During my rotation in ambulatory care I had the pleasure of rotating at an urgent care clinic.On the first day of my rotation the staff at the clinic showed me around all of the rooms and I was assigned my own computer where I could access the EMR. The site manager explained I should locate supplies and get familiar with the setups in the room. At first I followed one of the doctors on schedule for the day and discussed differentials and plans for each patient. Later I explained that I wanted to work on my clinical skills, so I was allowed to draw blood and give vaccines to the rest of the patients that required any that day. 

    We later had a pt that came in and wanted to be tested for BV after explaining how the specimen would be collected the doctor pointed at me and asked the patient “would it be ok if she took the specimen” she smiled and said “yeah its ok”. From that point on I confidently guided the patient through the whole process. The patient was very grateful and left happy. I learned that the confidence you portray has a big part in how much your preceptor will allow you to do and how much the patient will trust you.

      It was a very nice first day for me and my experience only got better with time. The next day was able to place a few PPD’s, start an albuterol nebulizer treatment, and perform full physicals on patients who came in for employment physicals. I really appreciated the full physicals since they allowed me to practice my skills. One patient was so surprised when I was performing the neuro exam and stated that they had never had it done before, even though had annual physicals done for their job. I later explained to the provider what the patient had disclosed to me and the provider stated that it was true. She explained that most providers lose their skill or sometimes skip through parts of the exam to limited time. From this experience I learned that the skills we have worked so hard to gain can be lost over time if we don’t use them properly.

    This urgent care had many offices throughout the boroughs of New York City and I was able to rotate between two of their locations. It was not long before I realized that the two locations were unique in the type of population it served. This helped me realize that the type of care you you provide will be influenced by your patients needs and expectations. For example one office served a population where most of the patients were younger, career focused, health conscious, and aware of the diseases they were at risk for due to their sexual orientation. The patient population at the other office mostly consisted of kids, married couples, elderly, drivers (CDL/DOT), and immigration patients. The approach to each population was a little different and I was lucky to be exposed to both. This taught me that the type of patient education and patient care depends on where you work and the type of population you serve.

       I formed a very strong relationship with my preceptors over time and by the fourth week there they were more concerned about my procedure log than I was. She was so excited for me when we had the first posterior ankle splint, and then when I did my first suture removal. With the suture removal it was a elderly patient who had formed thick scabs over the sutures on her chin. At first I thought I couldn’t remove them but then the preceptor explained that in cases like this we must peel the scabs off to access the sutures. Once she explained this the rest was very easy. I learned that forming a good relationship with your colleges and preceptors is very important. During my rotations my preceptors supported me so much they not only guided me but cheered me on when I performed well. This helped me become stronger and more confident at everything I did.This doesn’t only apply to your preceptor it also applies to every member of the team. To provide care for patients is team effort no one member of the team is more important that the other, and it is important to show respect to and recognize the hard work of every staff member.

    On the last week at my rotation we had a patient that came in with food poisoning. He was extremely dehydrated and the provider wasn’t comfortable placing an IV so I volunteered to do it. After I placed the IV the doctor came in looked at the patient and said “she is awesome isn’t she”. I felt so accomplished when the patient smiled and said “yes she is”. He thanked me multiple time before leaving stating he felt like a new man. We later received the patients results which indicated he was infected with campylobacter. The office manger later asked you must have done many IV’s before this right and I responded with “ nope it was my first”. 

One thing that I found I was very weak in was taking a history from the patient and typing on the EMR at the same time. I wanted to be more focused on the patient, but then I was afraid I would miss important details form the patients history. I found myself struggling with this until my preceptor started sending a scribe in with me when I saw the patients. This made the process go much smoother, but my concern still remains the same, since I wont have a scribe with me at other rotations. I want to work on this weakness of mine and learn to interact with the patient while using the EMR. I plan on asking for more tips and advise on this issue during my forthcoming rotations.

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