For our first EM site evaluation we came prepared with 3 soap notes and 5 pharmacology cards. We first reviewed our pharmacology cards and then presented our cases. I presented the case of a 40 y/o Hispanic male with no significant PMHx  who presented to the ED c/o occipital headache x 18months and dizziness x 2 months. I was glad I chose to present this case, because professor Herel later provided me with some very helpful information on how to assess such a patient. He taught me about the HINTS exam which I was not familiar with before my evaluation. This exam could be used for patients who are having ongoing vertigo for hours or days with spontaneous nystagmus. My patient was complaining of ongoing dizziness, so he would have been a candidate for this exam. I later looked up how to perform this exam and now it will be something I will be using to evaluate my patients in the future. Professor Herel, also took out many hours of his time for this evaluation so he could go through our questions with us and help us strengthen our presentation skills which we appreciated very much. He gave us provided us with helpful feedback and explained his expectations for the next evaluation.

For the second evaluation we prepared 5 soap notes, one journal article, and 5 pharm cards. I have to say I was extremely nervous during this evaluation since Professor Herel was once an ENT PA and my patient was like the many he encountered in his profession. The patient I presented was a 24 y/o male non-smoker, w/ no significant PMHx who presented to ED with ℅ throat pain x 2 months.

I chose to present this patient because I wanted his feedback on how to improve my care for such patients in the future. During the presentation we had some very good conversation on how to manage this patient in terms of Labs, imaging and outpatient referral. We went on to discuss my journal article form which I developed the plan for my patient, and we discussed some important points to consider for patients that present with multi nodular goiters. I shared some new information on nodular size and quantity, and how literature is starting to skew away from the belief that size of the nodule has a correlation with malignancy. We went on to discuss some other patient encounters and his recommendations on how to assess or manage them. Our evaluation lasted about 3 hours, it was very insightful and allowed us to clarify any doubts or concerns we came across during our rotation. I am very thankful to Professor Herel for his time and dedication towards our educations. It is inspiring that he wants us to become competent providers. He clearly puts in an enormous effort into teaching us how to provide quality care to our patients in the future.

Here a link to the HINTs exam: https://www.youtube.com/watch?v=1q-VTKPweuk

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