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Pathologists’ Assistant Program

Clinical Rotation Student Handbook 2016-2017

10-12-16

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Rotation Information:

I, , have received the Clinical Rotation Student Handbook (Student’s name)

for the Pathologists’ Assistant Program. I understand that the policies in this handbook and the Student Handbook I have previously

received are effective throughout the Pathologists’ Assistant Program and Clinical Rotations. Any violation of these policies will result in

disciplinary action.

Date Student’s Signature

Loma Linda University Pathologists’ Assistant Clinical Expectations

I, agree to adhere to the following list of clinical expectations: (student name)

Adherence to Loma Linda University Student and Clinical handbooks

Punctuality to duties at clinical rotation sites and adherence to listed hours. Staying voluntarily to complete assigned work is appreciated.

The dress code of each rotation site.

Proper use of cell phones (during appropriate times such as breaks) and internet Working hard to improve as a PA

Maintenance of a professional, respectful, and appropriate demeanor during clinical rotations and Pathology Review

Signature

Date

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This handbook is designed to serve as an informational guide for the students entering the Clinical Rotations in the Pathologists’ Assistant Program at the Loma Linda University School of Medicine. The contents of the handbook represent an official communication of the policies and procedures of the Program, as well as to set forth the expectations of the students and the clinical sites. Students are expected to be familiar with the contents of this handbook and the Student Handbook. The Student Handbook of Loma Linda University, the Loma Linda University School of Medicine and the Pathologists’ Assistant Student Handbook should be reviewed for academic and professional expectations, policies and procedures.

In order to reach the goals and fulfill the mission of the University, the requirements and regulation herein are subject to continuing review and change by the University administrators and the faculty of the Pathologists’ Assistant Program. The Program, therefore, reserves the right to change, delete, supplement, or otherwise amend the information, rules, and policies contained herein without prior notice. Changes to the handbooks will be re-published on the program web site and Pathologists’ Assistant students will be alerted of the changes.

The Pathologists’ Assistant Program is committed to a policy of Equal Opportunity and does not discriminate on the basis of race, color, sex, age, religion, handicap, veteran status, sexual orientation or national origin in the administration of its educational program or activities or with respect to admission and employment. As set forth in the Affiliation Agreement, clinical rotation sites are expected to adhere to this policy as well.

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Contact Information for Pathologists’ Assistant Program

Cheryl Germain, MHS, PA (ASCP) 909-558-8095 (office) or 724-812-2430 (cell) Program Director

Jeremy Deisch, M.D. Medical Director

Michael Weitzeil, MHS, PA (ASCP) 909-558-5609 (or 801-920-8925 (cell) Clinical Coordinator

Mary Dennis, MS, PA (ASCP) PA Faculty 909-558-5149

Maria Rabina-Vindua, MHS, PA (ASCP) PA Faculty

909-558-5149

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BOARD OF CERTIFICATION GUIDELINES FOR ETHICAL BEHAVIOR FOR CERTIFICANTS

Recognizing that my integrity and that of my profession must be pledged to the best possible care of

patients based on the reliability of my work, I will:

Treat patients with respect, care and thoughtfulness.

Develop cooperative and respectful relationships with colleagues to ensure a high standard of patient care.

Perform my duties in an accurate, precise, timely and responsible manner.

Safeguard patient information and test results as confidential, except as required by law.

Advocate the delivery of quality laboratory services in a cost‐effective manner.

Strive to maintain a reputation of honesty, integrity and reliability.

Comply with laws and regulations and strive to disclose illegal or improper behavior to the appropriate authorities.

Continue to study, apply, and advance medical laboratory knowledge and skills; and share such with other members of the health care community and the public.

Render quality services and care regardless of patients’ age, gender, race, religion, national origin, disability, marital status, sexual orientation, political, social, or economic status.

April 2012

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WORK POLICY

Students enrolled in the Pathologists’ Assistant Program are expressly prohibited from rendering care or treatment in any form to any patient, including other students or staff of the University, except when rendered as a part of the classroom or laboratory instruction and/or assigned participation.

The Standards for Pathologists’ Assistant Programs from the National Accrediting Agency for Clinical Laboratory Sciences addresses students working in the clinical laboratories. Standard 9C3 states:

"Policies and processes by which students may perform service work must be published and made known to all concerned in order to avoid practices in which students are substituted for regular staff. After demonstrating proficiency, students, with qualified supervision, may be permitted to perform procedures. Service work by students in clinical settings outside of academic hours must be non- compulsory.”

EMPLOYMENT POLICY

The aim of the Loma Linda University Pathologists’ Assistant Program is to provide a strong educational background in the anatomic laboratory sciences which includes anatomic laboratory experience in surgical and autopsy pathology. The experiences typically take place, (with exceptions in the second year to provide a complete experience), between 8:00 AM to 5:00 PM Monday through Friday, but may vary based on the needs and schedule of the laboratory.

However, senior students in clinical rotations may work in suitable positions that are supervised, voluntary, paid, subject to employee regulations, and outside of the hours (typically 8:00 AM - 5:00 PM, Monday through Friday) of their educational experience. At no time can outside employment interfere or replace academic or clinical experiences.

Pathologists’ Assistant Policy on Professional Appearance

Health Sciences students must maintain a professional appearance for infection control, to aid in communication and for cultural sensitivity. A professional appearance will help instill trust in you as a health professional and lead to better patient outcomes. General policy for all students:

1. Appropriate personal protective equipment must be worn while working in the surgical and autopsy suites. This includes but is not limited to eye/face protection, fluid-proof body covering, and gloves. Additional equipment may be required based on the procedure at hand.

2. Shoes worn in the student laboratory must cover the entire foot. Sandals, flip-flops, high-heeled shoes and canvas shoes are not allowed in the laboratory

3. Good personal hygiene is to be maintained at all times including regular bathing, use of deodorants/antiperspirants, and regular dental hygiene

4. Avoid distracting perfumes or colognes and cigarette odor 5. Fingernails should be neatly trimmed to no longer than ¼ inch past the end of the finger worn without polish or with

clear polish without chips or cracks. No artificial nails. 6. Visible body tattoos or visible body piercing are prohibited. (Ear studs (one per ear) are allowed). 7. Attire should be comfortable and not detracting from the educational atmosphere. Avoid dress or attire that could

be potentially offensive to the public, your peers, and faculty. 8. Identification must be worn at all times. If the site does not issue an institutional ID, wear your student ID at all times.

Additional policies for senior students in the clinical settings:

1. Scrubs should be clean, neat, and either blue or surgical green depending on the clinical rotation site and requirements of each rotation. NO neon or bright pastel or other scrub colors are allowed. If the clinical site requires a specific scrub color, the student should adhere to those rules.

2. Shoes must be comfortable, white, all-leather (no canvas shoes) walking or athletic shoes. Shoes must be clean and in good repair at all times. Appropriate hosiery and socks must cover any exposed part of the leg or foot.

3. Denim clothing or pants of a “blue jean” style, regardless of color or fabric, shorts, skorts, mini-skirts, sleeveless attire, tank/tube tops, tee shirts, midriff tops, halters, translucent or transparent tops, sweatshirts, sweatpants, yoga pants, running or jogging suits are prohibited.

4. Personal protective equipment is removed and disposed of following procedures. At no time should this equipment be worn outside of the surgical/autopsy suites. Gloves should be removed before touching phones, door handles, and any equipment that leaves the procedure area.

5. White lab coats are to be worn over scrubs when leaving the surgical suite

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Hair Maintenance:

1. Hair should be neat, clean and of a natural human color.

2. Hair should be styled off the face and out of the eyes. 3. Shoulder length hair must be secured to avoid interference with patients and work. 4. Avoid scarves or ribbons (unless culturally appropriate). 5. Beards/mustaches must be neatly trimmed; certain types of protective equipment are not effective when used with

full beards (i.e. HEPA masks for TB).

Jewelry:

1. Jewelry represents a potential for cross-infection. 2. The following are permitted: a watch, up to four rings, small earrings, academic pins, and other pins, badges or insignia

that represent an award, modest bracelets and necklace chains. Appropriate holiday pin during the holiday is suitable.

Pathologists’ Assistant Policy on Absence/Tardiness

Any student who misses an excessive amount of time (>2 days/quarter) during a clinical laboratory rotation will result in a review of his/her performance by the Pathologists’ Assistant Program Academic and Professional Standards Committee. Exceptions include interview opportunities, however, arrangements must be made in advance and the supervisor at the clinical rotation and the program director must be notified at least one week in advance of leaving for the interview. Proof of interview must be provided upon return. When requesting time off for an interview or alerting the clinical site/program of illness, an e-mail is to be sent to the Site Coordinator, with a “cc” to Michael Weitzeil and Cherie Germain.

The student must notify the Rotation Site (see below), the Clinical Coordinator Michael Weitzeil (mweitzeil@llu.edu) or Program Director Cherie Germain (cgermain@llu.edu) if they are sick or there has been a death in the family or an unavoidable emergency situation. Extenuating circumstances will be considered on an individual basis by the program director and other faculty. This notice should occur before 8:00 AM. Days off and holidays are according to the schedule of the assigned clinical sites. Students should not ask for extra days off if not included in the clinical site’s schedule.

No more than 1 total week can be missed for attendance of conferences/activities. If a student attends a conference he/she is responsible for notifying the rotation site where the absence will occur. The student should notify the site within three days of being given permission to go by Cherie Germain or Michael Weitzeil. The site must be given a minimum of a one month notice and Cherie Germain and Michael Weitzeil must be included in the email with a "cc". Failure to follow these instructions will result in revoked permission or other sanctions.

Missing more than two weeks for any reason other than interviews and scheduled days off will result in delay of the conferring of degree and the student making up time following completion of their assigned rotations. Depending on the length of time to be made up, the student may have a delay in certification eligibility and money submitted to ASCP for board examinations might be lost.

It is the responsibility of the student to report to the Program Office all absences due to illness or health care and to report to the office on his/her return. Failure to notify all required parties of an absence may result in expulsion from the program.

Safety

The program has made every effort to ensure the basic safety of students with proper supervision and orientation. It is the student’s responsibility to use common sense when traveling, stay out of unsafe areas, not be provocative and or aggressive towards others, and maintain a professional decorum. At no time is it acceptable for students to carry firearms or other weapons into the hospital/ clinical sites. When traveling through an airport, questionable items are to be left home. At all times, follow the rules of international travel and the airlines.

Use of Telephones

Students should use a cell phone for telephone calls. Cell phones should be off during clinical rotations except for communication with program faculty and emergencies. Communication with possible job opportunities must be kept to a minimum. Use of e-mail is encouraged for this communication.

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Social Networking Policy

As per the University policies stated in the Pathologists’ Assistant Student Handbook:

POLICIES, PROCEDURES, & GUIDELINES ON THE USE OF INFORMATION TECHNOLOGY RESOURCES

Use of Social Networking Sites, Blogs, and Instant Messaging Policies

In accordance with HIPAA, FERPA, and LLU Health Sciences Center IT policy, please be advised that faculty, staff, residents, and students are not permitted to post confidential patient information, including protected health information (PHI), educational records protected by FERPA, institutionally-owned asset data, confidential, proprietary, or private information on any social networking sites (Facebook, Instagram, Twitter, YouTube, etc.), personal / business related blogs, and /or via instant messaging service.

Make sure you understand the permanency of published material on the Web, and that all involved in health care have an obligation to maintain the privacy and security of patient records under HIPAA and that LLU fully complies with protecting the privacy of education records under FERPA policy.

Always comply with the current institutional policies with respect to the conditions of use of technology and of any proprietary information such as university logos.

Finally, please note that social networking sites are increasingly being targeted by cyber- criminals drawn to the wealth of personal information supplied by users. Data posted on the sites (i.e. name, date of birth, address, job details, email and phone numbers) is a windfall for hackers. Viruses on these networks can hijack the accounts of social networking site users and send messages steering friends to hostile sites containing malware, a malicious software often designed to infiltrate a computer system for illicit purposes. Malware can be used to steal bank account data or credit card information once installed on a personal computer. Another danger of social networking sites are the popular quizzes, horoscopes and games made available for free to users which can sometimes be used to hide links to hostile sites.

Examples of information that should not be shared on social networking, blog sites, and instant messaging services are:

Reporting on or about official medical activities and/or patient’s personal health information.

Requiring patients to participate in “social networking” activities to influence or maintain the provider/patient relationship.

Posting of and/or the discussion of student grades, evaluations, course feedback, etc.

Reviewing profiles of patients.

Participating in activities that may compromise the provider/patient or faculty/student relationship.

Providing medical advice on social networking sites.

Posting or displaying images of patient specimens or patient information

Breaks

Breaks are given in the clinical rotations and students should follow the rules specific to each site for breaks. At no time will refreshments and/or smoking be permitted in the laboratories. Rules of the laboratory apply for lunches and breaks.

Hospital Policies

The Pathologists' Assistant students must abide by the University policies as well as the policies of the hospital at which they are rotating.

Universal Precautions and Laboratory Safety

The student will be collecting, processing, and working with patient and known blood, body specimens, and microorganisms that could be potentially pathogenic during his/her professional education.

The student has been oriented to and understands the use of and need for Universal Precautions and will follow these guidelines both in the student and hospital laboratories (Appendix D).

The student will notify the Pathologists’ Assistant Program office and the course instructor or laboratory supervisor concerning ALL accidents involving breaks in the skin, contamination of mucous membranes (aerosols, splashes, etc.), or ingestion. Please note that you are not in trouble. This happens to every PA and reporting is for your safety and protection, and is not punitive.

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Key points to remember:

1. NO eating, drinking, smoking, mouth pipetting or application of makeup in the student or clinical laboratories. 2. NO placing of objects (fingers, pens, pencils, etc.) in the mouth. 3. Wash hands immediately if contaminated and before leaving the laboratory area. 4. Use of laminar flow hoods and other safety equipment where required. 5. FOLLOW UNIVERSAL PRECAUTIONS AT ALL TIMES. Consider all specimens/autopsies to be highly contagious.

Procedure following occupational exposure to blood/body fluids: If a student is exposed to another person’s blood or body fluid (e.g., through a needle-stick injury or mucous membrane splash),

s/he should take the following steps:

1. Remove the soiled clothing and wash the exposed area with soap and water. 2. Notify attending physician, resident, charge nurse, or site coordinator. 3. Obtain the name and medical record number of the source patient. 4. At LLUMC, report to LLUMC Emergency Department for evaluation and treatment. (If the exposure occurs at an off-campus site, present to the designated department at that site). It is vital that this be done in a timely manner. The Centers for Disease Control and Prevention recommends that treatment be obtained within two hours. If it is not possible to meet this timeline, treatment and evaluation should still be obtained as soon as possible.

During this visit to the designated department for immediate intervention, the following will occur: a. A risk assessment will be performed. This assessment will evaluate the type of exposure the student received and the

benefits of treatment. Baseline blood testing will be performed. b. The student will be given instruction regarding the procedures to be followed for discovering the source patient’s

infectious status. If the patient’s status is not known, hospital personnel will ask the patient for consent for HIV blood testing; and specimens will be obtained to screen for HIV, hepatitis B, and hepatitis C. The student should not ask the patient for this consent or for information. The source patient should be consented and drawn by hospital personnel other than the student. This should be managed by the person originally notified by the student about the exposure.

c. Information will be provided to assist the student in making an informed decision regarding postexposure prophylaxis. d. Vaccinations will be updated as necessary.

5. If the exposure occurs while the student is at an off-campus site (including the VA, Riverside County, etc.), steps 1–3 above should be followed, and the student should report to the location designated by that site for postexposure assessment and treatment. Laboratory accidents (other than a needlestick injury)

When a laboratory accident occurs: 1. Notify the instructor immediately. 2. The student is taken to the University Health Services if the University Health Services is open or the Emergency

Room of the clinical site. 3. When the student has to be taken to the Emergency Room (because the University Health Services is closed) a

written memorandum must be sent by the Program's Office to the University Health Services. 4. Laboratory accident forms must be completed and filed in the Programs' Office on all laboratory accidents. 5. The student cannot be made to go to the emergency room and can deny care from the emergency room, student

health, or employee health. Any medical bills incurred are the student’s responsibility.

Clinical Rotation Evaluations:

Evaluations are completed by the site coordinator at the end of each student’s rotation. An outline of evaluation tools used is included. Students should seek feedback at approximately three week or half-way intervals; constructive criticism should be considered an opportunity to improve and improvements should be noted on the evaluation. Students should make note of these conversations in the specimen log book.

Students are required to do a respectful, fair and honest evaluation of each clinical site following the completion of their rotation via the survey website.

Any problems or concerns should be addressed to the Program Director immediately for remediation.

Drug Screening

Students are subject to the policies of the hospital at which they are rotating. Students who test positive for any of the following drugs of abuse: cannabinoids, cocaine, opiates, phencyclidine, amphetamines, barbiturates, or benzodiazepines, or any other illegal substance will not be allowed to begin the clinical rotation and will be dismissed from the program.

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Attendance of Conferences: Students are invited to attend numerous conferences at the discretion of the site supervisor. At no time do conferences replace the clinical experience in the laboratories.

Specimen Log Books:

It is mandatory that students keep a specimen log. This can be in a notebook, an electronic log, or a small notepad. The purpose of this is to provide the student with a reference of specimens they have grossed including numbers and types of specimens at each rotation. Examples of dictations should be included for complex specimens. When the student attends a job interview, this information will be readily available to the potential employer. If possible, and the clinical site lab system allows, obtain a printout of the specimens that were grossed.

Academic and Professional Probation and Expulsion from the Program:

Please refer to the Pathologists’ Assistant Student Handbook for the policy on academic probation. Accommodations for Disability Please refer to pages 51-54 of the Loma Linda University Student Handbook for the process of requesting accommodations for disability of any sort. While the University and our affiliates will provide such accommodations, there is a process for request and provision of the appropriate and necessary accommodations.

Professionalism:

Please see objectives for a list of standards of professionalism. Remember that the clinical preceptors are not being paid to have students; be respectful of their time and efforts. Additionally, the program has a contract with these clinical sites and they are expecting a PA student to be present. Each student is graded based on performance both professionally and technically. Student Housing in Clinical Rotations

There are Clinical Affiliates that provide housing to our rotating students. The utmost respect for this privilege must be given so that it

can continue for subsequent students. Rules for these housing opportunities are as follows (these may change as necessary): 1) Keep the residence clean. Prior to leaving the residence at the end of your rotation, be sure:

a. All garbage and food in the refrigerator is removed. b. The kitchen is clean with counters and stove wiped down. c. The bed linens should be removed, washed and dried. d. The living areas should be swept clean. e. Bathroom should be cleaned, towels washed and dried.

2) Absolutely no smoking in any provided residence! 3) Absolutely no pets are to be brought to the residence. Arrangements must be made for pet care during these rotations. 4) Use common sense and courtesy- if you are not sure if something is allowed, ask questions or don’t do it, you’re only there

temporarily.

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Objectives for Clinical Practicums

PATH 761, 762, 763, 764 Pathologists’ Assistants Program Loma Linda University School of Medicine

The clinical rotations of the Pathologists’ Assistant program aim to provide students with the clinical skills pertinent to the duties of a Pathologists’ Assistant. The students will become proficient at the techniques used in surgical and autopsy pathology in order to assist the pathologist in diagnosis of disease and abnormalities.

Clinical Expectations: The surgical schedule should be reviewed the night before your rotation. Clinical histories on major cases should be reviewed and the student is expected to read Hruban, Lester and Robbins on the relevant grossing and pathology of expected specimens.

Objectives of the Clinical Practicums:

1) Professionalism Behavior and Attitude; the student will:

a) Demonstrate punctuality and attendance by:

i) Arriving at the clinical site at the specified time, prepared to start on time. ii) Returning from breaks at the specified time iii) Performing tasks at assigned time iv) Delivering assignments on due date.

b) Exhibit appropriate interpersonal skills by: i) Communicating thoughts clearly ii) Asking appropriate questions iii) Maintaining a non-judgmental attitude iv) Adhering to proper phone etiquette v) Showing respect through good listening skills and courteous prompt responses

c) Internalize the value of a professional appearance and neatness by: i) Maintaining personal cleanliness and hygiene

ii) Adhering to the dress code iii) Cleaning the work area after performing procedures iv) Consistently and routinely maintaining organization

d) Demonstrate an attempt to improve by: i) Not repeating mistakes ii) Investigating problem areas and asking for help to make it better iii) Requesting additional assignments or repeat work to improve performance iv) Following directions

e) Accepts constructive feedback by:

i) Willingly changing behavior or activity as suggested ii) Not getting defensive iii) Encouraging the feedback

f) Responds to laboratory pressures and stress by: i) Staying focused ii) Prioritizing work iii) Doing things without being told iv) Anticipating department needs v) Maintaining acceptable performance

g) Demonstrates professional ethics in these ways: i) Maintains patient confidentiality by not discuss patients’ conditions, diagnosis, or treatment unless necessary in the

performance of duties ii) Does not divulge confidential information iii) Does not remark about physicians or care of individual iv) Offers constructive criticism v) Is honest about mistakes and results vi) Will record tasks only if performed vii) Will total the correct clinical hours

viii) Will maintain an accurate specimen log to assist in correct evaluation h) Demonstrates safety measures by:

i) Washing hands frequently ii) Utilizing correct personal protective equipment for grossing specimens, preparing frozen sections, and other procedures

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iii) Wearing lab coat as lab policy dictates

iv) Avoiding touching face with hands v) Wiping up wet spots on the floor vi) Disposing of all contaminated materials appropriately vii) Adhering to fire drills

2) Performance; the student will: a) Complete procedures in a self-directed manner, ahead of schedule, with a high degree of competency, and seeks additional

tasks

b) Maintain accuracy using excellent work habits, rarely needing to repeat work c) Problem solve by correlating, sorting, and organizing information to recognize and resolve problems in a timely fashion d) Become proficient at procedures and perform work in a reasonable amount of time for level of expertise e) Organize and triage specimens so the work to be performed is done in a timely manner f) Maintain an organized, clean, safe work area g) Strive to work independently once procedures are mastered, handling most situations and making good decisions h) Work cooperatively with appropriate personnel in problem solving and decision making, seeking assistance when necessary

3) Medical Skills and Knowledge; The student will be proficient in:

a) Basic skills, such as: i) Correct evaluation and identification of specimen information on the specimen container and requisition for accuracy ii) Compile a correct dictation for the specimen being examined iii) Correctly processing an uncomplicated frozen section within nine minutes, providing the pathologist with a diagnostic slide iv) Seeking the assistance of a pathologist when appropriate v) Taking useful and appropriate photos of specimens vi) Independently processing simple specimens:

(1) GI biopsies (2) Simple skin biopsies (punch, shave, simple excisions) (3) Endocervical/endometrial curettage (4) Artery biopsy

(5) Bone marrow biopsies (6) Calculi/surgical hardware (gross only) (7) Cervical cone biopsy (8) Fallopian tubes/vasa deferentia for sterilization (9) Heart valves (10) Hemorrhoids (11) Hernia sac (12) Intervertebral disc (13) Breast core biopsy

(14) Lymph node for lymphoma protocol (15) Pediatric thymus resection (16) Parathyroid resection (17) POC (18) Prostate biopsies

b) Moderate skills, such as: i) Independently processing less complex specimens correctly, including but not limited to:

(1) Appendix

(2) Gallbladder (3) TURP/TURB (4) Oriented and wide skin excisions (5) Prolapse uterus (6) Extremity amputation, non-tumor (7) Fallopian tube (8) Femoral head for osteoarthritis (9) Oriented breast lumpectomy (10) Placenta

(11) Hysterectomy for leiomyomas (12) Thyroid resections (13) Prostate resections (14) Colon for tumor (15) Colon for non-tumor

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c) Complex skills, such as:

i) Independently processing complex specimens correctly, including but not limited to: (1) Laryngectomy (2) Pneumonectomy (3) Radical neck dissection (4) Mastectomy (5) Uterus for malignancy (6) Pelvic exenteration (7) Gastrectomy (8) Esophagectomy

d) Autopsy skills, under the direction of the attending pathologist, the student will:

(1) Consistently verify body identity/tags (2) Verify if consent is correct (3) Verify limitations on autopsy consent forms (4) Thoroughly reviews patient history/charts when possible (5) Perform a full external exam that identifies signs of death and features and signs of common diseases (6) Displays the ability to perform evisceration of a body (7) Displays proper dissection of organs and organ blocks

(8) Identifies structures that student cuts. (9) Collaborates with resident and faculty to formulate a PAD and Autopsy Report (10) Displays proper use and techniques of photography (11) Perform chart review as indicated, with a brief summary for attending. (12) Review autopsy consent: ensure it is complete and correct. (13) Formulate a Preliminary Anatomical Diagnosis (PAD) and autopsy report in conjunction with residents and attendings (14) Estimation of weight or use of the scale. (15) Length measurement (16) Description of hair, eyes, teeth, ears, head and neck region. (17) Description and full body exam to include but not limited to:

(a) Skin: scars, moles, tumors, evidence of medical intervention (catheters, ports, IVs, etc.), tattoos, (photograph) unusual injuries.

(b) Extremities: symmetry, any abnormalities (c) Genitalia: Male vs female, any abnormalities

(18) Perform evisceration with: (a) Proper utilization of “Y-shaped” incision and variations of incision based on autopsy consent. (b) Removal of organs using the “Virchow” method (c) Removal of organs using the “Rokitansky” method to include but not limited to:

(i) Removal of tongue and larynx en bloc (ii) Removal of spinal cord

(iii) Removal of brain (d) Proper dissection and tissue submission of organs: (e) Weighing organs (f) Photography of organs (g) Review of organ “blocs” (h) Photography of pertinent pathology (i) Proper preparation and presentation of cases at autopsy/gross conference

(19) Miscellaneous autopsy duties to be reviewed: (a) Release of bodies

(b) Tissue dumping and storage of tissue (c) Interaction with funeral homes, clinical floors (d) Set up of autopsy suite (e) Sign-out with Dr. Adams (f) Various duties as assigned by attending pathologist or assigned forensic technician

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Loma Linda University School of Medicine Pathologists’ Assistant Program Clinical Practicum

A Key to Evaluation of Psychomotor Objectives

Use the following factors and scale to complete the evaluation of the performance of the student’s skills as indicated on the following pages (whole numbers or numbers in between may be used).

1. Accuracy 100- Exceptional - rarely needs to repeat work; excellent work habits conducive to attaining accuracy. (Exceeds

expectations; provide comments) 90 - Above Average - occasionally repeats work; very good habits. (Exceeds exp.) 80 - Average - acceptable performance; repeat work is average in frequency. (Meets exp.) <75 - Needs Improvement - Difficulty in achieving accuracy in the non-routine technical procedures on a regular basis;

requires more repetitions than what is desirable. (Sometimes below exp. - need comments)

2. Problem Solving 100 - Exceptional - Correlates, sorts and organizes data to recognize and resolve various problems in a timely fashion.

(Exceeds expectations; provide comments) 90 - Above Average - with little prompting and some initial guidance is able to identify problem and develop a course of

action. (Exceeds exp.) 80 - Average - Usually needs input from peers to recognize a problem and significant input to determine an acceptable

course of action to resolve problem. Good follow through, however. (Meets exp.) <75 - Needs Improvement - Has difficulty recognizing a discrepancy or a potential problem. When the problem is

identified, can follow recommended course of action. However, cannot develop an acceptable course of action. (Sometimes below exp. - need comments)

3. Production/Efficiency 100 - Exceptional - Procedures mastered quickly. Organizes work load, performs almost at rate of seasoned tech. (Exceeds

expectations; provide comments) 90 - Above Average - Procedures mastered in timely fashion. Once mastered, does very well in getting the work

completed. Contributes to the department=s overall production and organization. (Exceeds exp.) 80 - Average - Most procedures mastered in acceptable time frame. Once mastered, production and efficiency increase

gradually. Sometimes a real asset to the department; at other times needs more help than expected. (Meets exp.) <75 - Needs Improvement - Takes longer than usual to master procedures and perform with confidence. With more time,

production and efficiency should improve somewhat. (Sometimes below exp. - need comments.)

4. Neatness and Organization 100 - Exceptional - Work is always organized and in order. Easy for someone else to enter into middle of task and

complete it if student had to leave unexpectedly. When completes tasks, grossing area is immediately cleaned-up and restored appropriately. (Exceeds expectations; provide comments)

90 - Above Average - Well organized. (Exceeds exp.) 80 - Average - Usually organized and neat. Generally restores work area appropriately. Sometimes additional minor

clean-up work needs to be done due to some neglect. (Meets exp.) <75 - Needs Improvement - Difficult to work with because not well organized. Additional clean-up is often substantial.

Sometimes work habits give appearance that results may not be good. (Sometimes below exp. - need comments)

5. Ability to Work Independently 100 - Exceptional - Once procedure mastered, needs very little direction; takes the initiative; recognizes responsibility

readily. Follows through on tasks. Handles most situations and makes good decisions. Communicates well with peers and superiors in and outside of the department. (Exceeds expectations; provide comments)

90 - Above Average - Once procedure mastered, may still need some direction, but recognizes and assumes responsibility readily. Follows through on tasks. Handles most situations and makes good decisions.

(Exceeds exp.) 80 - Average - Usually needs some specific direction each day as to what needs to be done. However, accepts assignments

willingly. Generally works without much assistance but will usually seek input on fairly routine decisions. (Meets exp.) <75 - Needs Improvement - Will usually wait to be assigned specific tasks for the day. Avoid making decisions without

assistance. However, there has been steady (albeit slow) improvement as time passes; suggesting that more experience is required before can work independently but average performance might be reached. (Sometimes below exp. - need comments)

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6. Ability to Work Cooperatively 100 - Communicates well - Actively seeks to involve appropriate personnel in problem-solving and decision making. Recognizes and

adapts to majority rule if applicable. Assumes appropriate responsibility in contributing to the team’s effort of completing the work of the unit. (Exceeds expectations; provide comments)

90 - Above average - Works somewhat comfortably with peers and when requested will engage in cooperative efforts and follow through well. Will assume responsibility and work with others as assigned. (Exceeds exp.)

80 - Average - Prefers to work alone. Usually needs specific direction as to the task at hand. Functions better and can communicate with group members if assignments are specific and task oriented and given on a relatively small scale. (Meets exp.)

<75 - Needs improvement - Not comfortable working with others. Easily intimidated and sometimes becomes defensive. Behavior is not conducive to cooperative work arrangements. Easily intimidated and defensive. Will criticize others. Insists on advancement of own ideas. A ‘my way or the highway’ attitude or approach. (Below exp.)

LLU Pathologists’ Assistant Basic Autopsy Skills The basic autopsy skills must be completed at a level of Meets Requirements of Practice or better. Failure to do so will result in remediation

Special Techniques Skill Log The special techniques could be brought to a job interview. Completion of this list of skills is not necessary to complete the LLU autopsy rotation.

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LLU: Surgical Pathology Rotation

Hours: Monday- Friday: AM Grossing PA Student: 8:00 AM-4:30 PM PM Grossing PA Student: 9:30 AM-6:00 PM

You receive a thirty minute lunch and two ten minute breaks.

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Contact Information: Maria Vindua PA(ASCP): 909-558-4000, ext. 45149 Maria’s pager: mnrabina@mytwoway.com, 5354

ID Badge: Wear your student ID badge

Parking: Park where you parked during your first year of study.

Dress code: Blue hospital scrubs and closed-toe shoes are required.

LLU Frozen Section and Autopsy Rotation

Hours:

Monday-Friday: 8:00 AM – 4:30 PM

ID Badge: Wear your student ID badge

Dress Code:

Blue scrubs with closed toe shoes. For LLU: it is your responsibility to contact the resident in charge of Autopsy to find out if there is an autopsy that day. If there is no autopsy scheduled, your next priority is working in the frozen section room. When there are no frozens, it is your responsibility to work in the LLU gross room. LLU Murrieta Address: Hospital: 28062 Baxter Rd, Murrieta, CA 92563 Talent Services: 28078 Baxter Road, Suite 210, Murrieta, CA 92563 Contacts: Naomi Howell (Talent Services): 951-290-4860, ndhowell@llu.edu Yeghia “Eli” Kamrekian (Lab Manager): ykamreki@llu.edu Preceptors: Dr. Yamil Lopez (primary), Dr. Roland Lonser, Dr. Jeremy Deish, Dr. William Saukel, Dr. Kevin Thompson

ID Badge: Wear your student ID badge Hours: Monday – Friday: 8:00 AM - 4:00 PM

Dress Code:

Blue scrubs with closed toe shoes.

On the first day of rotation you are to meet with Naomi Howell in Talent Services; from the parking lot of the hospital follow the elevated walk-way to the large glass building. Naomi is located in suite 210. You are to call Naomi the week before your rotation starts to schedule an appointment for the early morning of your first day. PATH MD Address: Lab: 8158 Beverly Blvd. Los Angeles, CA 90048 Apartment: 535 N. Hayworth Ave. Los Angeles, CA 90048 Contact: David Costanzo PA (ASCP) Cell: 310-486-6193 Email: dcostanzo@pathmdlabs.com

Hours: Monday – Friday: Student 1: 10:00 AM – 4:00 PM

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Student 2: 4:00 PM – 10:00 PM

Dress Code: Scrubs are provided by the lab and are available in the apartment. You may wear your own blue scrubs. Closed-toe shoes are required. Housing: Housing is provided throughout the duration of your stay at PATH MD labs. You are to contact David several days before the beginning of your rotation; schedule a time to meet him at the apartment the weekend before your rotation begins to get the keys. Sheets for bedding and kitchen supplies are provided. At the end of your rotation, you are to thoroughly clean the apartment and wash all laundry that remains in the apartment. Please see rules on page 10 for “Student Housing in Clinical Rotations”. You are expected to vacate the apartment no later than the Saturday after your last day of rotation. You are to park on the street during your stay in the apartment. Parking at the laboratory is not available; the apartment is located about 0.5 miles (about a 10 minute walk) from the apartment. Exams: When you are on rotation at PATH MD, you do not need to return to LLU for the monthly Pathology Review Exams. You are required to take the exam at PATH MD (not from the apartment). Communicate with David and he will help you find a quiet place to take the exam at the lab. Once you are finished with the exam, you are to return to working.

Victor Valley Global Medical Center Address: 15248 11th St, Victorville, CA 92395 Contact: Dr. Reda Tadros (pathologist) Cell: 626-802-0181 Email: redatadros@yahoo.com

Hours: Monday – Friday: 8:00 AM – 5:00 PM

Dress Code: Blue scrubs. Closed-toe shoes.

Eisenhower Medical Center Address: 39000 Bob Hope Dr., Rancho Mirage, CA 92270 Contact: Stephanie Cherry Baty Cell: 909-559-2252 Email: secherry1@yahoo.com

Hours: Monday – Friday: 10:00 AM – 5:00 PM

Dress Code: Blue scrubs. Closed-toe shoes are required.

Paperwork: the two forms below must be completed and submitted to Laura Mohlenhoff (lmohlenhoff@emc.org) and Diana Elizondo (delizondo@emc.org) two weeks before your start date:

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20

Items to be completed before Internship rotation at Eisenhower Medical

Center

1. Physical Exam. A written statement by a person lawfully authorized to perform the examination stating

the individual is physically capable of performing the essential functions of the job and is free of infectious

diseases. This health exam must be performed within one (1) year prior to an assignment at Hospital.

2. Tuberculosis Screening. The individual will have a TB skin test (a.k.a. PPD, Mantoux) that is read and

documented as “negative” within one (1) year of assignment to Hospital. The individual will provide documentation

that the individual has had a 2-step PPD skin test. If the individual has a documented “positive” TB skin test, the

individual must have a clear chest x-ray (defined as negative for active tuberculosis) within four (4) years of

assignment to Hospital.

3. Immunizations. The individual must be able to demonstrate immunity or proof of vaccination by

submitting the following blood titers OR immunization record signed by a qualified health provider on the following:

Measles, Mumps, Rubella, and Varicella. The individual must provide blood titers for Hepatitis B Surface

Antibody, Hepatitis B Surface Antigen, Hepatitis B Core Antibody, and Hepatitis C. Hospital shall not be

responsible for providing any immunization or vaccination of the individual. In addition, please provide proof of

vaccination of Influenza and Tetanus (either TDaP, or DTaP). Please note that the individual has the option to get

or decline the Hepatitis B vaccination, Influenza vaccination or Tetanus vaccination. Please inform Employee Health

right away.

4. Drug Screen. Evidence of Ten-Panel drug screen within the last year must be performed before taking

assignment at Hospital. The individual may begin their assignment before drug screen test results are known,

however, test results that indicate the presence of drugs and/or alcohol will disqualify the individual for assignment

with Hospital. In this instance, the assignment will be immediately discontinued, and no expense will be incurred by

Hospital. We recommend that you go get your Drug Screen done at Eisenhower Occupational Health in Cathedral

City (located in the Target Shopping Center)

5. Background Screening. Student shall complete a criminal background screening. The screening shall

meet the requirements of the Department of Justice and reveal any misdemeanor or felony convictions. Exceptions

include minor traffic violations, a misdemeanor conviction for marijuana-related offense that is more than 2 years old

or any felony or misdemeanor conviction that has been sealed, expunged, judicially dismissed or otherwise legally

eradicated. The student will go on the following website; www.mybackgroundcheck.com; on the right hand side they

will enter the code; C1P55. Once the background check has cleared the student will print a copy of the results these

are the items that must be included (Criminal, OIG, SSN and Sex Offender). We will accept background checks

from any other companies, so long as they have all our required items included. This must be brought in to Human

Resources and will be reviewed and cleared prior to attending an orientation.

6. Student Orientation. You will also need to attend a Mini-orientation. Time and date will be determined.

Once you have completed the above, please contact Diana Elizondo at 760-837-8507. San Bernardino County Medical Examiner Address: 175 S Lena Rd, San Bernardino, CA 92415 Contact: Dr. Sheridan

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Hours: Monday – Friday: 8:00 AM – 5:00 PM

Dress Code: Blue scrubs. Closed-toe shoes are required.

Hemet Valley Medical Center Address: 1117 E Devonshire Ave. Hemet, CA 92543 Contact: Perley Riley, perley.riley@phh.ms

Hours: Monday – Friday: 9:00 AM – 5:00 PM

Dress Code: Blue scrubs. Closed-toe shoes are required.

Redlands Community Hospital Address: 350 Terracina Blvd, Redlands, CA 92373 Contact: Dr. Si Nguyen, snguyen@affiliatedpath.com

Hours: Monday – Friday: 9:00 AM – 5:00 PM

Hoag Hospital Newport Beach Address: 1 Hoag Dr. Newport Beach, CA 92663 Contact: Mari Yang, mari.yang@hoag.com

Hours: Monday – Friday: 10:00 am – 6:00 PM Paperwork: the below paperwork needs to be completed and sent to studentunpaidinterns@hoag.org two weeks prior to your start date:

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Hoag Unpaid Intern Process & Procedure

Hoag Hospital upholds its commitment to teaching students from various disciplines access to our facilities for the

purposes of acquiring observational, clinical and/or managerial experiences. This document provides policy and

procedure guidelines related to participating in an unpaid internship here Hoag.

Responsibility of the Unpaid Intern:

The unpaid intern must present and review the following items below with the Hoag Manager (these documents

should not be kept by Hoag and given back to the student) • Proof of immunization or positive serology (titer) for rubella, measles and mumps

• Proof annual influenza vaccine or declination

• Proof immunization, positive serology (titer) or immune by history of disease for varicella

• Evidence of Hepatitis B either positive antibody titers or immunizations

• Annual proof of negative tuberculosis testing by Purified Protein Derivative (PPD) skin test. Any Student

who has a positive PPD skin test will be required to provide College with evidence of a negative chest x-ray

report taken within one (1) year of his/her initial date of participation in the program

Responsibility of Hoag Manager:

• Background Check Requirements- Due to the complex nature of our compliance requirements, Hoag will

be administering the background checks. Contact your Recruiter with the intern’s name, contact information

so that he/she may get them the background check request.

• Acknowledgement of Non-Employee Status Agreement -Signed by the Student & Hoag Manager upon the

interview/meeting with the unpaid intern.

• Safety Quiz- Completed on the Intern’s first day: Evidence of demonstrated knowledge of universal

precautions and the use of personal protective equipment: Hoag Manager will administer the Safety Quiz.

• Department Orientation Checklist- Completed on the Intern’s first day: Departmental Orientation Checklist

(found on the Wave) must be completed by Department.

Steps in Processing an Unpaid Intern:

• Once the Unpaid Intern has been identified- • Bring intern in for a brief interview/meeting to review compliance documents. Advise the intern that

they will be receiving a background check request from our background check company HireRight

and that they must complete this within 24 hours.

• Complete the Acknowledgement of Non-Employee Status Agreement with the Student.

• Contact your Recruiter with the intern’s name, email and phone, so that he/she may receive the background

check request.

• Once your intern’s background has cleared your Recruiter will notify you. • You must complete the Acknowledgement of Non-Employee Status Agreement -by checking the

background check box.

• Complete the Hoag Unpaid Intern Request Form and “email” both the Hoag Unpaid Intern Request

Form AND the completed Acknowledgement of Non-Employee Status Agreement to

studentunpaidinterns@hoag.org

IV. IMPORTANT:

It will be the Hoag Manager’s responsibility to keep completed: signed Acknowledgement of Non-Employee

Status/Agreement of Student form, departmental orientation checklist and safety quiz answer key for each Unpaid

Intern in a file.

The Hoag Manager will be responsible for picking up the Unpaid Intern’s badge prior to their first day and

collecting that badge upon the completion of their internship.

A signed Student Affiliation Agreement must be in place with the University and that specific program in order

for leader to consider that unpaid intern.

Each unpaid intern will have to go through their respective University Relations Coordinator in order to be

considered for an internship and must understand Hoag’s compliance requirements before acceptance.

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1

Hoag Unpaid Intern Process & Procedure

ACKNOWLEDGEMENT OF NON-EMPLOYEE STATUS/COMPLIANCE CHECKLIST

[TO BE EXECUTED BY EACH STUDENT]

The undersigned Understands and agrees that [Student Name]

his/her participation in the (the “Program”) at Hoag Memorial Hospital Presbyterian (“HOAG”)

does not in any way render said Student an employee of

HOAG or any HOAG related entity. Said Student further understands that HOAG participates in the Program

only to assist students in furthering their education in their area of study, and does not hire or employ Student

as an employee, independent contractor or otherwise.

Student further agrees that he/she is participating in the Program for educational purposes only, and will

receive no compensation for participating in the Program. In the event that appropriate medical and

professional liability insurance coverage for the Student is not provided and/or verified by the Program,

Student will be responsible for securing medical and professional liability insurance with a limit of liability

of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the

aggregate as a condition of participation in the Program.

The checklist below is inclusive of the compliance documentation that is required to participate in such Program. The Hoag Manager is responsible for reviewing these documents with the Student and verified accordingly.

Number Check Box Compliance Documents

1 Proof of immunization or positive serology (titer) for rubella, measles, and mumps

2 Proof of annual influenza vaccine or declination

3 Proof of immunization, positive serology (titer) or immune by history of disease for

varicella

4 Evidence of Hepatitis B either positive antibody titers or immunization

5 Annual proof of negative tuberculosis testing by Purified Protein Derivative

(“PPD”) skin test. Any Student who has a positive PPD skin test will be required to

provide College with evidence of a negative chest x-ray report taken within one (1)

year of his/her initial date of participation in the Program

6 Evidence of a criminal background check performed in accordance with Hoag's

accreditation requirements. (Hoag will submit a request through background check

vendor; Student must complete the request form).

7 Prior to Student Intern’s arrival at any Hoag facility, a student photo identification

(“ID”) or a photo ID (if Clinical Pastoral Education Intern) must be brought to

Human Resources in order for a badge photo to be taken. The badge must be worn

at all times while at Hoag facilities.

2

24

Hoag Unpaid Intern Process & Procedure

The undersigned also agrees that at all times Student is participating in the Program, and thereafter

as required by law, Student will comply with all relevant HOAG policies, procedures, guidelines and

standards of conduct as the same are in effect from time to time, all state and federal laws, rules, and

regulations [including, but not limited to the Health Insurance Portability and Accountability Act

(“HIPAA”)], the standards and regulations of The Joint Commission and accreditation organizations

applicable to the Program, and applicable ethical standards.

The completed Hoag Unpaid Intern Request Form & the Signed Acknowledgement of Non-Employee

Status Agreement MUST be emailed to studentunpaidinterns@hoag.org

Student Signature Date

Hoag Manager Date

3

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3

Hoag Unpaid Intern Process & Procedure

HOAG UNPAID INTERN BADGE REQUEST FORM

Before a Hoag Intern Badge Request Form can be submitted, please work with your assigned Recruiter to ensure that the

Non-Employee Status & Compliance Checklist Form and Background Check have been completed.

STEP 1: STUDENT INFORMATION (completed by Hoag Manager or Administrative Assistant)

School Name: Hoag Department Name: Hoag Manager: School Contact: Program:

NOTE: Please provide the following information below for EACH unpaid intern and submit to

studentunpaidinterns@hoag.org

Name

Email

Phone

Cost

Center

Start

Date

End

Date

Hours/

Week

Signed

Non-

Employee

Status &

Compliance

Checklist

Form

Completed

(Y or N)

STEP 2: HOAG BADGE AUTHORIZATION (completed by Hoag Manager) Completed Hoag Unpaid Intern Badge

Request Form & the Signed Acknowledgement of Non-Employee Status Agreement MUST be emailed to

studentunpaidinterns@hoag.org

I I acknowledge and confirm all requirements are completed and I authorize issuance of a Hoag Badge by HR Shared Services. Student has been informed that he/she will need to bring in their Photo ID in order for badge to be issued by HR.

Hoag Manager Name:

Hoag Manager Signature and Date:

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IMPORTANT:

DEPARTMENT ORIENTATION must be completed by department on the intern(s) first day.

SAFETY QUIZ must be completed by the intern on their first day. A copy of their answer key must be kept in

their unpaid intern file.

4