| Course | PA 628 Clinical Clerkship: Elective II |
|---|---|
| Week | 7 |
| Paper type | Synthesis paper |
| Length | About 450 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 628 Week 7
Elective Pair Synthesis: One Claim That Needs Both Rotations, That Diabetic Kidney Disease Is Managed in Two Rooms With One Guideline, Argued in Steps From Dated Occasions and Ending Where the Two Clinics Disagreed
Student Name
Chamberlain University
PA 628: Clinical Clerkship: Elective II
Instructor Name
Month Day, Year
Elective Pair Synthesis: One Claim That Needs Both Rotations, That Diabetic Kidney Disease Is Managed in Two Rooms With One Guideline, Argued in Steps From Dated Occasions and Ending Where the Two Clinics Disagreed
One Claim, Needing Both
Diabetic kidney disease at this medical center is managed in two rooms, nephrology and endocrinology, under one guideline that both follow, and the gaps in care come at the handoff between the rooms rather than inside either one.
Step 1: The Guideline Is Shared
Both clinics follow the same recommendations: metformin adjusted or stopped by filtration rate, an SGLT2 inhibitor for nearly everyone whose eGFR is 20 or higher and attention to hypoglycemia risk as kidney function falls (Rossing et al., 2022).
Step 2: Each Room Applies Its Half
Nephrology, October 14: started empagliflozin for a patient with an eGFR of 24 but left the glipizide unchanged, noting "glucose per endocrinology." Endocrinology, November 12: for a patient with an eGFR of 38, adjusted insulin for reduced clearance but did not mention the patient's rising potassium on an ACE inhibitor.
Step 3: The Handoff Is Where It Breaks
In the October case, the glipizide was not reviewed for six weeks because each clinic assumed the other would. In the November case, the potassium was addressed only when nephrology saw the patient two weeks later.
Neither failure was a failure of knowledge. Each clinic knew the guideline and applied it correctly within its own scope. The gap lay in who owned the parts of the medication list that fell between the scopes.
Where the Two Disagree
For one patient seen in both clinics, nephrology recommended stopping glipizide because of low kidney function; endocrinology preferred to keep it at a lower dose until a GLP-1 agonist was approved. Both positions were defensible; neither note acknowledged the other.
I raised the disagreement with both attendings, separately, and each agreed the other's view was reasonable. That is the point: two reasonable plans for one patient, written in two notes, can leave the patient with neither.
What Follows From It
A single shared plan line in both clinics' notes, "Glucose and kidney medications reviewed together on [date] by [clinic]," would close most of the handoff gaps I saw. The kidney benefit shown in large trials of SGLT2 inhibitors (EMPA-KIDNEY Collaborative Group, 2023) is only delivered if one clinic owns the whole medication list at each visit.
References
EMPA-KIDNEY Collaborative Group. (2023). Empagliflozin in patients with chronic kidney disease. New England Journal of Medicine, 388(2), 117-127. https://doi.org/10.1056/NEJMoa2204233
Rossing, P., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., Sadusky, T., Tandon, N., Tuttle, K. R., Wanner, C., Wilkens, K. G., Zoungas, S., & de Boer, I. H. (2022). KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease. Kidney International, 102(5S), S1-S127. https://doi.org/10.1016/j.kint.2022.06.008
What the PA 628 Week 7 assignment asks for
The seventh week asks for one argument with two sources, not two reports joined by a paragraph. Put the claim in the first few lines, and make it something that needs both electives to support it. Argue in steps rather than in halves, so each step draws on whichever rotation supports it. Use evidence as dated occasions: a specific patient or decision on a specific day. Show where the two services disagreed. End with what follows from the claim, ideally a practical change. Required rotations can appear where they support a step. If the second block simply confirmed the first, the claim should say what the confirmation adds. Cite guidance or evidence the argument depends on.
How the PA 628 Week 7 example is put together
The claim states that diabetic kidney disease is split between nephrology and endocrinology under one guideline, with gaps at the handoff. Step 1 sets out the shared recommendations from Rossing et al. (2022). Step 2 gives an October 14 nephrology visit that started empagliflozin but left glipizide to endocrinology and a November 12 endocrinology visit that adjusted insulin without addressing a rising potassium. Step 3 shows six weeks before the glipizide was reviewed and two weeks before the potassium was addressed. The disagreement section describes one patient whose glipizide nephrology wanted stopped and endocrinology wanted reduced. The final section proposes a shared plan line and cites the EMPA-KIDNEY trial.
Where the points sit in the PA 628 Week 7 rubric
Synthesis papers are graded on whether the claim needs both rotations. Two summaries with a joining paragraph earn little. Arguing in steps, with each step drawing on dated occasions from either block, is weighted heavily. A real disagreement between the services, described fairly, earns credit and shows the argument rests on events. Ending on a practical consequence completes the core. Accuracy about the guidance both clinics follow is checked. Citations should be in APA form. Faculty reward a proposal that follows from the disagreement, such as a shared note line, because it shows the synthesis changes practice. The two rotations must both be essential to the claim; if one could be removed without loss, the paper is a report, not a synthesis.
PA 628 Week 7 help from the desk
Synthesis papers commonly become a report on the first elective, a report on the second and a paragraph about how both were valuable. Another weak spot is evidence as impressions rather than occasions. Some papers also smooth over disagreements between services. If your electives connect differently, send the occasions from each that bear on one question; we would state a claim that needs both, argue it in steps with dated occasions, show where the services disagreed and end on what follows. If your second block confirmed the first, the claim would say what that confirmation adds.
Get a PA-628 Week 7 example written to your instructions
Send the instructions and the rubric rows for the synthesis, together with whatever you wrote for the two electives along the way. A custom example written to them comes back inside 24-48h, the first one free, with the claim built so that both blocks are load-bearing rather than decorative.
More PA 628 papers and MPAS samples
- PA 628 Week 1: Settled Point From Elective I Post
- PA 628 Week 2: Second Elective Justification
- PA 628 Week 3: Revised Objective Set
- PA 628 Week 4: Prior Rotation Comparison
- PA 628 Week 5: Feedback Carryover Memo
- PA 628 Week 6: Specialty Interest Statement
- PA 628 Week 8: Rotation Order Rationale
- PA 648 Week 7: Attestation Packet
- PA 626 Week 7: Directed Reading Brief
- PA 650 Week 7: Bedside Recommendation Statement
- PA 624 Week 7: Local Option Inventory
PA 628 Week 7 questions, answered
What counts as a claim that needs both electives?
One that changes if either block is removed. Claims about a specialty rarely qualify, since a single rotation supports those on its own. Claims about the conditions a writer works well under, about what a service has to provide before a student is useful in it, or about how a clinical question survives contact with two different teams need the pair, and the rows follow them.
Can required rotations go in alongside the two electives?
Only where your section's instructions allow it, and then sparingly. The rows here concern the elective pair, and material from core blocks tends to crowd out the two this week is marked on. Where a required rotation genuinely supplies the contrast making the claim work, name it in a clause and keep the evidence itself drawn from the electives.
What if the second block simply confirmed the first?
Then the strain section is where to look harder, because complete agreement between two services usually means the claim was pitched too safely to be tested. Narrow it until the blocks are able to disagree: not that communication matters, but that one particular way of checking a plan worked in one service and failed in the other.
Where can I find a free PA 628 Week 7 sample paper?
This page holds a complete PA 628 Week 7 synthesis arguing that diabetic kidney disease is split between two clinics under one guideline.
What change does the PA 628 Week 7 sample propose?
A shared plan line in both clinics' notes recording that glucose and kidney medications were reviewed together, on what date and by which clinic.