Rotation Summary 

My experience on my internal medicine rotation was especially rewarding and I learned a lot.  Starting the rotation, I was indifferent to working in internal medicine, I was hoping to learn a lot but I did not think I would enjoy it especially.  The past few weeks however, were invaluable to my education and forming my future goals as a practitioner.

Firstly, I worked with many PAs who prioritized teaching me, encouraged me to ask a lot of questions, take on different responsibilities and practice doing procedures.  I had the chance to be on different floors and learn more about the management of different types of patients, cardiac, renal, and heme/onc.  Additionally, going through the patients’ labs every morning helped solidify my understanding of which values are more alarming than others, which labs should be drawn daily and common lab errors.

Additionally, I got the chance to follow patients’ progression over the course of a few days and even weeks. I had the chance to build connections with them over this time which I found both enjoyable and rewarding.   I got to see what an important role a PA plays in supporting both the patient and their families.  Being a part of this interaction allowed me to contribute in a positive way to the patient’s care.

An especially rewarding experience was getting the chance to work in the ICU.  There I had the opportunity to learn more about how to care for very sick patients and explore more complicated cases.  I also got the chance to do a lot of procedures and gain comfort in doing so which was important to me going into the rotation.

One thing I found challenging, which I have encountered a lot over rotations is having to get used to working with someone new every day or two.  Each PA I work with expects something different from the student so it is important to communicate clearly to preform appropriately.  It’s definitely a benefit to get to learn different practitioners’ styles and approach, whether it’s how they manage a specific type of patient or how they communicate with family members.  It’s important for me to remember that even when the practitioners’ style differs from mine there is still something I can take away from that day and learn from them.

Overall, I think this rotation helped solidify more of my knowledge and learn more about not only how to treat a presenting problem but more about maintenance treatment.  I got the chance to appreciate the role an internal medicine PA gets to play in caring for a patient day in and day out.  I am truly thankful for this opportunity and believe it was imperative in my education.

Here is a log of the patients I saw Case logs5

Site Evaluation 

Reflection

My meetings with my site evaluator went well.  On the first evaluation I presented a patient with chest pain who was diagnosed with new onset atrial fibrillation. I was advised work on a more broad based differential which I really worked on for my second evaluation.  I presented a patient with a history of metastatic breast cancer presented to the ED for AMS.  There were a number of differentials that had to be considered, including a UTI causing AMS, further brain metastases and possible CNS infection of her Ommaya port. It was an interesting case to present because of the extensive work up that had to be preformed to narrow down the diagnosis.  Usually, I shy away from presenting less straightforward cases but I felt like I did a good job putting together the assessment and plan and learned a lot from choosing this case.

Here is the history and physical I presented HP Rotation 5

Journal Article

At my final site evaluation, I presented an article about the use of chemoports.

Summary

Use of Chemoports in a Comprehensive Cancer Care Center, Retrospective Study

This study was a retrospective observational study aimed to evaluate the use of chemoports in a comprehensive care center.  120 subjects who had more than 4 cycles of chemotherapy for a malignant tumor over the course of three years, from January 2015 to December 2017.  Data was collected from medical records and evaluated for procedure difficulties, infectious complications and difficulties with cannulation.

The data showed that procedure difficulties were present in 48 insertions, the most common one being multiple punctures for venous access, 3 patients developed a hematoma and one puncture of the carotid artery.  An interesting occurrence that happened three times was passage of the catheter to the opposite jugular vein.  There were no subclavian vessel cannulations or pneumothoraxes. In the follow up period, 12 patients were found to have cannulation difficulties, 6 of which required port removal.  12 patients experienced infectious complications, the most common site being the pocket site.

The study concluded that chemoports are easy to insert and manage and are a good way to deliver chemotherapy.  Proper management with the appropriate medical professionals is necessary in preventing any complications.

Here is the original article Chemoport