| Course | PA 602 PA Prof Prac Seminar IV |
|---|---|
| Week | 1 |
| Paper type | Discussion post with two replies |
| Length | About 560 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 602 Week 1
Week 1 Discussion: Initial Post
Two Workups From One Month of Rotation: A Careful Chest Pain Evaluation Followed by a Heart Attack and a Skipped Ankle Rule Followed by Nothing, and Why Only the First Would Be Called an Error
Two Situations, Not One
First situation. A man in his fifties came to an urgent care with chest discomfort that had lasted twenty minutes and resolved before arrival. He had an ECG on arrival and another two hours later, both normal, two high-sensitivity troponins below the threshold at the right interval, a documented risk score in the low range and a scheduled stress test within 72 hours. He was discharged with clear return precautions. Three days later, before the stress test, he had a heart attack.
Second situation. A teenager rolled an ankle playing basketball. The ankle was swollen, the clinician did not palpate the posterior edges of the malleoli or the base of the fifth metatarsal and did not apply the Ottawa ankle rules. No X-ray was taken, the patient was told to rest it, and it healed in two weeks.
What Was Available at the Time
In the first situation, every step that a careful clinician would take was taken, and documented. At the moment of discharge, the information available supported discharge. In the second, a two-minute examination that would have decided whether the ankle needed imaging was skipped. At the moment of discharge, the clinician did not know whether the ankle was fractured.
Luck, Named Rather Than Used
The teenager's good outcome was luck: the ankle happened not to be broken. The man's bad outcome was also, in part, bad luck: a small fraction of patients with a truly reassuring evaluation still go on to have an event. When reviewers know the outcome, they judge the same care differently. In one study, practicing anesthesiologists rated care as appropriate 31 percentage points less often when an otherwise identical case was given a permanent rather than a temporary injury (Caplan et al., 1991). I suspect our classroom would call the first workup a miss and never discuss the second.
The Claim
The first workup was not an error; the second was, even though no harm followed. If we judge clinicians by outcomes alone, we will reward the second clinician's habit and punish the first one's care.
The test I would propose for our classroom is simple: before reading how a case ended, decide whether each step was defensible on the information available at that step. Only then read the outcome.
One Line to Each Patient
To the man, if I were his clinician: "We did every test that would normally find this, and they were reassuring; I am sorry it happened anyway, and we will look at whether anything should change." To the teenager, nothing needs to be said about the outcome, but the clinic should still learn that the rules were not applied.
Replies That Take the Other Side
Reply to Tess: You say the first clinician should have kept the man for observation. On the information available that day, what finding would have justified admission, and how many low-risk patients would have been admitted to catch him?
Reply to Omar: You call the second situation "good clinical judgment." What did the clinician know that made an X-ray unnecessary, other than the outcome we now know?
References
Caplan, R. A., Posner, K. L., & Cheney, F. W. (1991). Effect of outcome on physician judgments of appropriateness of care. JAMA, 265(15), 1957-1960.
The Chamberlain PA 602 Week 1 instructions
The opening discussion asks for two brief clinical situations, stripped of anything that identifies a site or a person. One should be a workup somebody could defend line by line that ended badly; the other a weaker workup that ended well. Describe what was known at the time each decision was made, not what was learned afterward. Name luck explicitly where it played a part instead of quietly using it to judge the clinicians. The post should make a claim about which situation involved an error and why. Add a line you might say to each patient. Replies this week are meant to take the opposite side of a classmate's view, arguing it seriously rather than agreeing. A published source on outcome bias or hindsight strengthens the post.
Inside the PA 602 Week 1 example
The post opens with two vignettes in a few lines each. In the first, a man in his fifties with resolved chest discomfort had two normal ECGs, two troponins below the threshold, a low risk score and a stress test booked within 72 hours, and still had a heart attack three days later. In the second, a teenager's swollen ankle was never checked against the Ottawa rules or imaged and healed in two weeks. A section sets out what was available at each discharge. The luck section calls both outcomes partly chance and cites Caplan et al. (1991). The claim follows: the first workup was not an error and the second was. One line to each patient comes next. The replies ask Tess what finding would have justified admission and Omar what besides the outcome made an X-ray unnecessary.
Reading the PA 602 Week 1 grading rubric
The most points in this post depend on keeping process and outcome apart. A post that judges either clinician by how the patient fared, or that brings only one situation, loses the largest share. Next, graders check that each situation is described by what was available at the time; details known only later count against the writer. Naming luck explicitly earns credit, because silent use of luck is the bias the week targets. A clear claim about which situation contains an error carries a substantial share. The lines to each patient are graded for honesty and plain language. Replies score when they argue the other side with a real question, not when they agree. Any cited evidence on outcome bias needs correct APA form, and identifying details must be removed.
Common PA 602 Week 1 mistakes, and how to avoid them
The usual weakness here is a single story about a bad outcome, with the conclusion that someone should have done more. Another is a pair of situations described with hindsight, so the reader learns the outcome before the decision. A third is replies that applaud the classmate. If your section asks for situations you witnessed, send short accounts with identifying details removed; a post drafted from them would set the two side by side, describe what was known at each decision point, name luck plainly, make a claim about error and add a line to each patient. If you are asked to take a specific position in the replies, paste the posts and each reply will argue that position with a pointed question.
Get a PA-602 Week 1 example written to your instructions
Give us the week's instructions and the rubric, plus one line on the two situations you want paired, and an example post arrives written to those rather than to a general case. First one free, back inside 24-48h. Include PA-602 and the week number and it lands with a writer who works this seminar.
More PA 602 papers and MPAS samples
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- PA 602 Week 8: Complaint Response Letter
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PA 602 Week 1 questions, answered
Does the post have to use a case I was present for?
Usually not. Most sections accept a situation of the kind that turns up on any rotation, and an assembled pair often works better, because you can build the second half so the comparison actually holds. Keep names, dates and the site out of it either way, and describe the setting as a type of clinic rather than as yours.
Can I say a decision was right even though the patient was harmed?
Yes, and the week is largely asking for it. A decision made with what was in front of somebody can be defensible and still end with a person worse off, and posts refusing to say so end up arguing that every bad ending proves a bad decision. Say it plainly, then say what is still owed to that patient, which is a separate question.
How does this differ from the papers later in the term?
The opening post argues rather than reconstructs. Later weeks hand you an event and ask for a document about it: a timeline, a drafted conversation, a letter to somebody who has complained. Week 1 hands you nothing and asks you to bring two situations and hold them apart, so the marks sit on the comparison rather than on the accuracy of an account.
Where can I find a free PA 602 Week 1 sample paper?
This page carries a full PA 602 Week 1 post comparing a sound workup with a bad outcome and a weak workup with a good one, with replies.
What study does the PA 602 Week 1 sample use on outcome bias?
It cites Caplan, Posner and Cheney (1991), whose reviewers rated the same care as appropriate 31 points less often when the injury became permanent.