| Course | PA 614 Clinical Clerkship - Emergency Medicine |
|---|---|
| Week | 4 |
| Paper type | Medical decision making note |
| Length | About 500 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 614 Week 4
Medical Decision Making Paragraph for R.S.: Observations Paired With the Change Each One Made, Written in the Clinician's Own Voice, the Admission Option Set Down and What Stayed Unresolved at Discharge
Student Name
Chamberlain University
PA 614: Clinical Clerkship - Emergency Medicine
Instructor Name
Month Day, Year
Medical Decision Making Paragraph for R.S.: Observations Paired With the Change Each One Made, Written in the Clinician's Own Voice, the Admission Option Set Down and What Stayed Unresolved at Discharge
The Paragraph
58-year-old with 20 minutes of resting chest pressure, resolved before arrival. Differential considered: acute coronary syndrome, pulmonary embolism, aortic dissection, esophageal spasm and musculoskeletal pain.
Normal ECG at 00:50: no ischemic changes, so no activation of the catheterization team.
Pain resolved, normal vital signs, equal arm blood pressures and no tearing quality: dissection judged unlikely; no CT angiography.
Wells score 0 and PERC negative: pulmonary embolism testing not pursued.
HEART score 3 (history moderately suspicious 1, ECG normal 0, age 1, risk factors 1 for hypertension and former smoking, troponin 0): low risk, which supports an outpatient pathway (Backus et al., 2013).
First high-sensitivity troponin at 01:10, 5 ng/L; second at 05:20, 6 ng/L: no significant rise, so acute myocardial infarction is ruled out by the department pathway.
Option set down: admission for observation and stress testing. I did not choose it because R.S. is low risk with serial negative troponins, and a randomized trial of a HEART-based pathway found early discharge safe in such patients (Mahler et al., 2015). R.S. preferred to go home.
Discharge with stress test in 72 hours, aspirin 81 mg daily until then, return precautions.
Written in a Voice
The paragraph says "I did not choose," because a decision was made by a person. A chart full of passive verbs hides who decided.
The Option Set Down
Naming admission as the alternative not taken, with the reason, protects the patient and the record: a reviewer can see that admission was considered.
I also set down observation in the department for a third troponin at six hours, which the pathway allows for intermediate scores. With a HEART score of 3 and two values below the limit, the pathway did not require it.
A Level, and Its Item
The problem addressed is an acute illness with a threat to bodily function; the data reviewed include two troponins, an ECG and the outside medication list; and the risk of management includes a decision about hospitalization. The paragraph names the hospitalization decision explicitly because it is the element that sets the level of decision making.
What Stayed Unresolved
The cause of the chest pressure is not known at discharge. Coronary disease has not been excluded, only acute infarction. The stress test is meant to answer the remaining question, and the paragraph says so.
R.S. was told this directly: the tests today show no heart attack, but they cannot show whether the arteries are narrowed, which is what the stress test is for.
References
Backus, B., Six, A., Kelder, J., Bosschaert, M., Mast, E., Mosterd, A., Veldkamp, R., Wardeh, A., Tio, R., Braam, R., Monnink, S., van Tooren, R., Mast, T., van den Akker, F., Cramer, M., Poldervaart, J., Hoes, A., & Doevendans, P. (2013). A prospective validation of the HEART score for chest pain patients at the emergency department. International Journal of Cardiology, 168(3), 2153-2158. https://doi.org/10.1016/j.ijcard.2013.01.255
Mahler, S. A., Riley, R. F., Hiestand, B. C., Russell, G. B., Hoekstra, J. W., Lefebvre, C. W., Nicks, B. A., Cline, D. M., Askew, K. L., Elliott, S. B., Herrington, D. M., Burke, G. L., & Miller, C. D. (2015). The HEART Pathway randomized trial: Identifying emergency department patients with acute chest pain for early discharge. Circulation: Cardiovascular Quality and Outcomes, 8(2), 195-203. https://doi.org/10.1161/CIRCOUTCOMES.114.001384
PA 614 Week 4 instructions, in plain terms
The fourth week asks for a compact medical decision making paragraph, denser than anything else in the chart. Build it from pairings: something observed and the thing it changed. Ten or twelve lines of that is usually enough. Write in a voice, so it is clear a person decided. Set down the option you did not choose and why. Name the element that determines the level of decision making, such as a decision about hospitalization or the data reviewed. End with what stayed unresolved at disposition. The paragraph does not have to reach a specific answer the grader expects, but it must show how the decision was reached. Some sections want labeled subheadings; the pairings work under either layout. Cite any score or trial used.
Inside the PA 614 Week 4 example
The paragraph opens with the patient and a five-item differential. Pairings follow: a normal ECG at 00:50 means no catheterization activation; resolved pain, normal vitals and equal arm pressures make dissection unlikely; a Wells score of 0 and negative PERC stop embolism testing; a HEART score of 3, scored item by item, supports an outpatient pathway (Backus et al., 2013); troponins of 5 and 6 ng/L rule out infarction under the pathway. Admission is set down as the option not chosen, with Mahler et al. (2015) and the patient's preference. Sections explain the first-person voice, naming the alternative, identifying the hospitalization decision as the complexity element and leaving coronary disease to the stress test.
Where the points sit in the PA 614 Week 4 rubric
The paragraph loses the most when it lists findings without saying what each changed, which turns reasoning into a data dump. Next comes the passive voice throughout, which hides who decided. Graders deduct when the alternative option is missing, since a reviewer cannot tell it was considered. Faculty reward observation and change paired line by line, the element that sets complexity named and what stayed unresolved stated plainly. Accurate use of scores, with each item shown, earns credit. Concision is checked. Citation of the scores and evidence used, in APA form, completes the rubric.
PA 614 Week 4 help from the desk
Decision making paragraphs most often fall short by restating the history and results with "low risk, discharge" at the end. Another common problem is never naming the option not chosen, which leaves the decision looking automatic. Some paragraphs also claim more certainty than the workup gives. If your patient presented differently, such as with abdominal pain, headache or syncope, send the findings and the disposition; a paragraph written for you would pair each observation with its effect, write in a clear voice, set down the alternative, name the complexity element and state what remains open. If your section wants subheadings, the same pairings would sit under them.
Get a PA-614 Week 4 example written to your instructions
Send the assignment, the rubric and whatever format your site expects for this section, and a custom PA-614 Week 4 paragraph is written to it and returned inside 24-48h, the first one free. If the week supplies a case, send that as well so the reasoning is built on your facts rather than on invented ones.
More PA 614 papers and MPAS samples
- PA 614 Week 1: Emergency Note Reader Post
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- PA 614 Week 5: Interrupted Encounter Write-up
- PA 614 Week 6: Patient Callback Note
- PA 614 Week 7: Shift Documentation Audit
- PA 614 Week 8: End of Shift Summary
- PA 612 Week 4: Overnight Event Summary
- PA 610 Week 4: Medication Reconciliation Memo
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- PA 604 Week 4: Practice Agreement Outline
PA 614 Week 4 questions, answered
How long should this paragraph be?
Shorter than students expect, and the rubrics reward density rather than volume. Most sections want something that can be read in under a minute by somebody checking one decision, which in practice is a dozen lines at most. A sample built at that size shows what has to be cut to reach it, which is usually the part restating findings.
My section wants labeled subheadings instead of a paragraph.
Send the labels. Some sites break this section into named pieces, and a sample written as continuous prose has to be taken apart before it is usable, which loses the thing you wanted it for. With the headings in hand the example is written into them directly, and the pairing of finding and consequence still runs underneath each one.
Will the sample tell me what the right decision was?
No. The week is marking an argument, not adjudicating a choice, and a grader who would have decided otherwise can still give full marks to the reasoning. Treatment questions belong with the people teaching and supervising you rather than with a writing desk, and an example that started answering them would be writing a different assignment.
Where can I find a free PA 614 Week 4 sample paper?
The complete PA 614 Week 4 medical decision making paragraph for low-risk chest pain, built from observation and change pairs, is on this page.
What option is set down in the PA 614 Week 4 sample?
Admission for observation and stress testing, not chosen because the patient was low risk with serial negative troponins and preferred to go home.