My second rotation was emergency medicine at Metropolitan Hospital. During this rotation, I did three weeks of day shifts and one week of night shifts – all 12-hour shifts. I felt slightly more comfortable going into this rotation, as I worked in an emergency department for two years prior to PA school, but I was still extremely nervous. My days consisted of me arriving in the ED 5-10 minutes prior to the start of my shift so I could review the patients currently on the board, listen to sign-out at the start and end of the shifts and seeing patients on my own. I worked primarily with residents, except on Wednesdays when the ED was staffed by the PAs and on some overnights. It was a valuable experience to be able to work alongside many different clinicians, as this allowed me to see different techniques on approaching patients as well as physical exams and workups. Additionally, I received some mini lectures from attendings using the white board in the ED and got to observe a mock rapid response.

Throughout this rotation, I realized the importance of presenting the patient to the resident/PA in a succinct manner. While it is very essential to gather all of the pertinent information of the patient, it should be presented in an efficient and flowing manner, that way the clinician has a clear sense of what is going on with the patient. Additionally, I learned the best way for me to present a physical exam is head to toe, that way I do not miss any exam that I did perform. Also, exams in the emergency department are typically very focused, and this is how it should be presented. One aspect that was particularly challenging for me is patient education. I realized that I find I am not confident when discussing with a patient their current illness or why it happened etc.. I hope to improve on this by solidifying my pathophysiology knowledge and also thinking about easy, digestible ways to explain conditions to a patient, without overwhelming or confusing them. In this rotation, I also learned the need for me to take full initiative to see patients or do procedures. If I did not ask, I would likely not be asked, because the emergency department is busy and at a fast pace. Therefore, I learned and am proud of myself, in that I constantly asked if I could go see a patient before the resident/PA did, and I asked to do procedures such as suturing, IVs and venipunctures, that I otherwise would not have done if I did not put myself out there.

Metropolitan had a large population of Spanish-speaking patients, which was especially challenging for me because I do not speak Spanish. While the use of translator phones is even easier in the emergency department, you can call from your cellphone or use the Cyracom app on your phone, I still found it difficult. Not only is it not the same as directly conversing with the patient in their native language but is also takes a lot longer. This was especially difficult when the resident/PA spoke Spanish, as it is just easier for them to directly speak with the patient instead. However, I still got to continue to work on my ability to use an interpreter and speak to non-English speaking patients. I am currently using an app called DuoLingo to try and slowly learn Spanish, so that hopefully I am able to converse with patients in the future.

While there were several memorable patients during this rotation, the few that particularly stand out to me are the patients that were gracious enough to allow me to suture their lacerations. Understandably, some patients may not want to have students “practicing” on them, but several patients were kind and more than willing to let me to participate in their care. I am very appreciative of them, as they aided in my clinical skills tremendously. Another memorable moment was a young adult patient who had an incision and drainage done. I, in conjunction with the attending, drained and packed the abscess. The patient was told to follow up in two days for packing removal and she wanted the same individuals to participate in her care and she was excited to hear I would be at the hospital in two days for her follow up. Although I was not assigned to her on her follow up, I passed by her and I asked her how she was doing and if she was okay. Small yet kind gestures such as this can make a big difference to patients, especially those who are nervous, so I am proud of myself for following up on her and making sure she was comfortable.

One thing I would want my preceptor and the residents/PAs that I worked with this rotation to notice is that I tried to put myself out there as much as possible. I always asked to see patients and never hesitated to present to the clinician. I attempted assessment and plans as well and realize the importance of thinking about what to order, and not falling into the habit of just ordering the same basic labs and CXR for every patient. Additionally, I constantly asked to do procedures when they arose – such as the lacerations, incision and drainage and the one splint patient I saw. I am proud at my growth even from my first rotation just last month, however going forward I want to work on my differentials and plans. My plan to work on my differentials is to wait a moment after seeing the patient and think about what I believe may be the problem, prior to presenting to the provider. By thinking more thoroughly about my differentials, I believe my ability to generate a strong plan will follow, as I will know what I do and do not need to rule out diagnoses on my differential. Lastly I plan to continuously work on making my HPI, when presenting, as concise and easily digestible as possible. While I think the history taking and physical in my next rotation, psychiatry, will be very different, I hope I can use some of the skills I have learned and worked on this rotation during my future rotations.