I recently completed my seventh rotation in emergency medicine from August 26 to September 27, 2024. During this time, I learned to quickly evaluate patients using the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach, which allowed me to prioritize those needing immediate intervention. This systematic assessment proved invaluable, especially when managing multiple patients simultaneously. I frequently encountered cases of chest pain, shortness of breath, and trauma, which required swift decisions regarding diagnostic testing and treatment plans. This experience helped me develop the ability to differentiate between life-threatening emergencies and less critical conditions, an essential skill in emergency medicine.

I gained practical experience in assessing abscesses, determining optimal incision points, deciding on wound packing, and providing post-procedure care instructions to patients. These experiences significantly improved my technical skills and boosted my confidence in handling common emergency procedures. I also became adept at recognizing subtle red flags that indicated severe underlying conditions, such as altered mental status, hypotension, or tachypnea—often early signs of sepsis or other critical illnesses. For example, I learned to recognize that a sudden, severe headache might indicate a subarachnoid hemorrhage or that chest pain with diaphoresis could signal an acute myocardial infarction. These experiences underscored the importance of conducting a thorough history and physical exam in detecting warning signs.

Working closely with attending physicians, residents, and radiologists, I was able to correlate imaging findings with clinical presentations, enhancing my diagnostic accuracy. I had numerous opportunities to interpret diagnostic images, including X-rays, CT scans, and ultrasound, which allowed me to develop confidence in identifying conditions such as pneumothorax on a chest X-ray and recognizing when a CT scan was necessary for abdominal pain.

However, I realized that I occasionally doubted my clinical judgment when faced with unfamiliar cases. Moving forward, I recognize the importance of trusting my training while seeking guidance when needed. To build confidence, I plan to actively participate in case discussions and seek constructive feedback from supervising PAs and physicians. Additionally, my documentation was sometimes slower than desired, and I intend to improve this by practicing concise and structured charting to enhance both accuracy and efficiency.

During my emergency medicine rotation at Metropolitan Hospital from August 26 to September 27, 2024, I participated in a comprehensive site visit evaluation conducted by PA Sajid Mohamed. The evaluation consisted of two key meetings: a midpoint review and a final assessment, each lasting about an hour and a half. These sessions included three other classmates, and we were required to present two complete History and Physical (H&P) reports, a pharmacological drug card discussion, a patient management discussion, and a journal article.

PA Mohamed provided detailed and constructive feedback aimed at enhancing our clinical skills, particularly in areas of patient assessment, medical management, and pharmacological knowledge. In my case presentation, I discussed a patient who presented with weakness, fatigue, and vomiting over four days, experiencing multiple episodes of yellow emesis, nausea, abdominal discomfort, and bloating. This patient was diagnosed with acute liver failure. One of my classmates presented a case of appendicitis, leading to an in-depth discussion about its acute management, appropriate antibiotics, admission criteria, and indications for ordering a CT scan.

As part of the evaluation, I also discussed the mechanisms of action, indications, and clinical applications of ten medications, including Indomethacin, Labetalol, Clindamycin, Empagliflozin, Spironolactone, Misoprostol, Apixaban, Diazepam, Rosuvastatin, and Entresto. For instance, I highlighted Misoprostol’s various applications, such as its role in second-trimester pregnancy termination (alone or with methotrexate), expectant management of missed and incomplete abortions, cervical ripening and induction of labor, treatment of postpartum hemorrhage, and the prevention and treatment of NSAID-induced gastric ulcers in high-risk patients.

Additionally, I presented a journal article on barosinusitis, emphasizing its prevalence among airline pilots, flight attendants, and scuba divers, with an incidence rate as high as 40% among divers. The article covered the common symptoms such as nasal congestion, facial pain, headaches, and in severe cases, epistaxis. Management strategies included nasal decongestants, saline irrigation, steroid therapy, and pain management for mild cases. Functional endoscopic sinus surgery was recommended for refractory cases. We also discussed preventive measures, such as the use of decongestants before activities involving pressure changes, avoiding such activities during upper respiratory infections, and employing equalization techniques to manage pressure differences.

Overall, the site visit evaluation was an invaluable learning experience that provided me with constructive feedback and enhanced my clinical knowledge, presentation skills, and understanding of patient management.

Reflection on Ambulatory/Urgent Care Rotation

I completed my sixth rotation at Centers Urgent Care in Middle Village from June 24 to July 25, 2024. This experience significantly enhanced my ability to develop differential diagnoses quickly and accurately. In an urgent care setting, where patients often present with nonspecific symptoms that could indicate a wide range of conditions, this skill is crucial. I prioritized ruling out life-threatening or serious conditions early in the evaluation process to ensure patient safety and used clinical algorithms and guidelines to assist in decision-making, ensuring that all potential diagnoses were considered.

During this rotation, I gained proficiency in diagnosing and managing common respiratory infections such as acute bronchitis, pharyngitis, and upper respiratory tract infections, including the appropriate use of antibiotics. I also developed skills in assessing and managing minor injuries, including wound care, sprains, and simple fractures, which involved performing and interpreting basic imaging and applying appropriate treatment plans. Additionally, I learned and applied emergency protocols for conditions like chest pain, anaphylaxis, and severe asthma attacks, ensuring immediate and effective intervention.

Time management is a critical skill in a busy urgent care setting, where patient volume and acuity can vary widely. I improved my ability to prioritize patient care based on the severity of symptoms, ensuring that those in urgent need were seen promptly. I also learned to collaborate effectively with nurses, medical assistants, and other staff to delegate tasks such as triaging patients, taking vitals, and preparing rooms, which helped maintain clinic flow. Proficiency in using electronic medical records (EMR) systems is essential in modern healthcare settings. I improved my ability to document patient encounters clearly and concisely, ensuring accurate and complete records for future reference. I became adept at entering orders for diagnostic tests, medications, and referrals, reducing delays in patient care.

Although I performed several minor procedures, I recognize the need for more hands-on experience in this area. In future rotations, I plan to seek out opportunities to practice and improve my procedural skills under supervision. Additionally, I aim to stay updated with current guidelines and best practices and actively participate in continuing education opportunities to enhance my knowledge and skills. Communication is another area where I identified room for improvement. There were instances where I struggled to communicate complex medical information clearly and concisely, especially under time pressure. I plan to work on improving my communication skills to ensure that I can effectively convey important information to patients and colleagues, even in high-stress situations.

During my rotation at Centers Urgent Care in Middle Village from June 24 to July 25, 2024, I underwent a comprehensive site visit evaluation conducted by PA Fahim Sadat. This evaluation included two key meetings—one midway through the rotation and a final assessment—each lasting approximately three hours. During these sessions, I presented two complete History and Physical (H&P) reports, discussed a pharmacological drug, and patient management strategies, and reviewed one journal article. The meetings also included two other classmates, which facilitated collaborative learning and discussion.

PA Sadat provided constructive feedback focused on enhancing our clinical skills, particularly in patient assessment and medical management. One notable case I presented involved a patient with a persistent cough lasting ten days, accompanied by a runny nose, headache for one day, difficulty swallowing, chest tightness when coughing, throat sensation, and weakness. Through this case, I gained insights into managing Viral Upper Respiratory Infections (URI), Acute Bacterial Sinusitis, and Allergic Rhinitis. PA Sadat emphasized the appropriate use of medications such as Ibuprofen, Augmentin, and steroids for these conditions. He also highlighted that antihistamines are most effective when taken before exposure, ideally in the morning.

Another case involved differentiating between epididymitis, testicular torsion, and kidney stones. This discussion sharpened my diagnostic skills in distinguishing these conditions based on their presenting signs and symptoms. In addition, PA Sadat explained the use of ESR (Erythrocyte Sedimentation Rate) and CRP (C-Reactive Protein) tests for monitoring inflammation. These markers are valuable for assessing the effectiveness of treatment and tracking disease progression.

I also had the opportunity to present an article on the appropriate use of GI endoscopy. The article provided an overview of various GI endoscopic procedures, including Esophagogastroduodenoscopy (EGD), Colonoscopy, Flexible Sigmoidoscopy (FS), Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopic Ultrasound (EUS), Enteroscopy, and Video Capsule Endoscopy. I discussed specific indications and contraindications for each procedure.

Furthermore, I discussed the use of Proton Pump Inhibitors (PPIs) and H2 blockers in the management of Gastroesophageal Reflux Disease (GERD). I detailed the differences between these medications, noting that H2 blockers generally have a rapid onset of action and that PPIs, preferred for long-term management, have a slower onset but are also effective in symptom control.

Overall, the site visit and evaluations provided valuable insights and reinforced essential clinical skills, contributing significantly to my professional development.