My first rotation site was at New York-Presbyterian Queens. Overall, I believe I learned and experienced a lot that will serve as a foundation for the remainder of our clinical year. Internal medicine covers a very broad range of patients and illnesses that requires your ability to expand your thinking as compared to some of the smaller specialties within the medical field. Being in such a large network, I was able to work with a variety of PA’s, all of whom were ready to help a student begin to find their approach when working with patients. For four weeks, I rotated on various floors of general medicine, gaining experience of working up new admissions from the emergency department along with the day-to-day care and eventual discharge. A fifth and final week was spent specifically on the stroke unit, spending time with the neurology team and being the consultant when new patients presented to the hospital with stroke-like conditions.
While on the medicine service, I got a feel for what I believe to be the day-to-day operations of a general medicine floor and the validation that medicine must be a holistic team approach in order to be effective. Consulting any number of specialty services, conference calls with case managers, social workers, and nursing staff to review patients, and working with hospitalist and private attending physicians ensured that no step of patient care went unlooked. During my first two weeks, I found myself apprehensive of stating my opinion and presenting new cases to the team I was on for fear of missing steps. However, taking the constructive criticism I received from both the teams I was assigned and during my site evaluation, I begin to grow confident in asking to be a bigger part of providing care.
One of the areas that I found the most helpful to my ability to keep up with some of the more senior providers was my week of working nights. Because there is generally less staff, management, and visitors on the overnight, the PAs were more available to spend time with any particular case and work through it from start to finish. One of the PAs that I worked directly with would find a new admission and allow me to go conduct an interview before they would and come back to present and discuss. After my presentation, we would work through my initial list of differential diagnoses and discuss what I would do to work up every item on my list. From there, I would need to be able to justify every lab and exam that I ordered as they related to helping the patient get discharged. This is something that was quite similar to our clinical correlations course during the didactic year, except this time it was a real patient with true illnesses on the line.
Finally, spending a week dedicated to a specialty like the stroke team allowed me to see how a workup changes when you are aware of exactly what the problem is. Being able to round with the neurology team, I saw the difference in how patients are presented compared to how they were in either the emergency room or on a conference call. Additionally, I began to understand the importance of a focused H&P, something up to that point, I had not had much experience with. Learning this skill and understanding when a particular set of pertinent positives and negatives are more important than others is something that I will be able to take to the remainder of my rotations.
Looking ahead to my next rotation in ambulatory care, I hope to improve on my ability to take initiative in performing procedures with my patients. Because the ambulatory care center is in a very populated area in Astoria, Queens, I know there will be no shortage of patients for me to learn from. I believe this will also pose new challenges as it will force me to become comfortable seeing such a large volume per shift instead of my assigned 10-15 on the medicine service. In the few that I was able to do during this rotation, I saw my own competence in the skills we learned during didactic year and saw it begin to blend with the knowledge taken from each of our classes.