integrity that violates the academic foundation of an institution and compromises the integrity and well-being of the educational program. The policies on students’ academic and professional



responsibilities are included in the Appendices 1 through 4 of the Midwestern University Student Handbook.

Professional MisconductViolation of the policies, procedures and protocols of either, Midwestern University, the Arizona College of Optometry, or an affiliated clinical rotation site constitutes academic or professional misconduct. Professional misconduct includes (but is not limited to) dishonesty involving any component of clinical care or patient records by alteration, fabrication, forgery of signatures; excessive unexcused absences; habitual tardiness; practicing optometry without a license; use of the clinic for financial gains, or receiving a fee for services rendered or materials ordered. Patient endangerment or abandonment also represents professional misconduct. Any form of professional misconduct is grounds for disciplinary action as outlined in the Midwestern University Student Handbook.

ConcernsStudents and preceptors should contact the Assistant Director, Clinical Rotations to report verbally and/or in writing, violations of optometry rotation program policies. This includes alleged ethical and legal violations of the practice of optometry, alleged sexual harassment, verbal abuse, inappropriate and offensive physical contact and any form of discrimination. These types of incidents should be reported immediately. Immediate reporting of such incidents will allow the appropriate action to be taken in accordance with Midwestern University AZCOPT policies.



Clinical Rotation Policies

External rotation sites are considered an extension of the College’s clinical program. Therefore, policies of the College will be enforced, when applicable and not in conflict with existing external rotation site policies. Preceptors should be familiar with these policies and assist in their enforcement.

Student ScheduleThe external rotation program goal is for each fourth year student to average 40 hours of patient contact per week. Early weeks of the session may have less direct patient contact as the student’s abilities are being assessed and the student becomes familiar with the sites policies and procedures. As the student adapts to the site and the preceptor becomes more comfortable with the student’s competence, patient contact may occasionally increase above 40 hours per week, but not to routinely exceed 40 hours per week. Students are not limited to a 40-hour work week, Monday through Friday, and may be assigned whenever the practice is open.

Practice ManagementOne of the identified shortcomings of traditional optometric education is the lack of adequate training in optometric practice management. With this in mind, the students should be exposed to as much clinical practice management as possible at each external rotation site. The appointment scheduling process, patient flow within the clinic, billing and coding, and staff management are all important aspects of optometric practice. The student should gain exposure to all aspects of daily operations. Students should be included in discussions and office meetings with the site’s accountant, business manager, insurance specialist, procurement person, personnel manager, inventory clerk, and other individuals with knowledge and information whenever possible. Students should be encouraged to take advantage of this time and these opportunities

Absences and Time-off

Absences from clinical assignments (Please see Appendices 2 and 3 on pg. 37 and 38)An extern’s primary responsibility is to the patients and their care. Changes in the clinic schedule particularly those on short notice, may greatly compromise patient satisfaction and/or disrupt clinic flow. As a result absences from clinical assignments are taken very seriously.

If makeup time cannot be accommodated at the external rotation site the extern may be required to make up the missed time during make up days at the Midwestern University Eye Institute prior to and/or following commencement.

To maintain accreditation and maximize clinical experiences students are allotted 2 personal days and 6 professional days for the last professional year. Any day(s) taken beyond that will be made up on clinic makeup days specified by the Assistant Director, Clinical Rotations or the Assistant Dean of Clinical Affairs. Although the students are allotted the above time, it is solely at the discretion of the preceptor to grant any requested days off, excluding written National Boards examination times. If days in the personal or professional area are not used, it cannot be combined with time from another area.



Excused Absence for a Personal ReasonMake-up requirements for excused absences for personal reasons (i.e. illness, family issues) will be determined by the external rotation site preceptor and/or the course director. Failure to comply with any portion of the attendance policy or the process for requesting time-off, will be considered an unexcused absence. An unexcused absence is grounds for a failure of a rotation Time off for these reasons is limited to a maximum of two days during the last academic year of the program.

Excused Absence for a Professional ReasonProfessional time is a benefit that fourth year students can use for activities that further their professional career (i.e., interviews for residency programs, attendance at professional meetings of scientific organizations, etc). Fourth year students may be granted a maximum of six (6) professional days off during the last academic year of their program. In the case of an external rotation site closure or activity other than patient care, the external rotation site will notify in advance the Clinical Education Coordinator.

AZCOPT students are required to take National Boards. Time off for National Boards is excused. Travel time to and from National Boards Part III is also excused, but this time must be approved by the Clinical Education Coordinator, the Assistant Director, Clinical Rotations, the external preceptor, and the office of the Dean. Approved time off for this purpose is applied to the six (6) professional days off during the last academic year of the program. Failure to comply with any portion of the attendance policy or the process for requesting time-off, will be considered an unexcused absence. An unexcused absence is grounds for a failure of a rotation. All excused absences must be reported to the Clinical Education Coordinator and appropriate Clinical Rotation Absence Forms completed and submitted.

National Boards are typically administered the following times during the year:

Part I: March and AugustPart II: December and AprilPart III: variable dates throughout the yearState Law: varies by state

For those that are rotating through the Midwestern University Eye Institute at the time of the National Board Exams (Part 1 and/or 2) the day before the National Boards exam may be excused for first time test takers.

Jury DutyIf a student receives their first summons for jury duty, it is recommended that students first postpone their summons online as indicated on the letter received from the court. If students get a second summons, they should bring the summons to the Office of Student Services. The Office of Student Services will write a letter for the student, asking for a delay in jury duty. The next time a student receives a summons, a letter cannot be written and the student should appear for jury duty. The student should inform the court that selection would result in hardship. An absence for jury duty needs to be documented, and a copy of the summons given to the Clinical Education Coordinator prior to the duty date.



Maternity Leave / Prolonged Illness PolicyEnrolled students who become pregnant can request a leave of absence for maternity reasons. The request must be in writing and sent to the Dean; however, prior to the officially requesting a maternity leave, pregnant students must contact the Office of the Dean to discuss how a leave will affect their progress in the academic program and review options available to them. The amount of leave time granted depends largely on the personal needs of the student and the timing of the birth within the academic program. In addition, students must inform the Office of the Dean of their intentions to return to classes at least one month prior to the end of the leave of absence period. A final decision is reached after careful consideration is given to the personal and professional circumstances.

For maternity or illness reasons, if more than ten clinic days (not to exceed 80 hours of clinic time), of assigned clinic time during an OD-4 rotation block is missed, the rotation will be cancelled and the student will be rescheduled for a replacement rotation site at the start of the next regularly scheduled rotation block. Rotation rescheduling to the same site/ clinic as previously assigned cannot be guaranteed. As a result of the rescheduling, the student’s completion of graduation requirements will be delayed and the student may not qualify to participate in the graduation ceremony for his/her class. No exceptions will be made to this policy.

Process for Requesting Planned Time Off in Advance Requests for days off are often approved on a first come, first serve basis. The following process of taking time off must be followed and it is possible that at any point in this process your request may be denied at the discretion of the College. A Request form for a Clinical Rotation Absence must be submitted by the student and approved by the following individuals a minimum of 2 weeks in advance of the date of absence in the following order:

Midwestern University Eye Institute Rotation:

1. The Preceptor for approval2. The Clinical Education Coordinator for approval

The student must be signed out of the clinical assignment to be missed and signed in to the make-up clinic assignment (if required). (Copies of supporting documentation of invitations or conference date times etc. may be requested at this time).

3. The Clinic Manager for approval and to make the appropriate adjustments to the clinic schedule

4. The Assistant Director, Clinical Rotations for approval 5. The Office of the Dean for final signature and approval

External Rotation:

1. The Clinical Education Coordinator for approval The student must be signed out of the clinical assignment to be missed and signed in to the make-up clinic assignment (if required). (Copies of supporting documentation of invitations or conference date times etc. may be requested at this time).

2. To the Assistant Director, Clinical Rotations for approval



3. The external rotation preceptor for final approval. The external rotation preceptor can deny any absence request, regardless if approved by the College.

4. The Office of the Dean for final signature and approval

NOTE: At any point in this process the approval can be denied if just cause is determined. Flight reservations, professional conference or meeting documentation may be requested from the student at any time during this process. It is suggested that the student obtain approval before purchasing any tickets for transportation and payment of any meeting registrations fees. Midwestern University is not responsible for any cancellation fees for reservations that are made prior to approval being given.

Off Campus Activities Any students seeking permission to attend an off-campus conference or program must be in good academic and professional standing.

Midwestern University approved student organizations must seek and be granted permission from the appropriate college dean or program/division director to send student representatives to an off-campus activity. This written request (usually made by the president of the organization) must be made at least one month prior to the activity.

Students who desire to attend an approved off-campus activity must submit a Request for Clinical Rotation Absence form and supporting documentation to the Clinical Education Coordinator. Once the Clinical Education Coordinator has approved the absence request, the form will be submitted to the Assistant Director, Clinical Rotations, to the student’s preceptor(s), then to the Office of the Dean for final approval and filing. Approved and completed forms, along with supporting documentation are to be submitted to the Clinical Education Coordinator at a minimum of two weeks prior to the scheduled absence dates. Students in both the Midwestern University Eye Institute and external site rotations need to follow these guidelines for an excused absence.

Students attending off-campus conferences or events must take full responsibility for making up any missed clinic, classes, laboratories, examinations, or other course assignments

Non-Planned Absence due to Personal Illness or Family EmergenciesIf unforeseen circumstances make an absence necessary, such as illness or accident, the student must notify the preceptor or designated contact if out on external rotations. The Assistant Director, Clinical Rotations and/or the Assistant Dean of Clinical Affairs should be notified at the earliest possible opportunity. If the student is currently at the Midwestern University Eye Institute they must contact the Clinical Educational Coordinator and the Clinic Manager BEFORE 8:00 am of the assigned clinic day. Failure to notify the Clinic Manager and/or the Clinical Education Coordinator will result in an unexcused absence for the day. An absence not reported to the appropriate contact will be considered an unexcused absence and may result in rotation failure. The clinical make-up time will be scheduled with a one-to-one ratio if a doctor’s note or verifying documentation is provided on the day of the student’s return; otherwise the absence is considered unexcused and will result in a two-for-one make-up.



Remediation

Clinical Education Remediation The Arizona College of Optometry clinical education remediation policy is based on the following concept: Clinical education is an interactive process and successful clinical performance requires the full participation of the student. A student who has difficulty in areas of clinical performance (that have been identified by low scores on the grading form or by observation of clinical skills) is expected to seek help, to identify and understand the problem, and to take an active role in correcting it. Faculty and preceptors may provide intense supervision at the student’s request; ultimately, however, the success of remediation depends on the student.

Specifically if a clinical attending/external preceptor notifies the college of concerns or failure of the performance of a student clinician and there are documented deficiencies in expected competencies, remediation in the form of an individual education plan (IEP) may be created to assist the student in the documented deficiencies. The individual education plan will be developed and implemented by the Assistant Director, Clinical Rotations in concert with the Assistant Dean and Clinical Affairs at the request of any clinical attending faculty and/or if failure of the student is reported at midterm evaluations.

The IEP will be constructed to the following format:1. Clearly identify the area(s) of deficiency2. Outlines activities ideas to enhance the student’s clinical understanding and skills related to

the area(s) of deficiency

Student clinicians may be suspended from direct patient care if patient safety is an identified risk. This would be considered a failure of the rotation and dealt with according to Midwestern University Policies.

It is up to the student to work towards the set goals. Re-assessment will be made during the rest of the quarter but ultimately the final grade will determine if the student has successfully passed the rotation. Although maximum effort may be exerted by the student in the event of a potential failure, this does not guarantee a passing grade. The student’s expectations of themselves as well as the attending’s expectations will be higher at the final than the midterm and it is possible that the effort may not be enough to have achieved a final passing grade.

Grade Appeals, Externship Failure and Extended Program

Midwestern University Grade Appeals PolicyA student who wishes to appeal a non-failing course grade must make the appeal to the course director within one week following the receipt of the grade. The course director must act upon the student’s appeal within one week following the receipt of that appeal. A narrative explaining the basis of the appeal must accompany the request. An appeal must be based on one of the following premises:

Factual errors in course assessment tools Mathematical error in calculating the final grade



Bias

If the appeal is denied, the student has the right to appeal the decision to the course director’s immediate supervisor within one week of receipt of the course director’s denial. The course director’s supervisor should notify the student of his/her decision within one week following receipt of the student’s re-appeal. The decision of the course director’s supervisor is final.

Appeal of Course Grades Subject to Academic ReviewA student whose academic progress will be subject to review by his/her Promotion/Academic Review Committee and who wishes to appeal a grade must do so in an expedited manner prior to the scheduled meeting of the Committee. In this case, an appeal of a didactic course grade must be submitted within 24 hours following receipt of the grade and must be based on one of the premises stated above. The course director must act on this appeal within 24 hours. Any appeal of this decision will be addressed by the course director's supervisor. An appeal of a failing clinical clerkship or rotation grade must be submitted within one week after a grade for rotation is posted. The course director must act on this appeal within one week of receipt of the grade appeal. Any appeal of this decision will be addressed by the course director's supervisor. The student is responsible for notifying the chair of the Promotion/Academic Review Committee that a grade appeal has been filed prior to the meeting of the Committee.

All appeals and decisions must be communicated in written form.

Externship Failure (refers to OPTO Clinical Services XI-XIV)Externships are completed sequentially. If a student receives an “F/WF” in an externship he/she may appeal the failing grade, in writing to the course director. This must be done within 3 calendar days after the grade is posted. In this case the course director will review the premise of the failure and the college policies regarding course failures. After consideration of the circumstances of the “F/WF”, the course director will either accept or reject the appeal and must inform the student, in writing, within 5 working days of this decision. If the appeal is accepted the course director may place the student on an individualized education plan (IEP) under the direction of the course director and require that the student take coursework. The course director’s options are not limited to the above and can be modified on a case-by-case basis. If the course director decides to uphold the “F/WF”, the matter will be forwarded to the Status Promotion Graduation Committee who may exercise any combination of the following sequence:

a. Place the student in an extended program, if eligible;b. Put the student on a leave of absence to undergo a period of independent study;c. Require the student to repeat the failed externship rotation; ord. Be dismissed from the program

If a student receives an “F/WF” in an externship he/she may also petition the course director, in writing, to retake the same type of externship, if available. This petition must be filed within 3 working days of the failing grade being posted. The timing of any reassignment will be as early as possible once the student has satisfied the committees requirements or concurrent completion with reassignment and is subject to availability of sites as determined by the College. The reassignment, if granted, must be completed within 12 calendar months of the date the petition is received by the course director. If the student does not successfully complete the assigned options



or receives an “F/WF” in the reassigned or repeated externship he/she will be dismissed from the program. Students are allowed only one failed or withdrawn failed externship, and only one retake of the failed or withdrawn failed externship while enrolled at the college.

Extended ProgramProblems may arise that may necessitate the deceleration of a student’s academic course load. Accordingly, an individual’s academic course load may be reduced so that the student enters what is termed an extended program or split academic course of study. Such a program rearranges the course schedule so that the normal time period for the program is extended, usually by one additional year. Only enrolled students may enter an extended program. To enter an extended program, either one or both of the following conditions must be met:

1. Personal hardship. If a student is experiencing unusual stresses in life and an extended academic load could alleviate added stress, the student may petition the College for an extended program. This petition must be submitted to the Dean or Associate Dean of Academic Affairs and may not be automatically granted but may be approved in exceptional circumstances. The Dean, Associate Dean, and the Assistant Dean are responsible for reviewing and assessing the petition and may forward to the Student Promotion and Graduation Committee if appropriate. The student will be informed of the decision, in writing, by the Associate Dean of Academic Affairs.

2. Academic. As described above, a student ending an academic year with an annual GPA of less than 2.0 may be given the option to repeat courses from that year in which “F” grades were received. A student may be placed on an extended program for academic reasons at the discretion of the Student Promotion and Graduation Committee. A student placed on an extended program for academic reasons is automatically placed on academic probation and may not be returned to good academic standing until the extended program is completed.

If a student is placed on an extended program, such action does not modify or limit the committee’s actions for dismissal. Thus, the student may be dismissed for academic reasons while on an extended program.

A student placed on an extended program for academic reasons will be returned to good academic standing when he/she reenters the prescribed academic program and completes all courses that were unsatisfactory and are required for graduation.

A reentering student must achieve a cumulative grade point average of 2.00 at the end of each quarter to continue at the college. A student is allowed to go through an extended program only once.



Responsibilities of the Extern Students are required to have their updated Professional Portfolio readily available at all times during external rotations. This should be shared with the preceptor at the beginning of the external rotation. Failure to adhere to this program requirement will be handled on a case-by-case basis.

Professional Portfolio Requirements Prior to Start of External Rotation(Place all information in Portfolio in this order)

Updated Curriculum Vitae Student Goals and Expectations (Career Goals and Rotation Goals) Emergency Contact Information Immunization Record (Obtained from Clinical Education Coordinator) CPR Certification Documentation Annual Universal Precautions Related to Bloodborne Pathogens Certificate Annual HIPAA Privacy and Security Certificate Annual OSHA Regulations in Illness and Injury Prevention Certificate Health Insurance Coverage and Copy of Health Insurance Card

General Timeline of External Rotations Requirements

PRIOR TO START OF ROTATION Contact preceptor at least 2-6 weeks before the start of the external rotation. If unable to

contact them for any reason, contact the Clinical Education Coordinator immediately. Update CV and other documents for current portfolio.

WEEKS 1 through 3

Site orientation Familiarize self with site’s policies and procedures Review portfolio with preceptor Set goals and expectations (for student and preceptor) Complete Patient Activity Log

WEEKS 4 through 7 Mid-Rotation evaluation completed and reviewed with the student Complete Patient Activity Log

WEEKS 8-11 Review with preceptor a plan to complete any remaining work for the rotation Complete Patient Activity Log

WEEK 12 Final evaluation to be completed by preceptor and reviewed with student



Complete Patient Activity and anonymous and confidential Student Evaluation of the Site and Preceptor (if not completed after 3 calendar days of the end date of the rotation an incomplete will be given).

Student Expectations of Preceptors Preceptors will provide appropriate orientation to students regarding policies, procedures

and expectations. Preceptors will provide students with timely feedback regarding performance. Preceptors will provide appropriate guidance to assist the student in making improvements

in performance. Preceptors will ensure that students participate in the provision of optometric services that

optimize patient care. Preceptors take responsibility for providing adequate numbers of clinical encounters for the

students when applicable. Preceptors will endeavor to include the student in a manner that demonstrates the

importance and value of continuity of care. Preceptors will assist students in learning business or management principles and methods

that are necessary for success as an optometrist when applicable Preceptors will demonstrate appropriate attitudes and values that are necessary for success

as an optometrist. Preceptors will endeavor to demonstrate the value of community involvement, setting the

example of citizenship expected of a doctor of optometry. Preceptors will demonstrate effective patient communications that lead to patient

compliance and the most beneficial outcomes.

External Rotation Program Evaluations (Please see Appendix 5 on page 43)Midwestern University recognizes the value of evaluation of faculty and courses by students. The externs are required to evaluate the external rotation program as well as the preceptors. The preceptor evaluations were developed to provide constructive feedback from the externs. To be an effective clinical educator requires competency, technical skills, the ability to sort and analyze data, knowledge of management and therapy options and the ability to motivate and teach others.

Prior to the end of the rotation the externs will be provided with an electronic copy of the evaluation. The extern is asked to take a positive thoughtful approach to the evaluation process. The external preceptor will receive a print out at the end of the academic year to help keep the responses and identity of the extern confidential. The Assistant Director, Clinical Rotations will also receive a copy. It is mandatory for the extern to complete the evaluation within 3 calendar days of the last day of the rotation; if the evaluation has not been completed during that time, the course director will post an “I” for incomplete as the final grade. All incomplete grades must be resolved within 10 calendar days starting from the last day of the external rotation for the quarter. If an incomplete grade remains beyond the 10 calendar days, it is automatically converted to a grade of “F” by the Registrar, which signifies failure of the course. This will be dealt with like all other course failing grades according to Midwestern University policies.

Patient Activity Logs (Please see Appendix 6 on page 44)The extern will be required to maintain a log of their patient encounters on an electronic tracking system. This is part of a total patient care requirement necessary for graduation as well as accreditation purposes. These logs represent the minimum number of patient encounters required



during the extern’s clinical education. Demographics such as age, race and gender for each patient will be logged. In addition Patient encounters are to be logged into the following areas:

Exam Type: Primary Care Diagnosis: Refractive ErrorContact Lenses/Prosthetics Anterior Segment Disease Ocular Disease Posterior Segment DiseasePeds/Binocular Vision GlaucomaVision Therapy Neurologic DisorderLow Vision Binocular Vision DisorderSpecialty Testing DiabetesOptical/Dispensing HypertensionVision ScreeningObservationFollow-up

Example: if a student see’s a patient for a routine primary care exam that also wears contact lenses they will mark: primary care and contact lenses as the exam type. If this same patient also has diabetes and hypertension along with corneal scars from previous over use of contacts, the student will mark: refractive error, anterior segment disease, diabetes and hypertension in the diagnosis box.

All Logs will be reviewed by the Clinical Education Coordinator and/or the Assistant Director, Clinical Rotations. The student has 3 calendar days to accurately complete the log from the last day of the rotation; if the log has not been accurately completed during that time, the course director will post an “I” for incomplete as the final grade. All incomplete grades must be resolved within 10 calendar days starting from the last day of the external rotation for the quarter. If an incomplete grade remains beyond the 10 calendar days, it is automatically converted to a grade of “F” by the Registrar, which signifies failure of the course. This will be dealt with like all other failing course grades according to Midwestern University policies.

ConcernsStudents should contact the Assistant Director, Clinical Rotations to report verbally and/or in writing, violations of the optometry rotation program policies immediately. This includes alleged ethical and legal violations of the practice of optometry, alleged sexual harassment, verbal abuse, inappropriate and offensive physical contact and any form of discrimination. Immediate reporting of such incidents will allow the appropriate action to be taken in accordance with Midwestern University, Arizona College of Optometry policies.

If at any time the extern has a concern regarding the clinical education they are receiving at their site, they should do the following:

1. Meet with the external preceptor to discuss their concerns and allow sufficient time for those concerns to be addressed.

2. If the specific concerns are not satisfactorily addressed, the extern shall meet with the external preceptor once again and contact the Assistant Director, Clinical Rotations who will determine the next course of action to be taken with the approval of the Assistant Dean Clinical Affairs.



Documentation of the specific concerns and details of conversations with the faculty/preceptor will be required for any action to take place.

Responsibilities of the Site and the Preceptor

Role of the Site: The site will provide an orientation and/or procedure to guide externs in their clinical

assignments. Include scheduling (days and hours), parking, where students can store belongings at the site, evaluation methods, due dates for assignments, and overall responsibilities.

Although not required, an external rotation site may create and distribute a site manual or handbook with site-specific information that the student is responsible for and must know. If this is the case, a copy of this handbook will be provided to the Clinical Education Coordinator by the site preceptor. This handbook might include such orientation information as staff names and roles, patient services offered, hours and days of patient care, special dress code requirements, parking/phone/mail details, and information about the local community, and goals and objectives for the rotation.

The site will provide patients and instruction in clinical optometry and in so far as possible interdisciplinary clinical training experience.

The site will inform the clinical education coordinator in advance the number of optometry externs they will be able to accept at their facility

The site will designate an appropriate optometrist for the purpose of coordinating the schedule of externs with the clinical education coordinator to prevent conflicts during the extern’s clinical learning experience and to orient, supervise and evaluate the clinical performance of the externs.

The site will provide a reasonable space for the clinical training of externs The site will permit, upon request, the inspection of appropriate clinical facilities by

AZCOPT and/or agencies charged with the responsibility for accreditation purposes.

General Requirements and Responsibilities of PreceptorsStudent ConfidentialityPreceptors must maintain student confidentiality. Information pertaining to the student’s performance, health status, or background check should only be shared with the Assistant Director, Clinical Rotations or the Assistant Dean of Clinical Affairs. Legal ramifications are an ever-present possibility for breached confidentiality. Preceptors must abide by Family Education Rights and Privacy Act (FERPA) regulations.

More information can be found at http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html and http://www.aacrao.org/ferpa_guide/enhanced/main_frameset.html

TeachingThe preceptor has responsibility for ensuring that the student has adequate opportunities to demonstrate competence in practice functions specific to the external rotations. While the student may be capable of contributing to the clinic operation by performing optometrist staff functions, one-on-one preceptor-to-student interactions may better facilitate student development. The



http://www.aacrao.org/ferpa_guide/enhanced/main_frameset.html

preceptor should ensure that time is allocated to teach each learning objective and that minimum hour requirements are fulfilled. In assuming responsibility for the student’s education, the preceptor should assign tasks and/or activities based upon student need. At all times, preceptors must serve as a role model to be emulated by the student. The preceptors’ appointment as an adjunct clinical faculty member recognizes the contributions preceptors make as key players in this academic program.

ConcernsPreceptors should contact the Assistant Director, Clinical Rotations or Assistant Dean of Clinical Affairs to report verbally and/or in writing violations of AZCOPT external rotation program policies as soon as possible. This includes alleged ethical and legal violations of the practice of optometry, alleged sexual harassment, verbal abuse, inappropriate and offensive physical contact and any form of discrimination. These types of incidents should be reported immediately. Immediate reporting of such incidents will allow appropriate action to be taken in accordance with Midwestern University and AZCOPT policies.

Student EvaluationWith support from the Assistant Director, Clinical Rotations as required, preceptors must evaluate student performance at a minimum at the midpoint and end of each rotation, identify strengths and weaknesses and provide learning opportunities to ensure student development in the established competency areas. Constructive and regular feedback to the student is a critical element in ensuring appropriate student development. If a preceptor is away on vacation or will otherwise be unavailable to complete the final evaluation, the preceptor or site should notify the Assistant Director, Clinical Rotations of the situation immediately. It is very important that you contact the Assistant Director, Clinical Rotations with any concerns that you have with a student in any area, as documentation is required from the University to substantiate a poor performer or any course failure.

Preventing Problem Learning SituationsPrimary Prevention:1. Know the College’s specific expectations of students for the external rotation. Review

these expectations with the student during your first meeting..2. Make your expectations known to the student during the orientation. Inform the student of

site specific practices and policies that they should be aware of - dress code, hours, and contact information.

3. Determine what the student's expectations and goals are and determine if mismatches exist between your goals and theirs.

4. You should schedule time at week six (6) to review the midpoint evaluation. Likewise, the preceptor should schedule time for a final evaluation.

5. Plan for preceptor-related issues that may have an impact on your teaching experience. These can include unanticipated personal events, schedule/financial changes or an unanticipated personality clash with your learner. If these issues prevent you from doing what you need to do in your practice or could seriously affect the student's experience, consider declining the student for the quarter. In this case, notify the Assistant Director, Clinical Rotations as soon as possible.

Secondary Prevention:



1. Maintain awareness that things can go wrong. Don't ignore the early warning signs of difficult interactions.

2. If a potential problem/situation arises, seek help from the Assistant Director of Clinical Rotations or the Assistant Dean of Clinical Affairs.

Grading

Fourth Year Evaluation Form (Please see Appendix 4 on pages 39-42)During the fourth year, students will receive a midpoint and a final evaluation for each clinical rotation. Fourth year is a time to develop the critical thinking skills that are necessary for doctoral decision making, not a time to go over routine procedural techniques. The student should be competent to:

Identify, record and analyze pertinent history and problems presented by the patient Demonstrate the necessary skills to examine and evaluate the patient to arrive at a rational

diagnosis Formulate a treatment and management plan and understand the implications of various

treatment and management options Provide preventative care, patient education and counseling Recognize when it is necessary to obtain a consultation and to coordinate care provided by

healthcare providers and/or other professionals Demonstrate knowledge of professional, ethical, legal, practice management, and public

health issues applicable to the delivery of optometric care Effectively communicate orally and in writing with other professionals and patients Demonstrate basic life support skills for emergencies encountered in optometric practice

It is very important that the preceptor reflect on the students’ ability at the midpoint and end of the rotation and understand that expectations should have been achieved at that point. If not then the grade should reflect such inadequacies that have been noted. Students are often grade driven and may apply added pressures at times. We are committed to graduating quality individuals that exemplify our profession. The College must be made aware of any student that requires additional instruction early on so that we can help in the areas that have been identified as weak. Also keep in mind that the expectations at the final evaluation should be higher than at the midterm evaluation.

Don't give the learner a passing grade if you do not think they have met the goals of the course. This not only hurts the future clinician but impact patients and the future of our profession. If you have any concerns, please contact the Assistant Director, Clinical Rotations early.

Student ProfessionalismIt is the responsibility of the preceptor to notify the Assistant Director, Clinical Rotations or the Assistant Dean of Clinical Affairs if the student does not comply with the professionalism policies.

Dismissal or Removal from External Rotation SitesEstablishing clinical rotation sites, whether local or remote, requires a great deal of time and effort. The College and the site must maintain a mutually beneficial partnership. Students are required to meet and maintain the highest professional standards. Under certain circumstances, the Assistant Director, Clinical Rotations (for External Sites) reserves the right to cancel its obligation to Midwestern University External Rotation Manual


provide a rotation assignment for students who exhibit unprofessional behaviors as defined by the Midwestern University Student Handbook. This includes, but is not limited to, any student who steals any assets, property and/or drugs from any participating facility will be denied the privilege of participation in the rotation. Students recognized as being under the influence of any drug substance for non-medical purposes while on a clinical rotation may also lose their participation privilege. Such breaches will result in appropriate disciplinary actions.

Preceptors may request the student’s removal from patient care regardless of the location, if it has been determined that the student is potentially harmful to patient care, incompetent, behaving inappropriately, and/or exhibiting academic or professional misconduct. If the student violates any of the policies or procedures of the rotation site or the College, does not clear the background check, does not provide proof of proper immunizations, does not pass a drug screen, or fails to meet other necessary requirements, the student may have their rotation assignment cancelled.

If a student is removed from a clinical rotation or dismissed by the preceptor at the site or by the Assistant Director, Clinical Rotations, the student will not be placed at another external clinical site for that rotation block, will receive a failing grade, and will be subject to further review and action by the College Student Promotion and Graduation Committee (SPGC), and/or the Assistant Dean of Clinical Affairs.

The purpose of this policy is to ensure patient’s safety, honor the privilege of participating in the practice site, protect and support the preceptor, and maintain the College’s reputation. Student conduct is expected to be exemplary at all times.

It is considered unprofessional conduct if the student were to argue, beg and or plead in the event of a failing grade, and/or removal from a rotation. In the event that this happens, please contact the Assistant Director, Clinical Rotations immediately.

College Communication and ParticipationAs an adjunct clinical faculty member, the preceptor is encouraged to maintain frequent communication with the Assistant Director, Clinical Rotations. It is expected that preceptors will maintain updated contact information with the College, cooperate with the College in planning and coordinating experiences to meet educational objectives, comply with program policies and procedures and attend or complete applicable preceptor training programs. Comments and/or recommendations from preceptors to improve or enhance the AZCOPT optometry program are always welcome.

Preceptor Training ResourcesThe Clinical Education Coordinator encourages preceptors to access resources for preceptor development. In addition to the External Rotation Manual, the Assistant Director, Clinical Rotations is available to provide in person or telephone consultation regarding management of students on rotation, rotation assignments, students’ evaluations etc. The College will also conduct periodic site visits during which preceptors will receive feedback on the quality of the educational experience for the students.

Adjunct Faculty Status and Benefits



On-campus faculty members are College employees holding faculty rank. Adjunct faculty members are independent doctors, unsalaried and unsupervised by the Arizona College of Optometry, who have special contractual relationships with the University. These faculty members are non-voting members of the faculty who are not eligible for tenure and have term contracts with the Arizona College of Optometry. Appointments to adjunct faculty status are made by the Dean of the Arizona College of Optometry after a recommendation by the Assistant Director, Clinical Rotations and/or the Assistant Dean of Clinical Affairs. Appointments are made for specified time periods, which are renewable.

Primary preceptors will be afforded status as adjunct faculty member for all years in which a valid affiliation agreement has been executed. Additional preceptors at an external rotation site may also be afforded this status if they are recommended and endorsed by the primary preceptor at their external rotation site. In all cases credentials must be tendered to the College for analysis and review, and approved by the University, before adjunct faculty status is granted. Documentation for a credential review includes, at a minimum, a current curriculum vitae and a copy of a valid license to practice their profession. Upon appointment, adjunct faculty members are eligible for a certificate certifying that the doctor has been selected and approved by Midwestern University and the Arizona College of Optometry.

Preceptors can gain remote access to many library resources by faxing a request, on letterhead, to the librarian at 623-572-3306. Please include your name, telephone number, fax number and identify yourself as a preceptor for Midwestern University Arizona College of Optometry-. Any questions about how to access or use the resources should be directed to Barbara Nadler, Library Manager, at 623-572-3308 or [email protected].

HousingPreceptors are under no obligation to provide housing for students, although many sites may opt to do so. Although preceptors may be of assistance, the responsibility to obtain housing remains solely with each student. Preceptors who are in a position to assist students with housing arrangements should make certain that the Clinical Education Coordinator is aware of that assistance so students may be properly informed.

Administrative Responsibilities of Primary Preceptor Letters from the Clinical Education Coordinator requesting assignments for specific students for specific sessions are sent during Spring Quarter for the next academic year. Your signature of approval accepting the student(s) is required.

A Teaching Practitioner Affiliation agreement, Contract agreement, or Memorandum of Understanding must be executed for any external rotation sites to receive Midwestern University students. These agreements are typically auto-renewed or executed for a specific period of time. A preceptor or site representative signature agreeing to the Memorandum is required. Affiliation Agreements or Training Affiliation Agreements with government locations are renewed as directed in the agreement. The student will contact you approximately six weeks prior to their arrival at your practice. This reminder confirms that the student you agreed to accept (in the request letter sent during the Spring Quarter of the previous year) will actually arrive as scheduled. You should acknowledge this




confirmation especially if your situation has changed and you can’t accept the student. In that instance, you must inform the Assistant Director, Clinical Rotations as soon as possible so that alternate assignments can be made for the student.

Preceptor Expectations of StudentsIt is expected the students will:

Abide by all office policies and procedure guidelines. Be punctual and faithful in attendance. Demonstrate understanding of their personal responsibility for learning, taking initiative to

improve upon weaker areas or performance. Respect patient privacy. Properly identify themselves and their role in patient care. Interact with patients with courtesy, respect and compassion. Demonstrate the appropriate level of clinical competence for their level of training and

experience. Respond to preceptors with courtesy and respect. Be attentive and responsive to direction or to recommendations for improvement. Function with absolute honesty. Demonstrate willingness to accept all assignments that are relevant to their optometric

development. Maintain an appropriate level of respect and courtesy with all office personnel at the site. Complete all assignments on time and to the best of their ability.



Rotation Schedules

Students will identify external rotation site preferences from a list of AZCOPT-affiliated sites provided by the Clinical Education Coordinator.

Students will be required to rotate through at least one disease designated rotation site. This includes a Veteran’s Affairs Hopsital, Indian Health Service and Bascom Palmer.

To prevent conflicts of interest, the student will not be allowed to complete an external rotation with a family member, current/former partner, friend, or colleague.

Students are not permitted to complete external rotations at sites where he/she is currently and/or has previously been employed, unless the rotation experience is determined to be different educationally. The Assistant Director, Clinical Rotations will review requests and finalize rotation schedules on an individual basis.

Final external rotation assignments are at the discretion of the Assistant Director, Clinical Rotations, and if needed, the Assistant Dean of Clinical Affairs, following review of student site preferences, professional experience, considerations of site characteristics, College commitments to the site and rotation site availability.

External rotations will be completed at AZCOPT-affiliated sites. The student is responsible for any financial costs incurred for travel and housing during the external rotation program.

Once the external rotations schedules are finalized, students may not drop, change, or cancel rotations unless the student demonstrates that an extreme hardship exists, and the change in rotation assignment is approved by the Assistant Director, Clinical Rotations and the Assistant Dean of Clinical Affairs. In the case of a rotation reassignment, the student may have a delayed start that requires a late graduation date as well as additional tuition and fee charges.

In unforeseen circumstances, a rotation site may become unavailable and necessitate a change in the student’s schedule. In these instances, the Assistant Director, Clinical Rotations will handle all reassignments.

Students are not to make arrangements or travel plans that affect rotation schedules before receiving permission from their assigned preceptors.

The student is not allowed to at any point contact a site on their own without the proper permission to try and change their rotation assignments or obtain a new assignment in the event their original site got canceled. This is considered unprofessional conduct and could be subject to disciplinary action or a failing course grade due to poor professional conduct.



APPENDICES

Appendix 1. Incident Report Form



Appendix 2. Time off Internal Request Form



Appendix 3. Time off External Request Form



Appendix 4. Grading Form



Appendix 5. Preceptor and Site Evaluation

Midwestern University Arizona College of OptometryPreceptor and Site Evaluation

4th Year OD Student

Each student must complete an evaluation of their External Rotation Site and Preceptor(s).The evaluation is confidential and will be reviewed by the Assistant Director, Clinical Rotations and the Clinical Education Coordinator after each External Rotation for continuous quality improvement of sites and preceptors. A summary report will be distributed to the preceptors only after all external rotations have been completed for the academic year, and all student names have been removed to ensure confidentiality of the responses.

5Strongly AGREE

4Agree

3Satisfactory

2Disagree

1Strongly

DISAGREE

The preceptor was knowledgeable about the subject matter during patient encounters.

The preceptor discussed information at a suitable level of understanding.

The preceptor encouraged discussion and responded conscientiously to questions.

The preceptor served as a professional role model to me.

The site provided a good learning experience for me.The site was well organized and prepared for students.I would recommend this site to other students as a good educational experience.In what areas is the preceptor doing well?

What improvements could be made to the optometry practice experience at this site?

Additional Comments:



Appendix 6. Patient Log



Appendix 7. Miscellaneous Tips on Teaching with a Student Intern

Preparing Your Office for Your Preclinical Student

Effectively including a preclinical student into your practice will take some advanced preparation.

Provide your student with a workspaceYour preclinical student will need at a minimum a chair and desk space where they can put their books, lab coat and where they can sit and read if there is down time. Will the student sit in your office? Is there a colleague's desk space that the student can borrow while he/she is in the office? Will the student have computer access? Will the student have access to an in-office medical library?

Prepare your staff for the studentYour staff plays an important part in making the external rotation experience fit in your busy clinic day. If you work with a particular assistant, optician, ophthalmic technician, etc., let them know the days and times that the student is planning to be in your office. Some background information on the student may also be helpful to your staff such as their year in optometry school. When they take your patients to the examination room, they can screen your patients to see if they would like to help participate in the education of an optometry student. You may also ask your staff to help orient the student to your office. If you choose to inform your patients of the student's presence by hanging a sign in your waiting room, a front desk staff member may take this responsibility. Your front desk staff may also help prepare your patients for the student's presence by informing them that a student will be working with you when they call to confirm the patient's appointment.

Plan the student's orientation to your officeYou may decide to ask your office manager to help with part or all of the student's orientation to your office. A brief orientation with a tour of the facility and introductions to key employees (optician, ophthalmic technician, receptionist, etc.) is suggested. The orientation may include information on your practice and the patients served. You may also include information on patient flow within the clinic and office routines, procedures for documenting patient care, and other relevant methods. The orientation can be arranged with the student before patient care hours.

Set aside time to discuss the student's and your goalsFinding out your student's expectations will make this rotation more enjoyable for both the student and for you. If possible, schedule a 15- minute block of time to discuss the mutual expectations with the student. This time should also be used for you to outline your goals for the external rotation and any dress or scheduling expectations you may have with the student. Also, inform the student of any opportunities outside of the clinic for them to see patients with you. Time spent in other clinical areas can substitute for time in your clinic, though the bulk of your student's experience should be in the clinic.



Your First Meeting with Your Preclinical StudentBelow is a suggested template for your first meeting with your student. As each preceptor's office is different, feel free to modify the below suggestions to best fit your practice.

Orientation to your officeApproximately 30 minutes, with introductions to key staff, tour of the facility, brief discussion of types of patients served, services provided, procedures performed. Specific information on office policies and procedures should also be covered.

Discussion of Learning Plan Approximately 15 minutes. Review student's educational goals and briefly discuss your expectations of the student during this external rotation.

Student shadows you for a few patientsAllow student to get a feel of how your office runs and your style of care. Depending on student's level of training and comfort, you may have the student perform parts of the physical exam or history in your presence. Remember to obtain the patient's verbal consent prior to having the student observe or participate in the patient's care. You or your staff can obtain this consent. A suggested introduction might be "Susan Eager is a fourth year optometry student working with me today. I would appreciate it if you would tell her why you are here today. Then I will be in to see you shortly".

When you feel the student is ready, the student can perform part or all of the case history independently.It is recommended that the student review the patient's chart before the patient arrives. You may also choose to briefly discuss previous relevant experience the student may have had. From what you know of both the patient and the student, you will determine whether the student will observe you, assist you, precede you, or perhaps, not be involved with the patient. You can also give the student tips on what to look for, ask about, or what he/she might read to prepare. Or you may send them in "cold" to handle a patient.

Specific Skill Building With Your Student

Improving History Taking Skills: The One-Minute Preceptor MethodBy the end of the first year, all students have learned how to elicit and write up a complete adult medical history. There are several effective ways to help students improve their history taking skills. One method that can be useful is the One Minute Preceptor.

1. Get a Commitment - Get the student to commit to an aspect of the case. Encourages student to stretch beyond their comfort level and develop reasoning skills."Based on the patient's chief complaint, what parts of the history should you focus on?"

2. Probe for Supporting Evidence - Ask a question that seeks to understand the rationale for the learner's answer to part I. This enables you to determine the strength of the evidence upon which the commitment was made."Why do you feel it is important to obtain a past medical history in this patient who complains of memory problems?"



3. Reinforce what was done well- Comment on specific behaviors that demonstrated knowledge, skills, positive attitudes or values."Your history was well organized. You had a chief complaint followed by a detailed history of present illness. You included appropriate additional medical history and medications."

4. Give guidance about errors and omissions - Avoid terms such as "bad" or "poor", and use phrases, such as "not best" and "it is preferred", which carry less of a negative value judgment. Comments should be as specific as possible."You mentioned a cough in your history, but did not tell me how long the cough has been present or if the patient smokes. This information is particularly useful when considering the possible causes for the patient's cough and can impact your diagnostic and treatment decisions for this patient. "

This method can also be used to help students refine their clinical reasoning pathways.

Improving Communication SkillsPreceptors can help student learn effective communication techniques by role modeling the use of open-ended questions, using a non-judgmental attitude and by displaying empathy when interacting with patients. Preceptors can also observe students' interactions with patients to see if these elements are present and give constructive feedback on including these techniques in their patient interactions.

Talking Through ProceduresStudents learn by observing and assisting at procedures, and when appropriate, by guided performance of the procedure. Don't be reluctant to ask your student to talk through a procedure in detail before he/she is to assist you or perform it on a patient. The dry run also provides you a chance to embellish the basic steps with tips you've learned from experience.

Building on a Student's Interests Your student may indicate an interest in an aspect of optometry that is part of your clinic but is outside of your own interest or expertise (e.g. contact lens, low vision rehabilitation, vision therapy). Students greatly appreciate preceptors who find colleagues in their office who are interested in having a student observe them or assist them with these procedures and visits.

Providing FeedbackMany preceptors find evaluating students' interview and examination techniques to be their least favorite part of this course. Students, however, find their preceptor's evaluations to be helpful as they develop their clinical skills. Below are methods to help you feel more comfortable providing feedback to your student.

FeedbackFeedback allows for student improvement by addressing specific actions or skills. To be most effective, feedback is given close to the time of the relevant event and is informal. At times, giving feedback may seem unnecessary to you. Preclinical students often do not have the experience necessary to judge their clinical skills and providing feedback can help to reinforce good clinical skills. If you identify a potential problem in the way a student performs a history



or examines a patient, it is advisable to discuss this problem with the student immediately. Failing to do so may be taken as a sign by the student that they are performing the task acceptably. The IMPROVE strategy is one way to positively incorporate feedback into your preclinical student teaching.

The IMPROVE strategy1. I = Identify How Feedback Will Help the Student Meet the Goals for the Course.

Discuss with student how you will provide him/her with feedback on how well he/she is meeting these goals. Let the student know how often you prefer to give feedback. Use the student's past experiences with feedback as a way to individualize your feedback to the student. Encourage the student to perform his/her own skill self-assessments and to openly communicate to you when he/she needs your assessment or guidance on skills improvement.

2. M = Make an Environment in which Feedback is Welcomed. Let the student know that you and he/she are partners working towards the common goal of expanding his/her clinical skills. Comment on what the student does well in addition to what he/she could improve. Demonstrate that feedback is a part of clinical practice by giving and receiving feedback to staff, colleagues and patients.

3. P = Assess Performance. Directly observing the student is the best way to assess a student's skills, knowledge and attitudes. Ask other staff and clinicians for their observations to get a well-rounded view of the student's performance. You do not need to watch a complete history and physical on one patient: you can observe the student take a history on one patient and observe the student perform a physical on another patient. Observing the student with the first or last patient of the half-day may be less disruptive to your schedule.

4. R = Respond to the Student's Self-Assessment. Have the student evaluate his/her own skills and behavior before you provide your feedback. Students tend to be less defensive when they are allowed to self-evaluate. Use the student's observations in your feedback. Opening the discussion with a question such as "What did you like about your history and exam?" can help focus the student on specific skills and their own behavior.

5. O = Be Objective. Begin providing feedback by describing the specific behaviors and skills that the student demonstrated. Do not add any interpretations of what you think the student may have been thinking or feeling during the event. Once you've described the behavior, let the student know the potential outcomes that could follow the behavior."You started the interview by shaking Mr. Jones' hand and introducing yourself. Small actions like these seemed to make Mr. Jones more comfortable as he talked to you . "

6. V = Validate Positive Behaviors or Suggest Alternative Strategies. Reinforce what the student has done well and suggest ways that the student could find the information that he/she may have missed in his/her history or physical exam.



7. E = Establish a Plan to Improve Performance. Let the student know what skills he/she should work on and suggest ways to work on these skills. Is there a helpful text? Is there something different he/she should do the next time he/she enters the room with a patient? To ensure the plan is clear, you can ask the student to summarize what he/she will be working on the next time he/she is in the room with a patient.

Evaluating Students

Student evaluation is a key component of this course. By incorporating periodic evaluation into your teaching, you not only help the student to develop into a competent clinician, but you can avoid uncomfortable situations when it comes time to discuss midcourse and final course evaluation with your student. During your time with the student, you will be continuously gathering information on their clinical skills, knowledge and interpersonal skills. As you provide feedback, you will also be able to assess how well the student used this feedback to improve their skills. The midpoint and final evaluations are scheduled opportunities for you to summarize to the student his/her growth during the course and areas where he/she can continue to improve.

The Pitfalls of Evaluation

1. The Halo Effect – This is a situation where one favorable characteristic of the student has an effect on the evaluation. For example, a student who is likeable but whose clinical skills are not quite up to par may receive a very high evaluation based solely on their personality.

2. Insufficient Evidence - At the end of the rotation, the preceptor may have an overall sense of the student's performance, but cannot recall specific incidents to back up this perception. Developing a way to record specific behaviors and skills so that you can recall them later can be most helpful in preventing this pitfall.

3. ''You Never Told Me That" - By communicating to the student your expectations for performance and providing the student with feedback on a regular basis, students are less likely to be surprised by your overall evaluation of them.

4. ''But I NEED a Pass” - Some students bring particular expectations of a grade or evaluation for the course. Eliciting these expectations up front is key in helping the student to meet these goals or in explaining to the student why their goal is not realistic in your setting.

5. Should They Pass? - If you are having critical problems with your student, and feel that despite your best efforts, he/she is not meeting the core requirements of the course, seek help from the Clinical Education Coordinator or Assistant Dean of Clinical Education as soon as possible. By seeking help early, you should hopefully not have to ponder this question by yourself as you're filling out your final evaluation of the student.



Important Numbers and Contact Information

Arizona College of OptometryGlendale Hall Suite #12719555 N 59th AveGlendale AZ, 85308Phone: 623-572-3900Fax: 623-572-3911

Midwestern University Eye Institute19379 N 59th AveGlendale AZ, 85308Phone: 623-806-7200Fax: 623-806-7212

Donald E. Jarnagin, O.D.Dean, [email protected]

Sunny M. Sanders, O.D.Associate Dean of Academic [email protected]

Joshua C. Baker , O.D, M.S.Assistant Dean of Clinical [email protected] 623-806-7211

Alicia Feis, O.D.Assistant Director, Clinical Rotations [email protected]

Victoria KimberlinClinic [email protected]

Lori KleinClinical Education [email protected]









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