Saturday, January 4, 2014

Wrap up of the last year (part 1/2)

So, as I promised here I am to tell you some of the highlights of my past year.  I will try to be as concise as possible as well as making it kinda short and sweet now that I am official graduated and am a Physician Assistant.   Please make sure to leave me a comment with any other questions you may have about my clinical year experiences or graduation, I will be sure to answer you! :) So I will just go rotation by rotation with a quick synopsis and add in the important stuff from the school end as well

January-February: Psychiatry
   Well....psych was definitely the rotation I was dreading and I was kinda disappointed to see that I had it as my first rotation.  Now looking back, I am so happy it was.  My rotation was at an acute care unit meaning patients came to the hospital, got admitted, and were to be out with follow-up within the week.  Most of the patients did just that but I was so disappointed with the number of people who came in just to have a place to stay for a week and use the system.  Some were fine the whole time they were admitted and as soon as we had outpatient care or a sober house lined up for them, they were "suicidal" the day we wanted to discharge them because they knew this was a free and warm place for them to stay.  It was disappointing to see but I suppose if I was in their situation, I don't know how I would survive either.  I learned that no matter what rotation you are on, psychiatric illness is all around you.  This is why this rotation was good to start with, plus, the hours were pretty short and the medicine was just patient interviews, no physical exams.  It really allowed me to settle into what a clinical rotation was nicely and I learned a lot of valuable patient interviewing skills like asking open ended questions!

February-March: Emergency Medicine
   My ER rotation was at a level 1 trauma center which made this very exciting!  The hospital has two campuses, with 1 being the trauma center and 1 being a tertiary hospital.  I started at the smaller, tertiary hospital which I think was a great place to begin especially since it was my first "real" medical rotation.  My first day in the ER I was placed under the supervision of a great and very friendly doctor.  Our first patient was a Latino male who spoke very little English.  He had cut himself while trying to move a couch and had a 3-4cm laceration in his mid-forearm.  the doctor looked at me and asked if I had done sutures yet.  I said "no, today is really my first day in any rotation besides psych" (which he went on to call my first real day of rotations lol) then he said, "ok, this will be a great first suturing opportunity for you!"  Nothing like getting tossed into the fire!! :)   Luckily he stood over me and instructed me and said that I had done an excellent job and that I must have practiced (yes!) which was a great confidence booster.  The rest of the time at the tertiary hospital was just like this.  It was great being the only student in this ER and they had no residents so I got to choose a chart, interview the patient, report back to my preceptor with what I would order and what my differential was, and follow up as results came back.  After 2 weeks I switched to the trauma center and that was a bit different.  Soooo many residents and students are at this ER that it was really hard to find a place as a PA student without really just trying to befriend the residents and take on one of their cases and going over it with them.  This was a key portion of my rotation that a lot of other students didn't fit into as well (as I had heard).  Be great friends with the residents, they know their stuff and really just want to help and teach you what they know!  I learned a lot from them.  I saw 2 traumas while I was on shift, 1 skiing accident that had run off the lane and into trees and 1 MVA that was car vs pedestrian.  It was a big eye-opener as my MVA was the first death I saw on my rotations.  She was talking when they got her in and then the next minute, she had lost consciousness and they were pronouncing her.  Everyone reacts different to death so I can only speak for myself in saying that it's a very different feeling when someone dies but you never knew the person.  You have feelings about it but not like you would for a friend or family member.   This rotation taught me a lot, not just about medicine, but about team work and using the resources you have around you to succeed.

March-April: OB/Gyn
   My rotation was purely gynecology as the doctor was in his 60s and closer to retirement (and his wife said enough with the all night OB calls).  This was one of my favorite rotations as I already had a clinical interest in women's health and the preceptor was hard but a great teacher.  I walked in the first day he told me to sit down then just started grilling me with questions about who I was, what my family was like, and my background before PA school - nothing like intimidating me on the first day but really he just wanted to get to know me.  I had homework assignment from him every night and had to come in prepared to talk about it with him throughout the day.  Since OB was not a part of my rotation, I had reading topics specifically for obstetrics and then one day we spent 2 hours as he presented a patient in labor to me and asked me questions and what I would do if certain things helped me.  Even though I really would have loved to have an obstetrics experience, I still feel like I am very knowledgable about labor and delivery and that someday it would be a cool thing to be able to experience and see first hand.  In this rotation he had a great progression of how he had me as a student get a full experience in gynecology.  The first week I watched, second week I did histories and only watched physical exams, 3rd week I did histories and exams from the waist up, 4th week I did the full history and he came in as I did the entire exam (including pelvic), and then the last week I went in alone and did the whole history and entire physical with pelvic and he came in after to see the patients.  It was amazing and his patient population has been with him for the most part of 30 years.  They were all so welcoming of a student that I got a great experience.  I would hope that everyone gets the experience that I had because this was definitely a favorite rotation of mine.

April-May: Pediatrics
     My pedi rotation was at a large medical group with one of their newer doctors (she had been with the company for 2 years).  This specific medical group does not allow students to be with the patients alone (which realllyyy hinders one's experience but you make the best out of it).  I loved this rotation because I happened to be there during the week that my supervising doctor had to do newborn rounds (which only happens once every 3 months so I was lucky!).  So not only did I see outpatients but for 1 week (including 1 weekend) I got to get up every morning and from 8am-12pm I got to go to two of the nearby hospitals and do newborn exams.  This was an amazing experience, I really enjoyed getting up everyday and seeing the little ones and the parents who were just so excited that their bundle of joy was finally here.  I also got to do 2 nights at the pediatric urgent care center that this medical group has (mainly ear infections, strep throat, sinusitis, and small lacerations).  On a daily out patient basis, my doctor also happened to be the only doctor at this location that was accepting new patients so it was great to be able to have many newborn baby visits including at 1 and 2 weeks then again at 1 month.  Being able to follow up and see these babies get bigger in just their first month of life was a great experience.  Then the daily milk intolerance and otitis media every single day.  Peds was a fun experience and even though a lot of the pathologies seen are very common, still great to make a kid smile everyday...and have them make me laugh tons!


OK...just realized how much I have to say and I need to go to bed lol - so part 2 coming tomorrow (including primary care x2, surgery, orthopedic surgery, and surgical ICU)
Feel free to ask any questions!! :) Hope you are enjoying the stories so far!

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