Reflection

This was my last rotation as a physician assistant student and I feel very fortunate that is was internal medicine. Internal medicine encompasses all specialties therefore I found it advantageous for me to have already completed my other rotations. I was familiar with a lot of the diagnostic practices and treatments for conditions therefore could focus real-life application and nuances of these practices. During this rotation, it was a great review of all of the organ systems, their dysfunctions, and treatment plans options. I enjoyed looking at labs, correlating them with symptoms and seeing how they decided which specialist to consults with a differential diagnosis in mind. I was able to practice my skill set with ABGs and fine tune my technique. I was also able to assist in a lumbar puncture after watching several. My preceptor let me find the correct anatomy, mark where I would go, inject the anesthetic and guide the needle, checking every ~mm after pushing for fluid by removing the guiding needle. I saw how opening pressure was set up and taught why it’s important to get three tubes for collection. What I found challenging was knowing the dosages for certain medications. I am also still very much a novice at EKG reading- this is something I want to work hard to improve on. In order to improve on this, I would like to seek out to read EKGs even if it’s not my patient and discuss with the other provider whose patient it is in order to learn. During this rotation, I learned that I enjoy internal medicine, I enjoy the puzzle pieces and coordinating care. My favorite part of internal medicine was working as part of the stroke team. I found that neurology is one of my favorite subjects and will be seeking a job working in this field. The experiences I had on this rotation helped me to see the whole picture of what happens to a patient who is admitted to the hospital. It was also helpful for me to know the minimum/maximum numbers they use, for example if the persons O2 sat is below 95, they add nasal cannula with the liters needed to improve their O2 sat to >95. I also learned how hyponatremia can cause altered mental status and hypoglycemia can cause chorea. Overall this rotation was one of my favorites.

H&P 1 and 2:

Site evaluation:

The site evaluations with Andrea were very productive. I looked forward to her analysis of my H&P’s and her questions rewarding the case. Her insight was very helpful is continuing to help me sharpen my clinical analysis.

I have attached below my actual calendar on my MAC as I intend to follow this plan. I fly home December 19th and imagine for two days I will just be visiting with family. On Dec 21 and Dec 22nd, I plan on studying. This is before everyone will arrive at my house and I think it feasible to study two topics this week. I chose ENT and hematologic as those are two of my weakest subjects and I want to begin with them. I do not have any studying planned for Dec 23rd through Dec 26th, however if I did not make it through all of ENT or Hematology I know Dec 25th afternoon or 26 would be a good day to catch up. From there on Dec 27th, I want to take a 300 questions PANCE practice exam, treating each 60 questions as a section and giving myself breaks after. I will review my weakest subjects and possibly reorganize my topics from there but I plan on starting with my previously weak subjects of infectious disease, renal disease and then I have given myself off NYE and NY day, as NY day is my mothers birthday I know I will want to spend the day with her. However Jan 2nd, it’s possible that study. From here, I have all the topics of the pance listed. I am doing a particular organ system for each day and have organized from starting studying from my weakest to my strongest. I plan on studying these subjects by taking a tutoring kaplan exam while reviewing the PANCE pearls book and watching meded online. After making it through all organ systems, I plan on taking a second practice PANCE test one week before my PANCE. From there, I will review my worst subjects for four days and then review my best subjects two days before and relax the day before. This plan is flexible, yet doable for me. I am a couple days for cushion and have included adequate time off for any holidays plans. I am excited to begin studying as there are many topics I feel rusty on and would love to be up to date.