A few lessons learned on my rotations so far

         It has been my goal to take away something from every clinical experience I have on rotations. I have had many good experiences and, for lack of a better word, some interesting experiences... but believe it or not, I am always learning from every situation. Its like sifting through a stack of legos trying to find exactly what you need for your own creation! Basically choosing what you want to implement into your own practice of medicine when your done with school.

It typically goes like this:

You see one patient approach... 

you document it, and try it out... 

it works ...

then you repeat until...

it doesn't work very well...

then you scratch that and do it again!

Its a constant learning curve that I don't think I will ever get in front of... at least it seems that way, and perhaps this approach will constantly allow me to learn new things through my career as a PA. 

 I figure I would share a few lessons I have learned from my short experience on rotations so far in hopes that it might better prepare someone on their clinical rotations.  

1. Always take away something from your clinical experience

It might be something you saw your preceptor do, or a well formed question he or she asked... it might be something your preceptor did that you don't want to implement cause it doesn't suite your personality. Either way, take away your own personal lessons.

2. Always be nice to the supporting staff

This may mean you have to buy donuts to win over everyone! Don't undervalue how amazing the MA, Nurses, and front desk staff are. Always be wiling to help them, and never feel you are "too good" to do a simple task like taking vitals, or helping to take out the trash. Your rotation will go so much smoother if you make friends with everyone in the office. 

3.  Don't be afraid to make mistakes!

My current preceptor let me in on some amazing advice. He told me "don't be afraid to make a mistake! If you get something wrong, we will approach it again and try something different". Having support like this makes "flying out of the nest" a lot easier. It can be scary seeing a patient, coming up with a treatment plan, and approaching your preceptor about it... its a lot of pressure. But trust me, it gets easier with time. Having patient, helpful preceptors really make it easier to handle during your first few rotations.  


4.  Keep a good record of what you do on rotations


I was lucky enough to be instructed my first year to keep an active CV as I go through my rotations. This "clinical experience" section in my CV includes every rotation with a brief summary of my skills and experiences during the rotation. 

Having an updated CV throughout rotations will make it easier to give to a future employer whenever interested, without having to slap something together quickly. Plus it will be much easier to remember what you did on a rotation if recorded during that rotation rather than trying to remember 6 months or more prior.

5. Keep your sanity

Working full-time all the time without taking time to play will lead to a huge life imbalance. PA school is effective enough the first year at taking up all your time. Make sure you explore and have fun wherever your rotations take you. I really enjoy working out and have found a gym wherever my rotations have been. It helps me to keep my stress levels down, and allows me to keep my sanity. Of course I have found time to explore the cities and towns of my rotations. The pacific northwest is beautiful and taking weekends to go and explore really help to keep my life in balance.

Mora beach- a photo I took just outside of Forks

Rotation three and four: Family Practice

So I have made it to my 3rd and 4th rotations! I am currently in Forks, WA for my Family Practice rotation. I have really enjoyed the small-town feel and really like Family medicine. I haven't seen a lot of pediatrics up to this point and really like working with children and doing well-child exams. 

I like the variety that comes from seeing so many different presentations. You never know what is going to come into the office, especially out in a rural setting. I have done casting, suturing, well-male, well-female, well-child exams, a lot of balancing Diabetes, Hypertension, and other chronic disease states including chronic pain. I am learning a lot and enjoy the teaching that my preceptor is patiently providing me! 

I have had the opportunity to be in ortho surgery a few times now because the proximity of the hospital across the street. Its nice to have a balanced mixture of different cases and environments. 

I will continue to post anything new and interesting that I have experienced during this rotation.

Second rotation, Clinical Graduate Project.

My first rotation is now over and I am currently in the middle of my second rotation which is my Clinical Graduate Project. For the last two weeks I've been researching material to include in my Systematic Review. 

I think the hardest part so far has been finding a topic that I am interested in and making sure that it has enough material to make a systematic review. I still have a lot of work to get it all done, but I feel that I started off on the right foot. My next rotation will be in Forks, Washington for Family Practice. As always, i'll keep you up to date on the details.

First rotation... Primary care focus- Urgent Care.

I know everyone is excited to hear all about my first rotation... lets just say it is WAY better seeing the case right in front of you than sitting in a classroom learning about it. I love being able to see patients and learning from my preceptor! I really like Urgent care, its a great mix of lots of different areas of medicine. 

First week excitement:

• Got to suture two lacerations, and administer a digital block.
• Did tons of physical exams (getting really comfortable with that)
• Had to do a rectal exam
• Observed a LOT!
• Saw two cases of cellulitis
• TONS of musculoskeletal injuries (low back, shoulder, knee, wrist, neck pain)
• Found out I learned A LOT my first year... and yet there is still SO much more to learn.

Enjoying my time so far on rotations. I will keep my blog up to date on my learning adventures here in Washington! 

End of didactic year!

It is really crazy to think that I just completed my first  year of PA school! It has gone by so quickly... I am now off for many exciting adventures in my clinical year. My first rotation is my "Primary Care" rotation and I am assigned to an Urgent Care in Seattle. I start this upcoming monday... I can't wait! I'm excited and nervous at the same time... a thousand thoughts are going though my mind 

"will I remember everything?" "what is a physical exam again?" "I know i've heard the name of that disease... what is it?!" 

I'm sure everything will be fine, my preceptor knows this is my first rotation and i'll be happy to remind him of that... :) 

Here is a reflection with photos of the last few modules finishing my didactic year, it was such a blast!

 

Practicing OR technique

More casting

Hare traction splint

This is my classmate Laura's first IV! I volunteered to be her first victim :)

It doesn't show very well, but i'm trying to show off all the blood on my arm :)

Subcutaneous injections

Suturing is a blast

My beautiful pigs foot

Catching up...

OK so its been a while since I last posted... I guess PA school took up most of my time! I will do a quick recap of the last few modules we recently completed. 

Woman's health

This was a really fun 3 week module. Obstetrics was up for the first week and it actually turned out to be a really tough test! I could, however, see myself working in this field, it was a lot of fun. 

The last 2 weeks of the module were Gynecology where we completed our first pelvic exam and breast exam. I won't lie... I was pretty nervous, but the standardized patients were nice and were very helpful. Ok, so I have to share my funny pelvic exam story:

The exam room where I was assigned to do the pelvic exam was on the 3rd floor with the PT program. The sun blazed its heat right into the windows in that small exam room, and made the place really hot. This added with my long-sleeve shirt, white coat, and nerves made it very easy to sweat. So when I was performing the bimanual exam on the patient I was dripping beads of sweat from my forehead. The patient actually grabbed some tissues that were within her reach and dabbed my forehead with them! Ha ha, it was really funny! All my classmates got a kick out of it. 

Men's health

This module was a lot of fun also. It was not as complicated as the woman's health module which was a big relief for all of us... We made a lot of jokes how men were a lot less completed than Women :) We also completed our first male genital exam and prostate exam... needless to say I wasn't as nervous for these exams, even though I hadn't ever done these exams before. It went really well, and it was a cool learning experience. 

Geriatrics 

Lets just say this is a population that we will be exposed to a lot! We learned some awesome information in this module. The most important probably being the understanding that disease and drugs effect the elderly different than they do a younger population, and one needs to be aware of these distinct differences. We also got to visit the Maryville facility which I already posted pictures of.

Pediatrics

I have always loved playing with children and acting goofy to make kids smile. I never ruled out wanting to work in pediatrics after becoming a PA-C. I found children are a lot more complicated than I anticipated... not that its a bad thing, it is just a lot to know and remember. This was also our first "comprehensive" module, covering all body systems and diseases. To add to the massive workload there were a bunch of diseases that only affect children and infants to memorize. This was one of the more difficult modules, however, it was also really interesting to me. Our professor did an awesome job of helping us to think about what decisions and choices we would make when we are in the clinic... when it rests on our shoulders... it was a little scary. But at the same time I understand that I am still learning, and still have a long year ahead of me on rotations... and of course for the rest of my career to learn!

I hope that was cleaned before...

We have started our final semester in didactic year and just completed Emergency medicine and are in the last week of Surgery... both have been a lot of fun hands on stuff including IV's, Injections, casting, phlebotomy... more on that and pictures to come! 

Maryville Nursing Home opportunity and Gerontology module.

I just thought I would post the awesome experience we were able to have today as we finished up Gerontology. We had the opportunity to visit with a few of the residents at Maryville Nursing home. This was the first time that Pacific University had students here, and it was fun to be part of the first class there.

Group "E" for Excellent- at least thats what we say. 

Up to date with the last few modules!...

So its been a while since I updated the blog, but it has been really busy and lets face it... I've been lazy every chance I can! So here is an update of the last couple of modules we just finished:

• Woman's health (OB-1 week/GYN-2 weeks) 
• Behavioral Health (2 weeks)
• Neurology (3 weeks)

So lets start with Neurology- This was easily one of the most challenging modules we have had to date. It involved so much information and included the longest Physical Exam we had to perform. Luckily they spit up the Physical Exam into two different parts: Cranial nerves exam, and full neuro exam. Needless to say at this point in school, I started feeling much better with physical exams and I was a lot more confident. The final test was really difficult too, just because there was so much to know, and so many possible outcomes. 

Behavioral health was a different type of module, because a lot of what was taught, especially with the personality disorders, had no treatment besides cognitive behavioral therapy. Believe me... there are many different types of personality disorders. I gained a lot of appreciation for those who suffer from depression and bipolar disorder. I have to say I previously didn't believe the conditions to be an imbalance of neurotransmitters like I now know. 

The most recently completed module was Woman's health. I really found it to be an interesting area of medicine, and yet it was such a broad topic. I will talk more about this module in detail in the next post. 

This first year is really going by so fast. I can still remember the first time I started this blog with my journey to become a PA-C. I only have one more short semester left, just over 2 months until I start rotations. I should hear where my first rotation is going to be within the next few weeks! I can't wait until I can start working with patients on a daily basis! 

Endocrine, Christmas break, and spring semester starting with Musculoskeletal

Whew... the fall semester is over!! What an amazing relief to be done with more than half of the didactic year. The time in school has really flown by when reflecting back on the many months already passed. It goes by slow when neck deep in studying... but it goes by fast when looking back. 

First let me report on the Endocrine module, our last module before winter break, I'm sure I won't be the first to say the Endocrine module was HARD! 

There is a lot of work that goes into every organ system, and when learning about the endocrine system there are so many feedback mechanisms... it just gets very easy to get confused, look below and you'll see what I mean...

Endocrine organs and some of their hormones, It makes me dizzy just looking at it!

----------------Winter break!-----------------

What can I say more about the wonderful joy of a 3 week break after making it through one of the most intense semesters of PA school! It was a much needed break, and gave me the opportunity to fly home and enjoy the holidays with my family in sunny Arizona! I forgot how much I really enjoy the sun! we don't get the same amount of intensity from the sun here in Oregon, and it definitely doesn't come out to shine as much.

New semester!

January 2, 2013 we started the spring semester and started off with our feet running right into the Musculoskeletal module... I really enjoyed this module, although it was very difficult basically like every module... however this module turned out to be one of our most challenging due to its massive amounts of memorization. I really loved being able to do more activities, and less sitting and simply listening to lectures. 

Brief preview of this module: 

Muscles (insertions, origin), their innervation (sensory and motor), brachial plexus, lumbosacral plexus, fractures, osteoporosis, arthritis, rheumatic conditions, bone neoplastic disease, strains, sprains, tenosynovitis... just to name a few!

Brachial Plexus

Lumbosacral plexus

We had the opportunity this module to do casting on each other and it was really a blast! 

Boxers Fracture, look for the fracture at the pinky finger at the knuckle.

Me wearing a Ulnar gutter spint (used for a Boxers fracture) on my right arm and a short arm cast on my left arm (you can see that my classmates enjoyed drawing all over it before I cut it off)

My good friend Rachel sporting my first attempt at a short arm cast!

Anatomy was emphasized in this module more than any other module... so during this module we have spent a lot of time in the anatomy lab. Let me just say the forearm has a lot of muscles... each with pretty long names and it was/is a lot of memorization. 

This is not a cadaver in our lab (we don't take pictures of any of the cadavers) but an example of lab time. 

We also had a really cool opportunity to do a mock "ortho clinic" that gave us an opportunity to practice our physical exam skills and our history taking skills. There were about 5-6 musculoskeletal  scenarios that we were randomly assigned and we worked it up just like we would in clinic (including writing prescriptions). It was actually really fun, and an awesome learning experience. 

Next module is Neurology... and yes it will be a challenge, but it should be a lot of fun... I will of course keep the blog updated!