Alright, PANCE has officially done. I took it on Tuesday and will find out next week mid-week sometime how I did...eek!!
So now - as another distraction besides wondering how I did on the exam - I will finish up my summary of my clinical rotations
May-June: Internal Medicine
I did the 1st of my 2 internal medicine rotations as a small community hospital about 30 minutes away from my campus. It was a private office with 1 doctor and 1 nurse practitioner. I was placed with the nurse practitioner as my preceptor. She was great!! She was relatively young, had been a critical care nurse prior to going on for her masters and all of the patients in the office loved her. At this site they had a new EMR system so I could not do any charting of my own which was hard. I was also not allowed access into the EMR system so I had to go in with the NP each time with a patient and I listened while she did their history. Finally I was allowed to do all of the physicals (including DOT - department of transportation - physicals) for each patient that came in including problem visits, annual exams, and annual pelvic exams. I was also in charge of administering all of the injections and PPD tests that came in when I was available. This was a great way to practice my clinical skills. Altogether this rotation was ok - just kind of long and tiring when you are not able to complete histories or see any of your patients solo.
June-July: General/Vascular Surgery
This rotation ended up being amazing! I was so nervous going into my surgery rotation just because of all that you hear about surgeons being mean and yelling and all the pressure that comes with assisting in surgeries but it ended up being one of my favorite rotations/specialities! The hours were the worst part (esp since it was over the summer), we arrived at 5:30am and left anytime between 4-7:30 depending on the cases we were scrubbed in on each day. We would round in the morning from 6-6:30/7, then go down to the lecture of the day (each day was different, some days M&M, case presentations, whatever) then we had cases starting at 7:30 in the morning depending on what you were signed up for that day. I did my rotation at a large teaching hospital in the city I went to school so it was hard sometimes always having residents on the cases that we went in on. This allowed me to usually be the second assist, not the first which was hard. Luckily a grand majority of the surgeons were great and allowed us PA students to still be involved and pimped us to a certain extend (luckily had the surgical recall book which I HIGHLY recommend). I did get to first assist on a good half dozen cases so even though it was a resident-run service, I still got a great experience. After we finished up with our cases for the day in the OR, we would either go observe pre/post-op visits in the clinic, do a surgical consult, or help create the patient list for the day. I enjoyed the consults a lot because the residents would assign us one and we were able to go assess the patient our self and come back and present with our findings. The residents seemed to appreciate the help and were great at teaching us. My advice for a surgery rotation student is to each breakfast, get caffeine when you can, and carry snacks in your pockets :) Also, to read up on your case the night before so you know what the indications are for each surgery, complications, and your anatomy.
July-August: Orthopedic Trauma Surgery
This rotation was my biggest disappointment of my rotations. I was so excited because I love orthopedics and the fact that this was trauma only orthopedics was so exciting! My hours were 5:30-4ish most days. I went in each day and rounded on patients until 7:30, along with writing a progress note on each patient. I loved this part of the day because I chose to stick with the pediatric patients during my rotation and it was a lot of fun to see the come in "broken" and leave happy with their new favorite colored cast. Then we would have fracture conference (which included free breakfast every morning!!!) from 7:30-8ish. This was when all the residents plus the chief attending would look at all of the cases that came in over the past 24 hours and discuss how they were treated and their dispo plans (including planing their surgeries if it was necessary). I loved this part of the day because it was fun to see all of the films with their corresponding pathology from the day prior. The x-ray technician in me was thrilled :) After conference we would go off to what we wanted for the day - whether it was assisting in surgery or going to clinic to observe one of the attendings. I found this part of the day very hard to deal with. I loved going into surgeries but it was hard because if there were no traumas that week, it was very slow in the OR. I loved the OR when there were cases to watch because I got to assist and the orthopedic surgeons were AMAZING and were a lot of fun to work with. They let me close up a lot which was a great experience and the residents were an excellent help when I was having a hard time. Clinic made for very long days because the surgeons had to see all of their patients so I had no chance for physicals or histories. I felt a lot of the time that the residents did not care where I was or what I was doing so it was hard to stay focused and enjoy the day. Looking back, as I am writing this, maybe this rotation wasn't as bad as I was saying it was originally. I think a bit more direction for the student was needed so I felt like I had some part in the patient's care. Other than that, I think this was just the rotation I happened to be on when I was getting tired of clinical and was ready to be out on my own :) I guess it was bound to happen at some point during this past year.
September-October: Surgical Intensive Care Unit
This was my assigned general medicine elective (it was this rotation and the next which was internal medicine). I ended up loving this rotation experience as it was my first exposure to hospital medicine and showed me how much there was that I still had to learn and had no experience with and started to show me my passion as to how autonomous being a physician assistant can be. This rotation was Monday - Thursday from 8:00-6:00. I arrived in the morning and rounded with the team from about 8:30-10/10:30ish depending on our patient load. I rounded with the attending for the week, the PA coming off the 24 hour shift, and the PA coming on for the 24 hour shift. It was crazy the amount of care these patients needed after having a big high risk surgery or after having a surgical complication. I learned so much about ABGs and mechanical ventilation. After starting the rotation I was floored thinking that if I did not have this rotation that I would never have learned all that I did while doing my 5 week rotation there. After rounding I would go around with the PA coming on duty and examine the patients, input order changes for the day, and manage our patients' constantly changing status. This included a lot of bedside procedures such as A-lines and central lines. I got to see many procedures done and even got to help insert a central line and femoral line. This was also the rotation that I had a handful of patients die on my shift. This hit close to home because I had been trying to get these patients out of the critical care unit when instead they died. This was a rotation taught me a lot and I highly recommend all PA students have at least 1 rotation in an ICU setting. Best experience.
November-December: Internal Medicine
My final rotation was at an internal medicine office that was within the same large medical group that I did my pediatrics rotation with. I was placed with a physician who has been with this medical group since the beginning, he was also the chief medical officer for the medical group for awhile during his run with the company....no pressure! In the long run, I could not have had a better physician as my last preceptor in PA school. I learned soooo much from his years of experience including some clinical skills that are just not taught in schools anymore due to our reliance on diagnostic imaging techniques. I worked M-F 8:30-5 with a half day on Wednesdays. The first day I was there I shadowed the doctor to get a feel for how he completes a physical exam on a patient. Then from day 2 on (since he knew if was my last rotation), I hit the ground running seeing as many patients as I could each day and doing a full H&P on them and reporting back to my preceptor who would then go in with me and double check my work and see his patient. I could not have asked for a better last rotation to learn so much and have so much autonomy to show me exactly what it would be like in the real world for me working as an internal medicine physician assistant. It was a great way to end my rotations and a great place to say for the final time "Hello, my name is Heidi and I am a physician assistant student".
So now, it's official. I am a physician assistant.
I am also pleased to let you all know that after a month or a bit more of interviewing, I have accepted my first job as a physician assistant!!! :-D I will post all about it next post (just for some suspense and to keep you coming back)!
I will post again within the week and look forward to telling you all about my new adventure which I am so excited about!!!
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