Some of the many things that I learned on my Internal Medicine rotation at Northshore University Hospital were about the collaborative role a PA plays as part of the medicine service in a hospital coordinating with attendings, the patient, family, and various specialties. I also participated in inpatient rounding and taking efficient relevant histories and problem focused physicals.
On this rotation, I spent time in various parts of the hospital. My preceptor, PA Dawn Coburn works in the ED preparing patients for admission. Along with other PA students, I assisted her in seeing patients, verifying information from patients and families, and updating handoffs for admission. I reviewed labs and consult notes and updated the primary care team to-do lists based on recommendations from the primary attendings and other specialties. I listened carefully to how the PAs presented patients and had the opportunity to practice presenting patients as well, learning what information was relevant at that time. Experiencing the ED in a level one trauma center was a valuable experience for me because I was able to see higher acuity patients with various conditions that I did not have the opportunity to see at my Emergency Medicine rotation at Metropolitan. In the ED I also performed bladder scans, a straight cath, and an IV, and was able to observe a thoracentesis and rapid responses.
One of my favorite parts of this rotation was the times I spent on the telemetry floors. On those days, my preceptor paired me up with other experienced PAs to see patients. On those floors I rounded on patients who were admitted for a cardiology issue, or had cardiac comorbidities which required constant monitoring. Some of my patients were ICU downgrades, while others had NSTEMIs, DVTs and PEs, sepsis, various cancers, and other complications. I learned the management for many of these conditions by reading charts, speaking to, and examining patients, and asking many questions to the providers. While there wasn’t much opportunity to perform many procedures on the floors, I did have the opportunity to administer Cathflo to a clogged PICC line, and place a nasogastric tube, both of which are important skills to have in a hospital setting. I also practiced reading EKGs, and looking at imaging, especially CT scans and challenging myself to see if I could match up the image with the radiology read.
Another opportunity I had at Northshore was to observe endoscopy with the GI team. I was paired up with a GI doctor who taught me about endoscopies and colonoscopies as he performed them. I was amazed to see the intestines from inside and see the transition point between small and large bowel as well as the appendix. I also learned about biopsy methods and GI recommendations for various conditions. I plan to use that experience to be able to counsel patients what to expect when an endoscopy or colonoscopy is performed.
One other important skill I learned on this rotation is how to take a focused history in order to get relevant information to the issue at hand in a timely manner. For example, when rounding on patients, I learned that it is most important to ask “how are you feeling right now?” along with “do you have any questions?” and “is there anything you would like me to address to the team for you?” as well as taking a focused physical. I also realized that patients appreciated when you knew what they came in for and what was done for them so I read each chart carefully before seeing my patients. I did not hesitate however, to ask more about their medical history and what had been done for them in the past, especially when there were details in the charts that were not updated properly or seemed confusing.
In conclusion, I gained a lot from this rotation and learned many new skills. I now appreciate the role of the Medicine PA as being the one who is there on the floor and coordinating care between various providers. I will take this experience with me and continue to improve on the skills that I have acquired.
