Dear Applicant: Thank you for your interest in the Physician ...

College of Health Professions

Clinical ServicesPhysician Assistant

Program151 B Rutledge Avenue

PO BOX 250962Charleston • SC 29425

Ph (843) 792-3775FAX: (843) 792-0506

“An equal opportunity employer,promoting workplace diversity.”

http://www.musc.edu

Dear Applicant:

Thank you for your interest in the Physician Assistant Program here at the Medical University of South Carolina. Our program is housed in the College of Health Professions along with a variety of other health professional programs. Our students benefit from interdisciplinary training and opportunities to develop relationships with a large, diverse group of future healthcare colleagues.

You have chosen an excellent program and a strong profession. Physician Assistants contribute significantly to healthcare delivery for many South Carolinians and patients all across the country. The profession was recently ranked as the #1 fastest growing profession by Money Magazine™.

Our program earned approval in 2003 for an entry-level Masters of Science degree in Physician Assistant Studies by the Medical University of South Carolina and the South Carolina Commission on Higher Education. The program is fully accredited by the Accreditation Review Commission on Education for the Physician Assistants (ARC-PA). MUSC confers a Master of Science in Physician Assistant Studies (MSPAS) upon completion of the program.

We strive to prepare compassionate, diverse graduates to collaborate with physicians to provide high quality healthcare to all patients. Our innovative training program focuses on primary care and evidence-based medicine and is supported by the most current medical and information technology. We are proud to see our graduates become life-long learners who seek opportunities to advance our profession.

On behalf of the faculty, staff, and current students, I assure you that your application will be reviewed with utmost care. If you have any questions or concerns about our admissions process or the program, please do not hesitate to contact us at 843-792-3775.

Sincerely,

Paul F. Jacques, DHSc, MEd, PA-CAssociation Professor and Interim Director

HP PA Supplement 06/10

1. OFFICIAL TRANSCRIPT(S) • OfficialtranscriptsfromEACHpost-secondaryinstitutionyouhaveattendedarerequiredbymostprograms. • Usethe“TranscriptRequestForm”orsendyourownrequesttotheregistrarofeachinstitutionyouhaveattended.Besurethe

registrarfollowstheinstructionsprintedontheRequestForm.DONOTOPENTHEENVELOPEthatcontainsthedocument.Iftheregistrarwillnotgiveyouanofficialcopy,explainthisinanotetoMUSC’sEnrollmentManagementofficeandhavethetranscript(s) sent under separate cover.

• Final transcripts showing completion of work-in-progress and/or degree awarded must ALSO be sent to Enrollment Management and must be received no later than the end of the first semester of your enrollment. Failure to do so may result in your disenrollment at MUSC.

• ElectronictranscriptsarewelcomedbyMUSC.IfyourpriorcollegeregistrarcansendtranscriptselectronicallythroughthenationalservicesattheUniversityofTexas,Austin,pleaserequestyourpriorcollegetodirectdocumentstoMUSC’sOfficeofEnrollmentManagement.

2. OFFICIAL TEST SCORE RESULTS • Applicantsareresponsiblefortakingtheentrancetest(s)requiredbytheirprogramandforhavingthescoressentdirectlytoMUSC’s

EnrollmentManagementoffice. • Testscoreresultsmustbesentdirectlybythetestingservice.Photocopiesofscorereportsarenotacceptable.Scoresreportedon

transcriptsarenotacceptable,withtheexceptionofSATscores,whichcanbeobtainedfromofficialhighschooltranscripts. • Arrange to take the test your program requires and provide your testing agency with the proper test code for the Medical

University: 5407

• Testinformationandaregistrationformcanbeobtainedbycontactingtheagencyasfollows:

GRE:codeR5407(nodepartmentcode) TOEFL:(codeR5407) GraduateRecordExamination TOEFL/TSEServices (609) 771-7670 (609) 771-7100 http://www.gre.org http://www.ets.org/toefl • Testagenciesusuallytakefourtosixweekstoreportyourscores.

3. APPRAISALS/REFERENCE FORMS • Youareresponsibleforcontactingyourappraisers. • ConfidentialAppraisal/ReferenceFormsaresentelectronically.Typethenamesandemailaddressoftheappraisersonthe

forms.Typeyourownname,andindicateifyouwaiveyourrights.Requesttheappraisertoreadcarefullytheinstructionsforpreparationprintedatthebottomoftheform.DONOTOPENTHEENVELOPEcontainingtheappraisal.

• Appraisalsareusuallyprovidedbymajoradvisors,professors,oremployersbutmustincludeatleastonerecommendationfromalicensedhealthcareprofessional.Thesepeoplehavebusyschedules;contactthemEARLY.

Office of Enrollment Management41BeeStreet

MSC 203Charleston SC 29425-2030

4. COURSE LISTING • Oneorbothoftheseformsmustbecompleted,dependingonyourprogram,andincludedinyoursupplementalmailing: a)ALLprograms:PlansforRemainingAcademicYear(course-in-progressand/orfutureenrollment) b) SOME programs: Prerequisite Course Requirements 5. LICENSE • Includeacopyofyourlicenseifyouholdahealthprofessionslicense. 6. PATIENT CARE EXPERIENCE LOG 7. DEMOGRAPHIC PROFILE SHEET

ADDITIONAL ADVISORY INFORMATION FOR APPLICANTS:

VETERAN EDUCATIONAL BENEFITS • ContacttheVeteran’sCoordinatorat(843)792-1639.

MILITARY PERSONNEL or DEPENDENTS OF MILITARY • IncludeacopyofyourmilitaryordersandthePetitionforResidencyifyouareseekingin-stateresidencyclassification.

INFORMATION UPDATES • NotifyEnrollmentManagementimmediatelyofanychangeto: a) preferred mailing address b) email address c) legal name d) telephone number e) courses-in-progress f ) courses-to-be-taken

Whiletheapplicantmaycontactdepartmentofficesandfaculty,he/sheshouldknowthatoffersofadmissionoriginateonlyintheofficeoftheDeanofthecollegeinaformallettersignedbytheDean.

The applicant is advised to keep copies of all material sent to the University. All original application materials submitted to the University become the property of the University and cannot be returned to an applicant, cannot be copied for an applicant, and cannot be forwarded to any other institution on behalf of the applicant.

TheOfficeofEnrollmentManagementisavailable8:00a.m.to4:30p.m.MondaythroughFriday.Programadmissionspecial-istsaregenerallyavailabletoanswerquestions.Anapplicantmaytelephonetheofficeat(843)792-5396,maywritetoEnrollmentManagementincareofTheMedicalUniversityofSouthCarolinaat41BeeStreet,MSC203inCharleston,SC29425-2030,orsend email to [email protected].

Forms in this packet should be completed and mailed to:

OfficeofEnrollmentManagementMedical University of South Carolina

41BeeStreetMSC 203

Charleston, SC 29425-2030

NameofApplicant___________________________SSNor,PVID,orCollegeNetID:______________ Permanent Address ____________________________________________________________________

Program or Department of Interest ____________________________________

Please have this form completed by a current or former instructor, advisor, or supervisor who is in a position to evaluate your potential.

Some individuals prefer not to complete reference forms unless they can be assured of the confidentiality of their comments. It is our opinionthatcommentsprovidedonaconfidentialbasisarelikelytobeofmorehelptousinjudgingimportantcharacteristicssuchas creativity, originality, independence, and research capability. Therefore, the University is affording you the opportunity to waive your right of subsequent access to this reference statement. Regardless of your decision on waiving your right of future review, your application for admission will be given full consideration.

I do ❏ do not ❏ waive my right of subsequent access to this recommendation form.

____________________________________________________________________________________________________

Name of Evaluator ____________________________________________________________________________________

As required by the Family Educational Rights and Privacy Act, a student may elect to waive the subsequent access to this recommendation form. In either case, the admissions committee would appreciate your opinion concerning the applicant named above.

I have known the applicant for __________ years in my capacity as _____________________________________________________________________________________________________________________________

Doyouhaveanyreasontodoubtthisapplicant’sintegrity? ❏ Yes ❏ No If yes, please explain separately.

How would you rate this student (on a scale of 1 to 10, with 10 the highest) compared to other students at the same educational level with regard to: (Please expand wherever possible. Use “N.O.” for Not Observed.)

Previous accomplishments

Intellectual independence

Capacity for analytical thinking

Ability to organize and express ideas clearly orally

Ability to organize and express ideas clearly in writing

Drive and motivation

Perseverance

Emotional stability

Research aptitude

Ability to work with others

Reference FormCollege of Health Professions • College of Nursing

Please use black ink

Eval

uato

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(Please type or print)

App

lican

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Date Signature of Applicant




Whatdoyoufeelaretheapplicant’s:strongestpoints? ________________________________________________________________________________

_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

weakestpoints? _________________________________________________________________________________

_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

How would you rank this student compared to other students at the same educational level with regard to the probability of successfulhandlingofadvancedcoursework? ______________________________________________________________

_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

Please make other comments that you feel will help us evaluate the applicant. _____________________________________

_____________________________________________________________________________________________ _____________________________________________________________________________________________

_____________________________________________________________________________________________

recommend the applicant as follows: For admission to an undergraduate program

For admission to a masters program

For admission to a doctoral program

_________________________________________________________________________________________________Signature Date

_________________________________________________________________________________________________NameandTitle (typed or printed) TelephoneNumber

_________________________________________________________________________________________________Address City/State/Zip

__________________________________________________________ MUSCAlumni? _________________________E-mail Address

Please attach any other evaluative documents to this appraisal, place in a sealed envelope, sign across the seal, and return to the applicant or mail directly to the Office of Enrollment Management at the address

listed at the top of this form. If applicant requests that you fax this information in addition to returning the sealed original, please fax the information to the Office of Enrollment Management at (843) 792-6615.

The Medical University of South Carolina does not discriminate on the basis of race, creed, national origin, sex, age, or disability in the recruitment and admission of students, employment of faculty and staff, and the operation of other educational activities and programs as specified by federal laws and regulations.

Highest Strong Recommend Recommend with Recommend with Do not Recommendation Recommendation Few Reservations Reservations Recommend

NameofApplicant___________________________SSNor,PVID,orCollegeNetID:______________ (Please type or print)






____________________________________________________________________________________________________












Perseverance

Emotional stability

Research aptitude




Eval

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App

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_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

weakestpoints? _________________________________________________________________________________

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_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________


_____________________________________________________________________________________________ _____________________________________________________________________________________________

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_________________________________________________________________________________________________Signature Date














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Perseverance

Emotional stability

Research aptitude




Eval

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App

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_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

weakestpoints? _________________________________________________________________________________

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_____________________________________________________________________________________________ _____________________________________________________________________________________________

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_________________________________________________________________________________________________Signature Date









Prerequisite Course RequirementsCollege of Health Professions

Master of Science in Physician Assistant Studies

ApplicantName:_____________________________________________SSNor,PVID,orCollegeNetID: ____________________

TermofEntrance:■ Summer 20 ______ please ✓ or

complete as applicable: HOURS DATE NOW IN TERM/YR COURSES COURSE # EARNEDΔ COLLEGE EARNED PROGRESSor PLANNED

COLLEGE OF HEALTH PROFESSIONS – PHYSICIAN ASSISTANT STUDIES

EnglishcompositionorLiterature(6) __________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________Mathematics (3) – college algebra or above __________ ________ __________ ________ ___________ _________

Statistics (3) - required __________ ________ __________ ________ ___________ _________

Biology–mustincludelab(4) __________ ________ __________ ________ ___________ _________

Microbiology – must include lab (4) __________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

Anatomy – must include lab (4)* __________ ________ __________ ________ ___________ _________

Physiology – must include lab (4)* __________ ________ __________ ________ ___________ _________

Organic/Biochemistry(3) __________ ________ __________ ________ ___________ _________

General Chemistry – must include lab (8) __________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

General Psychology (3) __________ ________ __________ ________ ___________ _________

Behavioralsciences(6) __________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

Humanities (12) __________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

Electives** (30) __________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

Electives continued on page 2 __________ ________ __________ ________ ___________ _________

Requirednumberofsemesterhoursinparentheses.Listonlycoursescompletedwithagradeof"C"(2.0)orabove.Surveycoursesarenotacceptable to satisfy science requirements.

* CombinedAnatomyandPhysiologycoursesareaccepted;however,youMUSTtakeAnatomyandPhysiologyIandIItofulfilltheseparate Anatomy and Physiology requirements.** Recommended electives include courses in communications, computer science, epidemiology, and medical terminology. Course must be liberal arts/sciences and not professional or technical in nature.Δ Semester hours (convert quarter hours, if necessary – 1.5 qtr. hr.=1 sem. hr.)

(more)

Choose from at least two: education, fine arts, speech, foreign language, literature, philosophy,economics, history, political science

anthropology, sociology, psychology



(Pleaseuseblackink•Pleaseprint)

ApplicantName:_____________________________________________SSNor,PVID,orCollegeNetID: ____________________

Electives** (continued) __________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

_________ ________ __________ ________ ___________ _________

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__________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

__________ ________ __________ ________ ___________ _________

Information about the transfer course articulation among South Carolina colleges and universities may be found at http://www2.musc.edu/

ES/transfer_policy/transfer_index.html

In concert with current policies and procedures, candidates will be chosen on the basis of (1) prior academic work, (2) GRE scores, (3)

recommendations.Subsequentclassselectionpreferencewillbegiventointervieweeswithdirect“handson”patientcareexperience.All

participants selected for admission must have completed at least 1 interview.

** Recommended electives include courses in communications, computer science, epidemiology, and medical terminology. Course must

be liberal arts/sciences and not professional or technical in nature.

Plans for Remaining Academic YearPlease PRINT in black ink for all information below:

Name ____________________________________________SSNor,PVID,orCollegeNetID: _____________________Program __________________________________________ For pre-admission counseling and to evaluate your qualifications for admission, please list courses in which you are presently enrolled (in progress)andcoursesyouplantocompletepriortoenteringtheMedicalUniversityofSouthCarolina.Transcriptsofanywork,plannedorinprogress,mustbesentassoonascompleted.Officialfinaltranscriptsofallcollegeworkcompletedmustbereceivedpriortotheendofyourfirst semester of enrollment at MUSC. If you have completed all coursework, please write N/A at the top of this form.

Courses in Progress:College/University __________________________________________ Semester/Quarter & Year _____________________________

COURSETITLE CREDITHOURS(S/Q) ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________

Courses Planned to be Completed Prior to Entry:College/University __________________________________________ Semester/Quarter & Year _____________________________


College/University __________________________________________ Semester/Quarter & Year _____________________________


_______________________________________________________ _________________________________________________Applicant’sSignature Date_______________________________________________________ _________________________________________________Applicant’sAddress City/State/Zip

Attach another sheet if additional space is needed.



Physician Assistant Program LOG OF HEALTH CARE RELATED EXPERIENCE*

____ Check here if you haveno health care related experience

Reviewed by: ____________________________ Date: _______________TobecompletedbyOEM(internally)

*Health related experience is not required in order to be eligible for acceptance into this program. Patient care experience does, however, add value to your application. If you accrue additional experience between the application period and an interview date, please notify the event coordinator prior to your first interview.

TotalHoursThisPage

Hours from Previous PagesTotalHoursPage ____________ of _______________

Category of Experience(Paid or Volunteer)

Clinic / HospitalName

Description of Work Performed

Dates of ServiceBegin Date End Date

SupervisorName

SupervisorContact

Information

Total Number of Hours

Name:_________________________________________________SSNor,PVID,orCollegeNetID:_______________________ please print or type in black

Medical University of South CarolinaPhysician Assistant

Demographic ProfileName:_________________________________________________SSNor,PVID,orCollegeNetID:_______________________ please print or type in black

The following questions are asked to help us understand how your background may fulfill the MUSC Physician Assistant Mission Statement.

PleasemailthisformtoOfficeofEnrollmentManagement,MedicalUniversityofSouthCarolina,41BeeStreet,MSC203,Charleston, SC 29425-0203

1.Howwouldyoubestdescribeyourhometown?

■ Rural (outside of city limits - population less than 9,999) ■ Small town (population between 10,000 and 24,999) ■ Suburban (population between 25,000 and 49,999) ■ Metropolitan (population 50,000 and over) ■ Inner city (neighborhood consists of more than 50% lower income housing) ■ Inner city (neighborhood was medically undeserved)

2.Areyouthefirstpersoninyourfamilytohaveattendedcollege?■ Yes ■ No

3.Informativeyears(first12yearsoflife),didyoucomefromasingle-parenthousehold?■ Yes ■ No

4.Informativeyears(first12yearsoflife),didyourfamilylivein?

■ Subsidized housing ■ Rented house ■ Owned home

5.WasalanguageotherthanEnglishspokeninyourhome? ■ Yes ■ NoAreyoufluentinalanguageotherthanEnglish? ■ Yes ■ No

6.Inwhatareaofthecountrydoyouhopetopursueyourcareer?

■ Rural South Carolina ■ Anywhere in South Carolina ■ Southeastern U.S. ■ Wherever there is a demand ■ Outside the U.S. ■ Not sure yet

7.Howmuchofyourannualundergraduatecollegeexpensesdidyouearn? (not including scholarships and/or student loans)

■ 25% or less ■ 51% to 75% ■ 26% to 50% ■ 76% or greater

8. Family Income while growing up (total income of all members living at home):

■ $25,000 or less ■ $75,000 to $99,999 ■ $25,001 to $49,999 ■ $100,000 or greater ■ $50,000 to $74,999

9.Howmanypeoplelivedinyourhome?__________________

10.AreyouaveteranoftheUnitedStatesuniformedservices? ■ Yes ■ No

Signature :__________________________________________________ Date:____________________

University Minimum Abilities for Eligibility to Participate Successfully in Educational Programs and Activities

The following abilities are needed by all students in the university. While admission decisions do not take disabilities into consideration, nor are applicants invited to disclose a disability, all persons interested in entering a health profession education program should be aware of minimum abilities required for success.• Abilitytomakeproperassessmentsandlawfuljudgmentsregardinghealthcare.

• Abilitytoprioritizeandcarryoutinterventions.

• Abilitytoadapttoavarietyofpatient/clientsituations,includingcrises.

• Abilitytocommunicateeffectively.

• Abilitytoobtain,interpret,anddocumentdata.

• Abilitytomeasureoutcomesofpatientcare.

• Abilitytoparticipateindiscussionintheclassroom,intheclinicalarena,andwithcolleagues/patients/clients/thepublic.

• Abilitytoacquireinformationdevelopedthroughclassroominstruction,clinicalexperiences,independentlearning,and consultation.

• Abilitytocompletereadingassignmentsandtosearchandevaluateliterature.

• Abilitytocompletewrittenassignmentsandmaintainwrittenrecords.

• Abilitytosolveproblems.

• Abilitytoperformdutieswhileunderstress.

• Abilitytomeetdeadlines,tomanagetime.

• Abilitytocompletecomputer-basedassignments,andusethecomputerforsearching,recording,storing,andre-trieving information.

• Abilitytocompleteassessmentexaminations.

These abilities may be accomplished through direct student response, through use of prosthetic devices, or through personal assistance (e.g. readers, signers, notetakers, etc.). The responsibility for the purchase of prosthetic devices serving a student in meeting the above required abilities remains with the student and/or the agency supporting the student. The university will assist with providing notetakers, readers, signers, and other attending services.

Upon admission, a student who discloses a disability (with certification) is assured of reasonable accommodation. These accommodations include: opportunities for individual and group counseling; peer counseling; linkages with community services; faculty advisory committees that are aware of disabled students and their needs; career counsel-ing;assistancewithjobsearchesandinterviewskills;and,ofcourse,themorefamiliaraccommodationsofextendedtest-takingtime,andotherenablingservices.Studentsseekingaccommodationinitiatetheirrequestintheofficeofthe dean of the college in which they have matriculated.



Program Minimum Skillsfor Eligibility to Participate in Educational Programs and Activities

The following skills are needed by applicants to this program. Applicants and students should possess these abilities, or with the help of compensatory techniques and/or assistive devices, be able to demonstrate ability to become proficient.

Ability to use therapeutic communication: • attending • clarifying • coaching • facilitating • touching •reading •writing

Intellectual ability to accomplish: •measurements •calculations •reasoning •analysis •synthesis •problemsolving

Ability to be assertive

Ability to delegate

Ability to function (consult, negotiate, share) as part of a team

Ability to participate in role-playing activities

Ability to display and maintain mental and emotional stability

Other:Tobepoisedandself-confidentTobeabletoread,write,understandand

communicate proficiently and effectively in the English language

Tobeabletoremaincalmduringemergencysituations

Tobeabletomeetanddealwithpeopleofdifferingbackgrounds and behavioral patterns

Todisplayandmaintainmentalandemotionalstability

Tobefreefromanyactivediseasesthatareinfectiousand may be spread by routine means, such as handshakes, skin contact and breathing.

NOTE: Studentsseekingtorequestreasonable accommodation may do so by filing a "DisabilityAccommodationRequest"formin the Student Services Center, College of Health Professions.

Manual dexterity: • wrists(both) • hands (both) • fingers(all) • arms (both) • grasping • fingering • pinching • pushing • pulling • holding • extending • twisting (rotating) • cutting

Sensation: • palpation • ausculation • percussion

Visualperception: • depth • color • acuity (corrected to 20/40)

Physical strength: • to support another person • to position another person • to transfer to/ambulate with walker, cane, crutches, bed, chair • provide motion exercises • to stand for long periods of time • to perform CPR; resuscitation

Ability to use sterile techniques and universal precautions

Ability to operate and maintain equipment (e.g., ventilator, electronic monitor, etc.)

Ability to measure: • body (height, weight, range, strength, etc.) • vital signs • intake and output • outcomes, results (e.g. lab tests) • psychological status (general) • using a variety of monitoring modalities

Dear Applicant: Thank you for your interest in the Physician ...

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