My long-term care site evaluator was Professor Emily Davidson. During my first evaluation, I submitted one H&P and five pharm cards. I presented my first H&P on a patient with abdominal distention with an unknown origin. I thought this was an interesting topic because it opens a discussion of many different differential diagnoses, which is always an important aspect of being a clinician. I was alone for this Zoom meeting; however, I believe this afforded me the opportunity to go in-depth about my patients and discuss the importance of geriatric assessments for long-term care patients. In the first evaluation, we discussed other differentials that I did not include and which differentials I thought were more likely. Additionally, we conversed about the best way to organize a history of present illness when there are multiple parts to the history. I received feedback on my first H&P prior to my second evaluation, which I was grateful for as it allowed me to review my own work before presenting and submitting my H&Ps for my second evaluation.

During my second evaluation, I presented one H&P (but submitted two), five pharm cards and a journal article. I presented a journal article assessing a training program in the UK about dementia for healthcare workers. I decided to choose this article after my second H&P, which was an elderly patient with dementia. I realized I do not always feel comfortable with patients with dementia and do not always know the best way to approach the situation or care for them. Therefore, I wanted to learn more about training programs and their efficacy. I also hope to take a training program such as the one in the UK, if there are some available in the US, as I believe it would provide me with a better approach and understanding of these patients. I also presented more pharm cards and we discussed the importance of using these cards to not just list facts about the drug, but rather how to apply it to cases and patients.

The two site evaluations for my long-term care rotation were thorough and valuable. The one-on-one sessions allowed for extra time discussing patient cases, reviewing the HPIs and formulating plans for the patients. Additionally, we were able to discuss the importance of aspects that are specific to long-term care patients such as the geriatric assessment and what to try to obtain from nursing home documentations. While my rotation was in internal medicine and not long-term care facility specifically, I believe I still was able to assess some of the same aspects I would in these facilities. Moving forward, I hope to retain a lot of the in-depth history taking skills that I learned during this rotation and these site evaluations. I also hope to continue addressing each issue in the plan, that way no diagnosis or problem is overlooked.