Clinical Rotations, Advice from 2nd Years

Recently a group of our second year students (who are about 2 weeks from graduation) came in to talk to us a bit more about rotations. It was great to hear about all of the experiences and get their recommendations and words of wisdom before starting our rotations on Sept 6.  I wanted to share the Top 5 Pearls that I got out of the session. Each person seemed to have a slightly different preparation style so not all of these will be applicable to everyone, but I hope you will find 1 or 2 things helpful. 

1. Readings: If you are looking for something structured and general to help you get through rotations - the Blueprint series seems to be the recommendation. Spend your rotation reading through the book so that you are using the final week to complete the test in the back of the book. (Good prep for the end of rotation exams).

2. Prepping for surgical rotation? Recall books are great when prepping for all of those pimping questions that you are bound to be asked, but it does little to prepare you for the details of procedures. They also suggested brushing up on anatomy. Don't focus on the big stuff - everyone knows where the heart is - focus on large blood vessels, blood supply and innervation to organs... be prepared to answer the following questions:

a-What is this? 
b-Where does it get its blood? 
c-What nerve innervates it?

3. During surgical rotations: 
a-Eat and pee before scrubbing in. You never know when a complication will arise - you could be in there for 10+ hours! 
b-Review the procedure, complications, and risk factors for each of the surgeries that you will be participating in the next day.

4. Be flexible! I was amazed at the variety between rotations. For example, one internal med rotation had hours from about 8 am to 6 pm with some on-call responsibilities, while another internal med rotation just down the road ran 6 days a week, 5:45 am to 7 pm. The same variation is applicable to preceptor-style. Some preceptors ease you into the process. They build on your responsibilities day by day. Other preceptors throw you into the fire immediately and inform you that you are on-call your 1st night. (Always have an overnight bag and change of clothes in your car!)

5. One of my favorite pieces of advice: Don't be afraid to say, "I don't know." They're going to be several questions that you don't know the answer to - that's OK. The key is that if you don't know the answer - go home and look it up because you will probably get asked the same question the next day. 

I'm excited. I'm nervous. I think my excitement is edging out my nervousness.... but check back with me on Sept 5. 


Ultrasound, My New Obsession

I have never used an ultrasound machine, but I am fascinated by the possibilities of its use. We recently had a 4 hour lecture/lab on the uses of ultrasound in the ED and I was immediately hooked. Unfortunately, like a lot of PA school, we only get a taste of many subjects and we rely on our clinicals to gain more knowledge - but I am, by nature, impatient. It is the curse of a Type-Aer.

So if you are like me or you were just curious about ultrasound - when it is used? how to use a machine? how to read an ultrasound image? (or if you are avoiding reading what is actually due this week) Check out some of the absolutely amazing sites that I found for ultrasound tutorials.

Ultrasound Guide for Emergency Physicians, An Intro
Beatrice Hoffmann, MD, PhD, RDMS

Society of Ultrasound in Medical Education
[Learning Modules]

Detection of Pleural Effusion - Ultrasound


Primary Care Case Answer!

The pt has CAP. The critical decision to make in evaluating a pt with pneumonia is whether to admit or treat as out-pt. Factors to consider when making the decision: (in addition to clinical judgement)...
2-presence of co-morbidities
3-mental status
4-vital signs 
5-several lab markers
[all part of the pneumonia severity index]

The index is a general guideline. Clinical judgement is more important.
Antibx: Macrolide or Fluoroquinolone.

Case from Step Up to Medicine Agabegi and Agabegi

Primary Care Case

In light of the primary care exam I have tomorrow morning... Here is a case study for others to suffer along with me...

A 66 year old M is brought in the office by his wife with complain of productive cough, fever, and chills for the past 2 days. The pt lives with his wife and is retired. PMH is significant for DM (for which he take insulin), CHF (ejection fraction of 40%), and has a hx of renal insufficiency. He is alert and oriented. There is no hx of smoking or ETOH abuse. On PE, he has crackles over his LL lung. Cardiovasc exam is normal.

Vital signs are:
BP 130/64
HR 128
RR 24
O2 sat on room air 97%

Chest xray shows infiltrates and consolidation in the LL lobe of the lung. Lab tests show WBC 15, hct 36, Na 142, glucose 167, BUN 36, Cr 1.5. What is the next step for this patient?


Senioritis, Didactic Year Burnout

Senioritis. I wasn't convinced that it could happen in 1 year. I am here to tell you that it can. I have about 7 weeks left to my didactic year and I'm spent. As far as I can tell, many of my classmates have hit the wall as well. My mind is tired. I'm a bit of a knowledge addict. Always have been. I like to read everything that I can find on every subject, but currently I am finding it difficult to read the bare minimum. Perhaps my brain is full. You come into PA school on a high... revved up and ready to learn. Your excitement (or shear terror) gets you through the first couple semesters, but as you near the end... burnout becomes a factor.

PA school is an amazing experience and the end result of getting the C after the PA and having the ability to see patients is what it is all about. I think the only way to get through all of this is to remember the end goal and seek support in classmates and friends/family. I share this feeling/experience because as a student, you will feel this. It might come earlier or later, it may be short-lived or a semester long... but, to be honest, I haven't met very many PA students who haven't experienced this. Expect it, stay positive, and get through it. Students graduate each year proving that it can be done.