| Course | PA 616 Clinical Clerkship - Surgery |
|---|---|
| Week | 1 |
| Paper type | Discussion post with two replies |
| Length | About 440 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 616 Week 1
Week 1 Discussion: Initial Post
Who Reads My Note First on the Foregut Surgery Service: Four Positions From Intern to Attending, What a PA Student May Put in Writing and One Request Sent One Rung Up
Positions, Not Personalities
On my general and foregut surgery service there are five positions above me, in the order a note of mine travels: the first-year resident (intern), who reads every student note before rounds; the third-year resident, who runs the floor; the chief resident, who sets the operating schedule and signs out to the attending; the attending surgeon, whose name is on every operative note and who carries responsibility for every patient; and the nurse practitioner who manages the clinic follow-up.
The First Reader Is One Rung Up
My first reader is the intern. If my progress note says "tolerating diet," the intern decides whether that is enough to advance the diet for a patient two days after a Heller myotomy, so I should write what was eaten, how much and whether there was chest pain or regurgitation, not the conclusion.
What I May Put in Writing
I may write progress notes, which the intern or resident cosigns, and draft operative notes, which the attending must review and sign. I may not enter orders. I may not write that a patient is ready for discharge; I may write the findings that would support it. I can describe a finding but not the decision.
That boundary is easy to cross by accident. "Ready for discharge" feels like a finding, but it is a decision, and on this service it belongs to the resident and attending. "Tolerating clear liquids, walking independently, pain controlled on oral medication" are findings that let them decide quickly.
One Request, Addressed Upward
My request to the intern this week: "Could you mark one of my notes each day with the line you changed and why?" That gives me a correction loop without taking time from rounds.
Why This Matters for Surgery
Postoperative problems are often first visible in the details a student records at 05:30. In achalasia surgery, for example, chest pain or fever on the first day can signal a mucosal perforation, a known complication of myotomy (Vaezi et al., 2020). Whether that detail reaches the attending depends on each position passing it on.
Replies That Test the Placement
Reply to Leah: You place the attending as your first reader. On your service, does the attending really see your note before the resident does?
Reply to Kofi: You say you may write orders under supervision. Is that a site policy you have seen in writing?
References
Vaezi, M. F., Pandolfino, J. E., Yadlapati, R. H., Greer, K. B., & Kavitt, R. T. (2020). ACG clinical guidelines: Diagnosis and management of achalasia. American Journal of Gastroenterology, 115(9), 1393-1411. https://doi.org/10.14309/ajg.0000000000000731
PA 616 Week 1 instructions, in plain terms
The opening discussion of the surgery clerkship asks you to describe the service by position, not by personality. Name the positions in the order your notes travel, from the first reader to the person whose name carries responsibility. Identify your first reader, usually one rung up, and what that reader needs from you. Say what you may and may not put in writing as a student on this service. Close with one request you will address upward, specific enough to be granted. If you have not started the rotation, describe the chain as your site's orientation materials set it out. If your site has no residents, the chain still exists and should be named as it is. Replies should test a classmate's placement against how their service works.
How the PA 616 Week 1 example is put together
The post lists the intern, the third-year resident, the chief resident, the attending surgeon and the clinic nurse practitioner in the order a student note travels. A section names the intern as first reader and shows the difference between writing "tolerating diet" and recording what was eaten, how much and whether there was chest pain after a Heller myotomy. A section sets out that the student writes cosigned progress notes and draft operative notes but enters no orders and writes findings rather than discharge decisions. The request asks the intern to mark one changed line a day. A section cites Vaezi et al. (2020) on perforation after myotomy as an example of a detail that must travel up the chain. Replies ask Leah whether her attending reads before the resident and Kofi whether his order-writing policy exists in writing.
Where the points sit in the PA 616 Week 1 rubric
The post earns most of its credit by naming positions accurately and in order. A post about the people on the service, or about surgery in general, costs the most. After that, faculty check that the first reader is identified correctly and what that reader needs. Faculty reward a clear statement of what a student may and may not write, since it shows the writer understands the limits of the role. The request upward must be specific and grantable; a general wish to learn more earns little. Replies score when they test a classmate's placement against their service's actual workflow. Citation of any clinical source used as an example, in APA form, completes the rubric.
PA 616 Week 1 help from the desk
Opening posts most often go wrong by describing team members' personalities or the excitement of the operating room. Another common problem is placing the attending as the first reader when the resident reviews student notes first. Some posts also end without any request. If your service is organized differently, such as a community hospital without residents or a surgical subspecialty, send what you know of the chain; we would set out the positions in order, identify your first reader, list what you may write and close with one request addressed to a named position. Send me the posts you must answer; every reply would check that classmate's placement against how their service runs.
Get a PA-616 Week 1 example written to your instructions
Put the discussion instructions into the request in the form your classroom shows them, along with the rubric and the orientation sheet your site gave you on day one. A PA-616 post written to those materials comes back inside 24-48h at no charge for the first, and the numbered elements are answered in their published order.
More PA 616 papers and MPAS samples
- PA 616 Week 2: Pre-rounding Data Sheet
- PA 616 Week 3: Service Census Update
- PA 616 Week 4: Case Preparation Card
- PA 616 Week 5: Operative Note Draft
- PA 616 Week 6: Postoperative Check Note
- PA 616 Week 7: Procedure Log Summary
- PA 616 Week 8: Chief Resident Feedback Reply
- PA 614 Week 1: Emergency Note Reader Post
- PA 612 Week 1: Inpatient Day Count Post
- PA 610 Week 1: Family Medicine Difference Post
- PA 608 Week 1: Score Report Figure Post
PA 616 Week 1 questions, answered
I have not started the rotation yet. How do I describe a service I have not seen?
Most sections expect exactly that, and the orientation packet a site sends out is a legitimate source for the structure. List the positions it names, say which one you expect to be writing for first, and mark anything you are stating as expectation rather than as observed fact. A hedge that is visible reads better to faculty than a confident invention.
My site has no intern and no chief resident. Is there still a chain to describe?
Then the order is shorter and the post says so. A two-person service with one attending and one physician assistant still has a sequence for who reads a draft, who corrects it, and whose name closes it. Describe the sequence you actually have, and say what the shorter chain changes about how much you are asked to write. Small services usually ask more of a student, not less.
Is this post supposed to be about surgery at all?
Only in so far as the service shapes the writing. The opening week is not marking anatomy or operations, and a post that turns into a summary of what surgeons do has used its length on something the rubric never listed. Keep it on the order of people, the documents attached to each position, and where your own writing enters that order.
Where can I find a free PA 616 Week 1 sample paper?
This page carries a full PA 616 Week 1 post placing a PA student on a surgery service by position, with a request to the intern and two replies.
What may the student write in the PA 616 Week 1 sample?
Cosigned progress notes and draft operative notes, but no orders, and findings that support discharge rather than the discharge decision itself.