Skills or situations that are difficult for you (e.g. presentations, focused H&Ps, performing specific types of procedures or specialized interview/pt. education situations) and how you can get better at them

I rotated with three different attendings meaning they all had different expectations regarding the morning presentation of the H&P and physically examining the patient. One attending expected a brief description of the chief complaint and HPI, while other attending requested a detailed comprehensive H&P with specific emphasis on HPI and abnormal findings. I personally found both ways of presentation to have drawbacks and strengths. I liked the detailed presentation because it gave me more opportunities to improve my communication skills with the patient and effective data collection. Also, while collecting information I realized that sometimes the admitting doctor missed some critical information. For example, a lung cancer patient came in with shortness of breath and she was on subcutaneous heparin for previous history PE however, there was no history that patient recently missed taking two days of anticoagulation therapy. After I presented information to the attending doctor, the suspicion of Pulmonary embolism was higher and the patient was transferred from the floor to step down. Overall, I found the detailed version to be more helpful in identifying the patient’s diagnosis. 

Types of patients you found challenging in this rotation and what you learned about dealing with them

I had a great time interacting with the patient of all kinds, but it was challenging to collect history from a patient with dementia and schizophrenia. Even though I found these patients to be friendly most of the time but based on their mood it can be challenging sometimes. I had to learn to collect their story from their family, call the pharmacy and previous providers. Overall, its a good learning curve to learn to adapt to a challenging situation to provide care to the patient.

How was the way I did my work differently from how other people did theirs?

I tried to spend more time with the patient compare to other students who were doing their rotation with me. For example, after the morning rotation with the attending, all the students had to wait for instruction from the resident and intern to do the next task. While waiting for the task, I would go to the patient that I have seen earlier in the morning to ask whether they are comfortable, if they have any complain that they want the doctor to be aware of, and speak to the family member if they have any concern. This made me stand out among the other student because the patient would acknowledge me the next morning during the round.

What do you want to improve on for the following rotations? What is your action plan to accomplish that?

Since IM was my first rotation, I was a little reserved in the beginning and did not participate in a few procedures out of the fear of making a mistake. However, for the second rotation, I want to grasp all the opportunities because this is the platform to make a mistake and learn from it. Also, I want to continue to learn to interpret CT scans because that was valuable learning from IM as the resident invested a good amount of time with the student to explain the different views of CT scans and when to use what form to identify the pathology. Furthermore, I want to continue to improve my history-taking skills because OB /GYN rotation history is going to different and unique in its own way.

What did you learn about yourself during this 5-week rotation?

During these five weeks on the floor, I learned that I love to listen to patient concerns and communicate with them to build a trustworthy relation. I learned that if you have a good rapport with the patient, which can be easily developed just by showing gesture that you care, allows you to practice new procedure and learn more about the patient and became part of a team of the provider. For example, I spend a lot of time with the patient just checking if they need any assistance which makes me trustworthy to them, so they requested that I do the venipuncture, ABG, NG tube, when I went with other medical students. I believe, my genuine concern made me stand out as a PA student out of all the medical students and I felt very proud to be a PA on the internal medicine floor.  Also, my good relationship with patient allowed me to see a chest tube placement in IR and be presented and experience ways to break bad news to patient and family, I really believe in the concept now that if I consider the patient as my family member then that will oblige me to give them the attention they deserve. Hopefully, I continue to have an empathetic relationship with the patient because I want to be a supportive provider who the patient will feel safe to share their health concerns.