Some of the many things that I learned on my Emergency Medicine rotation at Metropolitan Hospital were about workflow and how different hospital teams work together to best care for patients. I also learned a lot about ultrasounds and different procedures. I worked with attendings who liked to teach and gained a lot from their quick lectures on various topics. Since this was my second rotation, I felt more comfortable approaching patients, clearly stating my role and working with the team.
PA Seligson, my preceptor is an experienced ER physician assistant. I enjoyed working with her and learned from her bedside manner and knowledge. She took the time to teach me to become proficient at examining patients and taking a good history. She also took the time to give me feedback on my HPIs. The skill of taking a focused history and writing effective HPIs in a short amount of time is something I greatly improved upon during my time in the ED. It was challenging at first, but learned to work quickly and efficiently while not leaving out important questions and details. Since I became proficient at using the interpreter service at my last rotation, I was able to communicate effectively with my patients who did not speak English.
I used the time on this rotation to become more proficient at my physical exam skills. On my last rotation at long term care I became better at listening to hearts and lungs and checking the lower extremities for pulses, swelling and skin changes. On this rotation I improved my abdominal exams, neuro exams, and pelvic exams. At first I found the neuro exams challenging because I was afraid I was forgetting parts of it and I had a hard time explaining to the patient what I wanted them to do. By the end of my rotation, I felt confident that anyone with a headache or head injury got a systematic cranial nerve and basic sensory and motor check. I also improved on my GYN exam skills which I think will be very useful on my OBGYN rotation. I plan to use each rotation to improve on different physical exam skills that are most relevant to that rotation.
Another thing that I learned is how various organs appear on ultrasound. In Metropolitan ED, bedside ultrasounds are performed frequently by residents, PAs and attendings. Every time I saw someone wheeling the ultrasound machine towards a patient, I asked if I could join them and observe. I learned that a lot of the skill of doing an ultrasound is pattern recognition. Things don’t necessarily look like you would expect them to since it is all 2- dimensional. After observing many ultrasounds, I became familiar with arteries, veins, nerves, eyes, kidneys and other abdominal organs. I watched a number of FAST exams and was allowed to perform one as well. I was also excited to observe ultrasound guided IV lines, a central line and an arterial line.
I gained a lot from working with the nurses in the ED. They took the time to teach me various tips and tricks when putting in IVs and administering injections. When a procedure did not go as smoothly as I would have liked, I asked the nurse that I was working with how I could improve for the next time.
In conclusion, I gained a lot from this rotation and learned many new skills. I now appreciate how an emergency department runs, who needs emergent care and which people just need reassurance. I also learned about when labs and imaging are required, when different hospital services must be consulted and when a patient will be able to be discharged home. I will take this experience with me and continue to improve on the skills that I have acquired.
