Rotation Reflection:

I really enjoyed my internal medicine rotation at New York Presbytarian Queens. This was my first time rotating in an inpatient setting, as my previous rotations were in an outpatient pediatric office and the psychiatric ER. All of the PAs that I followed during this rotation were eager to teach and help me practice my skills at a variety of procedures. I was able to do ABGs, venipunctures, NG tube insertion, removing shiley catheters, and assist with lumbar punctures. I realized that the best way to improve in these skills is by repetition, and I am excited to continue practicing them during my upcoming rotations.

Besides for the medical knowledge I was gaining, I also learned from how the PAs interacted with the patients and their families. It was particularly painful to hear from families of COVID-19 patients because their loved ones had often been healthy and functioning well before contracting the virus. I learned about the hospital’s protocol for treating COVID patients, and tried to convey to the families that the medical team was doing everything they could to help. It was also interesting to learn about the experimental treatments that some COVID patients were receiving, such as stem cell infusions, and I would often read up on these new treatments after seeing the patients. I am sure new studies will continue to be published as more data is collected regarding safety and patient outcomes.

I gained a lot from following patients on many different floors and seeing how each of their cases were managed. The PAs typically cared for between 13-19 patients a day. Each morning they meticulously read through the charts and followed up with specialists recommendations. I found it challenging at first to get familiar with so many new patients and diagnoses each day, but as time went on I became more comfortable with it.

I also got to follow the stroke service for a week, and completed an online certification in the NIH Stroke Scale from The American Heart Association. I joined the stroke team in assessing patients in the ED, bringing them to have CT and CTA scans, and observed two thrombectomies in the cath lab. I also observed patients admitted to the stroke unit and followed their progress over the weeks.

For my future rotations I will continue to take initiative and ask to do procedures and patient examinations. I would also like to work on patient education and explaining the care plan to patients. Often, the PAs are very busy and would appreciate a student taking the time to listen to the patients concerns and questions. 

Site Evaluation Presentation

I met with my site evaluator Ms. Andrea Pizarro twice during this rotation. In total I prepared three H&Ps, ten drug cards, and one article. My first H&P was regarding a patient with hypertension who had not seen a doctor in over 15 years who presented to the ED with a hemorrhagic stroke. The second H&P was about a patient who had BPH with a chronic foley catheter that had hematuria for two weeks.

The feedback I received on my H&Ps were very relevant and helpful for the future. I also appreciated hearing my classmate Bianca’s H&Ps and discussing differential diagnoses together. We also talked about the importance of addressing each of the patient’s conditions in the plan, to make sure that none of the necessary medications or dietary restrictions are overlooked.

We were also quizzed on our drug cards that we prepared. We discussed the importance of monitoring BUN/Creatinine in the use of certain medications because of many of them can be damaging to the kidneys. We also spoke about why we monitor the vancomycin trough and what do if the levels are too high or low. At the final site evaluation, we presented our procedure log book and discussed which procedures we had practiced during this rotation. I found the meetings with Ms. Pizarro to be very insightful and helpful. I felt comfortable asking questions and appreciated her interest in my progress.