My internal medicine site evaluator was Shu Qiu. I submitted three comprehensive H&Ps, ten pharm cards and a journal article with summary. Unlike other site visits where other colleagues on my rotation were also in the site visit, I was one-on-one with the site evaluator during each visit through Google Meets. This was beneficial for me, as we were able to discuss each case for a long period of time and evaluate what parts of the H&P could have been improved, or what should have been added. For example, in the first case I presented, we discussed including how long the patient had diabetes and hypertension, and important topics to have with the patient regarding educating them about each disease. We also discussed how it can be worthwhile to call the patient’s primary care provider or other clinicians, to update them on their patient and what additional labs/imaging may be needed when they are discharged. By having this communication with the patient’s outside physician, it closes any communication gaps and provides important continuity of care. Additionally, we discussed moving information around in the physical exam, that way it is more consistent with each appropriate area, i.e., moving the exam findings of bilateral malleolar ulcers to the extremities exam section rather than keeping it in the skin exam. For my pharmacology cards, my site evaluator discussed the infusion timing of one of my drugs, Meropenem, as well as the importance of medication reconciliation for patients. This occurs not only when a patient is admitted, but also when changing a medication during their admission or going through the patient’s medication when there is a change in mental status.

During my second site visit, we discussed another one of my H&Ps, which was a patient that was admitted for syncope likely secondary to urinary tract infection. I discussed the importance of a syncopal episode workup, especially in patients that are older and may have a cardiac history. Again, I appreciated the thoroughness of my site evaluator and discussing what additional information could have improved the chart, which in turn would provide the patient with the best care possible. For my journal article, I discussed catheter-associated urinary tract infections (CAUTIs) and ways to prevent them, specifically with antimicrobial or silver coatings. The patient I presented for my last visit had an indwelling catheter, and I thought it was important to discuss the possible mechanisms available or being developed to prevent CAUTIs in patients.

My internal medicine site evaluations with Shu were very insightful and informative. By having time one-on-one, it allowed me to thoroughly review each case with her and discuss the important aspects of the case and my notes. I appreciated the feedback she emailed back for each H&P, as I can save it for future reference. Providing thorough notes and obtaining all the history from the patient allows for a well-rounded view of the patient, no matter what service I am from as the clinician. I will certainly be taking the recommendations and knowledge provided during this evaluation to my time in family medicine and when I graduate PA school.