Pace University – Lenox Hill Hospital

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  • 1. Pace University – Lenox Hill Hospital Physician Assistant Program Supplemental Application Thank you for your interest in the Pace University-Lenox Hill Hospital Physician Assistant Program. Students who successfully complete the program will receive a B.S. Degree from Pace University and a Certificate of Completion from Lenox Hill Hospital. This application must be completed and submitted to the address listed below if you have NOT previously submitted a CASPA application and you wish to be eligible for the professional phase of the Physician Assistant Program. Please see our web site at www.pace.edu/dyson/paprogram, or call 212-346-1357 for detailed information on requirements for admission into the professional phase of the PA Program. Pace University- Lenox Hill Hospital Physician Assistant Program One Pace Plaza, Room Y-31 New York, NY 10038 The Pace University- Lenox Hill Hospital PA Program operates on a rolling admission basis. Therefore, students who submit this supplemental application early have a better chance of successfully securing a seat in the class. The priority deadline is November 1, 2006. THE CHECKLIST BELOW WILL ASSIST YOU IN COMPLETING THE APPLICATION PROCESS  Health Care Experience Form and Documentation  3 Completed Recommendations  Completed Personal Statement  Updated Transcripts  Change of Major Form (if applicable)  Change of Campus Form (if applicable) Once your file is complete, the Admissions Committee and the Physician Assistant Program will review it. If you meet the criteria, an interview may be scheduled. Interviews will be conducted starting January 2006.
  • 2. Pace University – Lenox Hill Hospital Physician Assistant Program Recommendation Form To the Applicant: (Please remember that you need 3 recommendations for a completed application.) Print Name: _____________________________________________________________ Social Security Number ________________________ Phone _____________________ I waive access to this evaluation. I do not waive access to this evaluation. To the Evaluator: If the applicant has not checked one of the boxes above, it will be assumed that she/he wishes to have access to this evaluation. In what capacity do you know the student? ____________________________________ For how long have you known the applicant? ___________________________________ Please evaluate the applicant based on you actual observations. Check the number, which most closely reflects his or her performance, with 5 being the best score and 1 being the lowest or most unfavorable score. Motivation: The level of incentive demonstrated by the applicant as it applies to assignments and other responsibility. 5 4 3 2 1 Not observed Leadership: The ability of the applicant to present him/herself in an authoritative and influential manner with others. 5 4 3 2 1 Not observed Sensitivity: Applicant’s awareness of attitudes and feeling of others and his or her ability to be discreet. 5 4 3 2 1 Not observed Responsibility: Reliability and accountability for his/her own actions and obligations. 5 4 3 2 1 Not observed Integrity: Honesty and straightforwardness in dealing with others. 5 4 3 2 1 Not observed Flexibility: Ability to adjust well to unexpected change. 5 4 3 2 1 Not observed
  • 3. Maturity: Ability of the applicant to handle academic and personal issues in a mature, responsible manner. 5 4 3 2 1 Not observed Appearance: Dress, hairstyle, neatness, etc. appropriate to the work or school setting. 5 4 3 2 1 Not observed Interpersonal Skills: Ability to relate appropriately to peers and those in authority. 5 4 3 2 1 Not observed Attendance: Ability to be at designated functions as scheduled and on time. 5 4 3 2 1 Not observed Judgment: Ability to arrive at an appropriate conclusion by carefully weighing, discerning and comparing evidence and testing premises. 5 4 3 2 1 Not observed Relating to peers: Ability of applicant to interact with patients in a professional and compassionate manner. 5 4 3 2 1 Not observed Because of the rigorous academic demands and significant patient care responsibilities give to physician assistants, the applicant must be of above average intellect, mature, disciplined, able to accept criticism and highly motivated to succeed. With this in mind, how would you rate this applicant? Outstanding Above average Average Below average Comments: (Please print) Evaluator’s name: ___________________________________ Title: __________ Address: __________________________________________________________ Signature: _________________________________________________________ Do not return this evaluation to the applicant. Mail this form to: Kristina Aranbayeva, Senior Admissions Counselor Pace University- Lenox Hill Hospital’ Physician Assistant Program One Pace Plaza, Room Y-31 New York, NY 10038
  • 4. Pace University – Lenox Hill Hospital Physician Assistant Program To the Applicant: (Please remember thatForm 3 recommendations for a Recommendation you need completed application.) Print Name: _____________________________________________________________ Social Security Number ________________________ Phone _____________________ I waive access to this evaluation. I do not waive access to this evaluation. To the Evaluator: If the applicant has not checked one of the boxes above, it will be assumed that she/he wishes to have access to this evaluation. In what capacity do you know the student? ____________________________________ For how long have you known the applicant? ___________________________________ Please evaluate the applicant based on you actual observations. Check the number, which most closely reflects his or her performance, with 5 being the best score and 1 being the lowest or most unfavorable score. Motivation: The level of incentive demonstrated by the applicant as it applies to assignments and other responsibility. 5 4 3 2 1 Not observed Leadership: The ability of the applicant to present him/herself in an authoritative and influential manner with others. 5 4 3 2 1 Not observed Sensitivity: Applicant’s awareness of attitudes and feeling of others and his or her ability to be discreet. 5 4 3 2 1 Not observed Responsibility: Reliability and accountability for his/her own actions and obligations. 5 4 3 2 1 Not observed Integrity: Honesty and straightforwardness in dealing with others. 5 4 3 2 1 Not observed Flexibility: Ability to adjust well to unexpected change. 5 4 3 2 1 Not observed Maturity: Ability of the applicant to handle academic and personal issues in a mature, responsible manner. 5 4 3 2 1 Not observed
  • 5. Appearance: Dress, hairstyle, neatness, etc. appropriate to the work or school setting. 5 4 3 2 1 Not observed Interpersonal Skills: Ability to relate appropriately to peers and those in authority. 5 4 3 2 1 Not observed Attendance: Ability to be at designated functions as scheduled and on time. 5 4 3 2 1 Not observed Judgment: Ability to arrive at an appropriate conclusion by carefully weighing, discerning and comparing evidence and testing premises. 5 4 3 2 1 Not observed Relating to peers: Ability of applicant to interact with patients in a professional and compassionate manner. 5 4 3 2 1 Not observed Because of the rigorous academic demands and significant patient care responsibilities give to physician assistants, the applicant must be of above average intellect, mature, disciplined, able to accept criticism and highly motivated to succeed. With this in mind, how would you rate this applicant? Outstanding Above average Average Below average Comments: (Please print) Evaluator’s name: ___________________________________ Title: __________ Address: __________________________________________________________ Signature: _________________________________________________________ Do not return this evaluation to the applicant. Mail this form to: Kristina Aranbayeva, Senior Admissions Counselor Pace University- Lenox Hill Hospital’ Physician Assistant Program One Pace Plaza, Room Y-31 New York, NY 10038 Pace University – Lenox Hill Hospital Physician Assistant Program Recommendation Form
  • 6. To the Applicant: (Please remember that you need 3 recommendations for a completed application.) Print Name: _____________________________________________________________ Social Security Number ________________________ Phone _____________________ I waive access to this evaluation. I do not waive access to this evaluation. To the Evaluator: If the applicant has not checked one of the boxes above, it will be assumed that she/he wishes to have access to this evaluation. In what capacity do you know the student? ____________________________________ For how long have you known the applicant? ___________________________________ Please evaluate the applicant based on you actual observations. Check the number, which most closely reflects his or her performance, with 5 being the best score and 1 being the lowest or most unfavorable score. Motivation: The level of incentive demonstrated by the applicant as it applies to assignments and other responsibility. 5 4 3 2 1 Not observed Leadership: The ability of the applicant to present him/herself in an authoritative and influential manner with others. 5 4 3 2 1 Not observed Sensitivity: Applicant’s awareness of attitudes and feeling of others and his or her ability to be discreet. 5 4 3 2 1 Not observed Responsibility: Reliability and accountability for his/her own actions and obligations. 5 4 3 2 1 Not observed Integrity: Honesty and straightforwardness in dealing with others. 5 4 3 2 1 Not observed Flexibility: Ability to adjust well to unexpected change. 5 4 3 2 1 Not observed Maturity: Ability of the applicant to handle academic and personal issues in a mature, responsible manner. 5 4 3 2 1 Not observed Appearance: Dress, hairstyle, neatness, etc. appropriate to the work or school setting. 5 4 3 2 1 Not observed
  • 7. Interpersonal Skills: Ability to relate appropriately to peers and those in authority. 5 4 3 2 1 Not observed Attendance: Ability to be at designated functions as scheduled and on time. 5 4 3 2 1 Not observed Judgment: Ability to arrive at an appropriate conclusion by carefully weighing, discerning and comparing evidence and testing premises. 5 4 3 2 1 Not observed Relating to peers: Ability of applicant to interact with patients in a professional and compassionate manner. 5 4 3 2 1 Not observed Because of the rigorous academic demands and significant patient care responsibilities give to physician assistants, the applicant must be of above average intellect, mature, disciplined, able to accept criticism and highly motivated to succeed. With this in mind, how would you rate this applicant? Outstanding Above average Average Below average Comments: (Please print) Evaluator’s name: ___________________________________ Title: __________ Address: __________________________________________________________ Signature: _________________________________________________________ Do not return this evaluation to the applicant. Mail this form to: Kristina Aranbayeva, Senior Admissions Counselor Pace University- Lenox Hill Hospital’ Physician Assistant Program One Pace Plaza, Room Y-31 New York, NY 10038 Pace University – Lenox Hill Hospital Physician Assistant Program Personal Statement Form
  • 8. Please complete this form by explaining why you wish to become a Physician Assistant and what qualities and strengths you have that make you a good applicant for this program. Please include what factors motivated you to select our program. (You may submit a typed one page personal statement if you’d like or attach additional pages if necessary). Name: ___________________________________ Telephone:_____________________ Pace University – Lenox Hill Hospital Physician Assistant Program Health Care Experience Name: ______________________________________ SS #: ______________________
  • 9. At least 200 hours of health care related experience must be completed to be eligible for the professional phase of the Physician Assistant Program. Please submit a letter or appropriate supporting documentation as verification of completion. In addition, complete the table below. Hours per Total hours From To Position week completed Total Hours of Health Care Experience ____________________________ PACE UNIVERSITY-LENOX HILL HOSPITAL PHYSICIAN ASSISTANT PROGRAM PA PROGRAM TECHNICAL STANDARDS Technical standards define the attributes that are considered necessary for candidates to possess in order to complete their education and training, and subsequently enter clinical practice. These standards are prerequisites for entrance, continuation, and graduation from the Pace University – Lenox Hill Hospital Physician Assistant Program. A candidate for the Physician Assistant Program must have abilities and skills in five categories: observation, communication, motor, intellectual, and behavior/social. Reasonable accommodation for persons with documented disabilities will be considered on an individual basis, but a candidate must be able to perform in an independent manner. The following skills are required, with or without accommodation. OBSERVATION
  • 10. Candidates must have sufficient sensory capacity to observe in the lecture hall, the laboratory, the outpatient setting, and the patient’s bedside. Candidates must be able to accurately observe a patient near and at a distance, noting nonverbal, as well as verbal signs. Candidates must be able to observe changes in body movement, observe anatomic structures, discriminate among numbers and patterns associated with diagnostic tests such as electrocardiograms and electroencephalograms and competently use diagnostic instruments such as otoscope, ophthalmoscope, and microscope. Specific vision related criteria include, but are not limited to, detecting and identifying changes in color of fluids, skin, culture media, visualizing and discriminating findings on x-rays and other imaging tests, and reading written and illustrated materials. Sensory skills adequate to perform a physical examination are required. Functional vision, hearing and tactile sensation must be adequate to observe a patient’s condition and to elicit information through procedures regularly required in a physical examination, such as inspection, auscultation and palpation. COMMUNICATION Candidates must be able to clearly communicate with patients in order to elicit information, accurately describe changes in mood, activity and posture of patients, and understand verbal as well as nonverbal communication. Candidates must show evidence of effective written and verbal communication skills. Specific requirements include, but are not limited to the following: rapidly and clearly communicating with the medical team on rounds or elsewhere, eliciting an accurate medical history from patients, and communicating complex findings in appropriate terms to patients and to various members of the health care team. Candidates must learn to recognize and promptly respond to emotional communications such as sadness and agitation.
  • 11. SENSORY AND MOTOR Candidates must possess sufficient sensory and motor function to perform physical examinations using palpation, auscultation, percussion and other diagnostic maneuvers. Candidates must have sufficient motor function to execute movements reasonably required to provide care to patients. Candidates must be able to negotiate patient care environments and must be able to move between settings, such as clinic, classroom building, and hospital. Physical stamina sufficient to complete the rigorous course of didactic and clinical study is required. Long periods of sitting, standing, or moving are required in classroom, laboratory and clinical experiences. Candidates should be able to execute motor movements to provide general care and emergency treatments to patients. The candidate, therefore, must be able to respond promptly to urgencies within the hospital or practice setting, and must not hinder the ability of their co-workers to provide prompt care. Examples of emergency treatment reasonably required of a physician assistant include arriving quickly when called and assisting in cardiopulmonary resuscitation (CPR), administering intravenous medications, applying pressure to arrest bleeding, maintaining an airway, suturing uncomplicated wounds, and assisting with obstetrical maneuvers. As further illustration, CPR may require moving an adult patient, applying considerable chest pressure over a prolonged period of time, forcefully delivering artificial respiration and calling for help. INTELLECTUAL Problem solving, a critical skill demanded of physician assistants, requires intellectual abilities which must be performed quickly, especially in emergency situations. These intellectual abilities include numerical recognition, measurement, calculations, reasoning, analysis, judgment and synthesis. Candidates must be able to identify significant findings from the patient’s history, the physical examination and laboratory data, provide a reasoned explanation for likely diagnoses, and choose appropriate medications and therapy. The ability to incorporate new information from many sources in formulating diagnoses and plans is essential. Good judgment in patient assessment, diagnostic and therapeutic planning is primary. When appropriate, candidates must be able to identify and communicate the limits of their knowledge to others. BEHAVIORAL AND SOCIAL ATTRIBUTES Candidates must possess the emotional health required for full utilization of their intellectual abilities, the exercise of good judgment, the prompt completion of all responsibilities associated with the diagnosis and care of patients and the development of mature, sensitive and effective relationship with patients. Candidates must possess the ability to monitor and react appropriately to one’s own emotional needs and responses. For example, candidates need to maintain PA Program Supplemental Application Updated 10/24/05
  • 12. emotional demeanor and organization in the face of long hours, fatigued colleagues and dissatisfied patients. The ability to function in the face of uncertainties in clinical practice, flexibility, compassion integrity, motivation, interpersonal skills, and concern for others are required. PA Program Supplemental Application Updated 10/24/05