Reflection on Rotation

One of the best things about my Internal Medicine rotation at NYPHQ was the clearance process, it was extremely easy. Even though I was fearing the rotation itself the fact that there was no stress before the rotation started was a huge plus. On the first day of the rotation I went in and met with Ms. Dean to collect my schedule, at that time she assigned me a preceptor for the week. She explained I would be alternating every week starting with pulmonary the first week followed by stroke, and then cardiac. I was given a schedule that consisted of day shift for the first week, and then night shift from the second week on till the end of my rotation.

When entering my assigned unit, I was pleasantly surprised to learn that the medicine floors were all run by PAs. The first day there I listened in during hand off, rounded with the PAs, and was able to do some procedures such as ABG’s and blood draws. On my second day, there was an extubation scheduled for a patient in our unit, so I asked my preceptor if it was possible to be in the room when it took place. He agreed and arranged for me to meet with the case worker and the palliative team, who then very kindly guided me through the whole process. In the room there was the palliative team, the priest, the patient’s family, the respiratory therapist and the case worker. It was an experience I will never forget, since it taught me how many members were involved in such a delicate situation. The palliative team member explained how they need to be prepared for the worse outcome, since many patients can expire mins to hours after an extubation. This patient however had a very good outcome, he started breathing on his own a day after the extubation, and then was discharged to a nursing home a few days later.

During the first week I learned multiple things such as how to use the EMR (All scripts), write discharge summaries, and learned the importance of asking questions when you are not sure about something. There is no stupid question as my preceptor would say “if you don’t know ask”, since it can prevent bad things from happening to your patient. After he said this I started to realize all the PAs there would come to one another to ask questions when they were unsure of something, and they all helped each other out in difficult situations. Seeing this relationship among the PAs was very inspiring, and it showed me the importance of keeping a good strong relationship with your fellow PAs. There is no way we can know what to do during every single patient encounter, which is why it is essential to stay close with your team members and always ask for advice when you need it.

On the second week I transitioned to night shift and was assigned to the stroke team. My preceptor for the week was one of the senior stroke PAs at the hospital. She started off telling me that I might not see many stroke consults, therefore I should hang out in the cardiac unit with the cardiac PA. She then went on to explain how she doesn’t like keeping students on night shift and she wanted me to switch my schedule back to day shifts after this week was over. She then instructed me to come down to the trauma unit whenever stoke team was called for over the intercom. When she sent me away I remembered what Professor Shami stated during one of our rotation information sessions. She had said “if your preceptor sends you away you should understand that it’s not a good thing” and here I was getting sent away. Her words echoed in my head and I was very disheartened. I went up to the 2nd floor and met with the cardiac PA and explained why I had been sent there. Within half an hour there was a stroke call on the intercom, and I rushed down to the trauma room with excitement. I watched her evaluate the patient and asked her questions as she made decisions about the patients care. As we walked out of the ED after finishing with that patient there was another call for stroke team over the intercom. We both turned back around and went back to the trauma room to evaluate the next patient. We were still standing next to the second patient, when yet another patient was rolled in for a stroke consult. Together my preceptor and I went through 7 stroke consults in one night, four of them were actual strokes, one was a tpa candidate, and two were false calls. It was my first time dealing with stroke patients and, I was able to see how the different providers had to all come together to care for the patient. Each of the individuals involved in the care of the patient clearly knew their role and performed their part without slowing down the evaluation. This was very important, since TIA/stroke patients need to be quickly evaluated and diagnosed to provide timely management. I learned that to efficiently treat a TIA/ stroke there has to be clear communication between team members (nurse, doctors, CT tech, radiologist, and stroke team) and they have to be able to work well together to make immediate decisions.

Later in the night my preceptor invited me to go see a stroke consult in one of the units so I went along.  As we walked into the room she said I want you to examine the patient and so I did as she said. She watched me quietly while I examined the patient, when we left the room she said “you performed a good examination” which made me very happy. As I got off the elevator to my floor she held the door open and said “I think you can stay on night shift for the rest of your rotation, and I want you to come down every time you hear there is a stroke consult. I thanked her for allowing me to stay on nights for the rest of my rotation, not because I wanted to work at night, but because she was no longer trying to get rid of me. From this experience I learned if you really want to learn medicine you have to be persistent and a little aggressive, this shows the preceptor you’re actually interested in learning and not just wasting their time.

For the last few weeks I was on the cardiac unit and also went down for stroke consults when they were called. On the cardiac floor we covered ED consults, evaluated patients for admission to the unit, and provided acute care to the patients on the floor. I really appreciated this part of the rotation, since it taught me most of the responsibilities that come with being a medicine PA. On the cardiac floor I performed many blood draws, placed a foley catheter(male), perform rectal exams (collected stool samples), perform multiple ABGs, assisted in removing a chest tube, and closed a laceration on the chest after a chest tube removal. I also wrote many admission/discharge/progress notes throughout the rotation. Overall, I gained an immense amount of knowledge at this rotation and I owe it to the PAs at NYPHQ, they really are very supportive of PA students, and go the extra mile to help them learn all there is to be a medicine PA.

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