My first rotation was general surgery at Woodhull. During this four-week rotation, I was with general surgery for three weeks and specialty, orthopedics, for one week. I was nervous and excited to start my rotations, and with general surgery first, I anticipated I would feel exhausted and perhaps overwhelmed with the experience. The medical students and residents were willing to help me get acclimated to the daily schedule of surgery. This included going to the OR on MWF and surgery clinic on Tuesday and Thursday. Morning rounds typically started around 6AM and evening rounds around 4-5PM, although the times varied. I attended lectures including the medical students Friday lecture, the residents Friday lecture, radiology conference as well as tumor boards and chairman rounds. I had the opportunity to present three cases at tumor boards. During this opportunity, I reviewed patient’s charts and included the pertinent HPI, PMHx, PSHx etc., on the patient as well as what imaging plus/minus labs were ordered on the patient leading up to their cancer diagnosis. While I was extremely nervous to present, it helped me understand the progression of the presentation and workup for a cancer patient.

I listened carefully during rounds, in order to further my understanding of how to present a surgical patient, and the pertinent information to include. Additionally, I learned the importance of EMRs, and how one can read all of the notes in the EMR, but what is most crucial is to physically see the patient and ask them how they are doing. One of the best experiences for me was during surgery clinic. This was the time I had the most autonomy, which allowed me to improve on my focused questioning on medical problems such as varicose veins or hernias, as many of these patients are routine follow ups. It also afforded me the opportunity to work on some of my physical exam skills, such as palpating for a hernia or varicosities, removing staples or working on my wound care skills by applying Unna boots for patients with ulcers secondary to venous insufficiency.  I tried to go by “see one, do one” so that I could first learn how to perform wound care, and then do the Unna boots on my own. As many patients are not English speaking, the clinic also helped me get comfortable with using the interpreter line and speaking in short sentences/phrases that makes it easier for translation. However, it was certainly difficult for me to do focused history and physicals in a short period of time, as I found myself wanting to ask more questions for the history, when in these settings it is not always necessary. A challenge I had throughout my rotation was in regard to suturing. While I did not have many opportunities to try to suture myself, it was difficult for me being left-handed. I even had difficulty with cutting sutures but had better luck when using my right hand instead. This has actually increased my interest in trying to learn suturing with either hand, as I think it may be easier to use the instruments with my right hand.

Two experiences from my last week of general surgery were very memorable. A patient in the surgery clinic came in for follow up for his inguinal hernia and I was the student seeing the patient prior to the surgeon. The patient confided in me about another medical problem he was having, and I listened and discussed with him some of the options available to help him. The clinic is a fast-paced place, as many of these patients are routine follow ups, but I think because I am still learning, am slower at obtaining the history and physical and took a longer time with the patient, he felt comfortable confiding in me. We ended up giving the patient a referral to the proper specialty, but this was certainly a moment that stood out to me. Taking the time to listen to a patient’s concerns, even if they are not directly related to their appointment, is extremely important and will make the patient feel heard and cared for. The second experience was on my last day, in my last few hours of my third week with general surgery. A trauma was brought in – a patient who was struck by a motor vehicle and had multiple injuries including diffuse cerebral edema, splenic lacerations and liver lacerations. I was able to scrub into the exploratory laparotomy, and this was a true surgical emergency case. A splenectomy was performed, along with mesentery sutures and perihepatic packing. Unfortunately, the patient passed away shortly after being transferred to the ICU.  This case was extremely interesting to me and increased my interest in the roles of surgical PAs in trauma cases. This is something I discussed with my site evaluator at my second site visit, as I was more intrigued by this case than the standard OR cases I had seen previously during my rotation.

Additionally, I really enjoyed my experience during my orthopedics week. I was able to observe PAs, which allowed me to better understand a PAs role in this setting. I was in both the clinic and the OR, which enabled me to see the different aspects of this specialty. Some surgeries I saw include a total knee arthroplasty, ORIF of a fibula fracture and ORIF of a scaphoid fracture. While I do not want to go into a specialty right after PA school, I think orthopedics is a specialty I will consider in the future.

Regrettably it took me awhile to become comfortable at asking nurses to allow me to practice my phlebotomy skills or for me to work independently in the clinic. I attribute this to it being my first rotation. I plan to work on putting myself out there, introducing myself to more staff earlier on, asking questions and asking for feedback earlier during my rotation, so that I get the most out of it. This will hopefully afford me the opportunity work on my history and physical skills, as well as my procedures going forward. I learned that I while it is normal and I should be fearful to make mistakes, the time to do so is as a student, and therefore I should continue to say yes when wanting to practice a procedure or see a patient. I also realized how much more there is to learn than the amount I already know. Throughout my rotation, I wrote a list of questions, topics, diseases etc., that I want to learn more about. My intention was to research each night so I can learn daily, however I did not accomplish this. I hope to be able to do this on my future rotations so I can learn each night and the research can be more manageable, instead of having the list grow too long. Additionally, I hope to continue to use resources such as UpToDate, Epocrates and Pance Prep Pearls to aid in my learning. I look forward to using the knowledge I have gained from my first rotation and applying it, and adding onto it, in my second rotation in emergency medicine.