Overall, I think this was a good rotation for me to begin with and get exposure to different chief complaints and how to work them up. I thought it was interesting to not have one specific preceptor because I would come in each day unsure of who I would be working with and I would have 2 PAs available to work with. I would try to alternate seeing patients assigned to each of the 2 PAs, that way I had more exposure to different styles of care. Every PA had a different style that worked for them and it was really great seeing how they worked and also keeping note of things that I liked that they did (such as HPI style, writing physical exam findings or how to get children to be more compliant with exams) and things that I would like to do or mistakes to avoid in the future when I am a PA.

I learned a lot about treatments, which I think was an area where I lacked. Some preceptors would ask me for which antibiotics to prescribe for certain common diagnoses such as UTI, strep, muscular pain, etc. While many of thee antibiotics I knew, one thing I was not expecting to be asked was dosages, duration, etc. In most cases if I was unsure, my preceptor for that day would tell me to guess and it was interesting to see how much I remembered from working as a scribe in an urgent care prior to PA school. Although I was put out of my comfort zone by being asked about dosages, my preceptors always reassured me that they too sometimes would forget dosages, but that uptodate or other resources are always there to quickly look it up before prescribing something.

I would say I was happy with my exposure to procedures. On my first day of rotations my preceptor had me do an IM injection and she saw how nervous I was doing one since it was my first patient. The next time I worked with this same preceptor was on the very last day of my rotation and it was good to see how it came full circle and she pointed out how much more comfortable I was going in and giving injections without needing supervision. In addition, I was able to suture once. Surprisingly, there weren’t many opportunities to suture as there was a company policy to only suture wounds that weren’t more than 12 hours old, so many of the cases opted for just wound cleaning or if they were shallow and well approximated, we were able to dermabond them. However I would say that my first laceration repair experience was very difficult for me because of the location (under the patient’s chin) along with the fact that he had a beard that matched the color of the suture material. I plan to improve with suturing my practicing at home whenever I have the time available. But I was still able to complete it and learned that you will never know what to expect and have to work with what you have available to you. I was also able to practice splinting and in one case I was with an ortho PA and was able to watch her attempt to reduce a fracture while splinting so it was really great to be able to see that.

I think my HPI writing evolved while on my rotation. At the end of my rotation, my preceptor had me writing notes for ER visits and notes for MVAs that would be audited and it was great to see how much she trusted and appreciated my notes. I was able to learn what to include in an HPI especially for certain chief complaints, for example in a laceration chief complaint you would want to include if the patient has any neurovascular compromise such as numbness, tingling or loss of sensation, along with their tetanus status, if they are on any blood thinners or have any known clotting disorders. My preceptors were able to teach me what are important things to include, which I will carry on to my future rotations.

For my next rotation, one thing i would like to focus on specifically to improve are my physical exams. I was having trouble with ear exams at the beginning and I expressed this to my preceptor and I was given the advice to look in everyone’s ears even if they were there for an unrelated complaint, that way I can learn what normal is. I would like to continue doing this for other aspects. For example, now I am focusing on the lung exam. Towards the end of my rotation, I was able to identify certain lung sounds such as wheezing and rhonchi, however there were cases where I was still having trouble. I will improve at this by making sure I have proper technique and also if the patient has on too many layers, having them take some off. Also, I plan to look up videos of different lung sounds so I can better identify them.

I am looking forward to applying what I have learned for this rotation to my future rotations and also having more exposure to different patient cases. I also am excited to have more exposure to different types of procedures that are done in family medicine that aren’t typically done in ambulatory care.