Reflection on Internal Rotation

During my internal medicine rotation at New York Presbyterian Queens Hospital from April 15 to May 17, 2024, I gained invaluable experience in managing acute medical conditions such as heart attacks, strokes, and infections. This exposure significantly enhanced my clinical reasoning skills, enabling me to differentiate between similar presentations and consider broad differential diagnoses. For instance, I became adept at distinguishing between various causes of chest pain, such as myocardial infarction, pulmonary embolism, gastroesophageal reflux disease, and musculoskeletal pain. By evaluating patient histories, physical exam findings, and diagnostic test results, I learned to prioritize the most likely and serious conditions first. This process deepened my appreciation of the subtleties of different diseases and their manifestations, ultimately enhancing my diagnostic accuracy and patient management strategies. Additionally, I improved my communication skills, learning to explain complex medical information to patients and their families in an understandable and compassionate manner.

Despite these advancements, I recognize areas where I need to improve. I sometimes struggle with breaking bad news and dealing with non-compliant patients. To address this, I will practice through role-playing exercises, seek feedback from preceptors, and attend meetings and workshops on patient communication and counseling techniques. My clinical documentation also requires enhancement in detail and clarity, which I will improve by reviewing exemplary notes from practicing PAs and physicians and using templates and checklists to ensure completeness. Additionally, I need to refine my presentation skills to present cases more clearly and confidently during rounds and meetings. This involves not only organizing my thoughts and information logically but also improving my public speaking skills to ensure clarity and confidence. I will practice my presentation skills by preparing and presenting cases to peers and preceptors for constructive feedback. Learning to navigate patient charts more efficiently and honing my patient interview techniques to gather comprehensive and relevant information are also priorities.

By focusing on these areas and adopting an active learning approach, I aim to continuously improve in future rotations. I plan to engage more deeply with each case, seek out additional information beyond what is immediately required, and regularly seek feedback from preceptors, and peers. Setting specific, measurable goals related to knowledge, skills, and professional behavior at the beginning of each rotation will help guide my learning. Additionally, implementing effective time management strategies, building a network of colleagues for guidance and support, will be essential in becoming a more competent, confident, and compassionate Physician Assistant.

During my Internal rotation at New York Presbyterian Queens Hospital from April 15 to May 17, 2024, I underwent a comprehensive site visit evaluation conducted by PA Andrea Pizarro. The evaluation process involved two meetings, one midway through the rotation and another for the final assessment, where my classmate Fredrique Green and I presented two complete History and Physical reports of patients encountered during our rotation.

Throughout these sessions, PA Pizarro provided constructive feedback aimed at enhancing our clinical skills, particularly in patient assessment and medical documentation. She emphasized the importance of meticulously analyzing laboratory results and understanding their clinical implications, citing specific examples relevant to cases we had encountered. For instance, she highlighted the significance of lab values such as alk Phos, pro-BNP, troponin, and lactate in assessing a patient presenting with shortness of breath and chest pain, given their medical history of asthma and COPD.

Furthermore, PA Pizarro encouraged us to think critically and consider alternative approaches to patient care. For instance, she underscored the use of Sequential Compression Devices (SCDs) as an alternative DVT prophylaxis measure in patients for whom LMWH might be contraindicated. This emphasis on critical thinking not only broadened our perspective but also reinforced the importance of individualized patient management.

In addition to case presentations, I had the opportunity to discuss an article on the transfusion of blood and blood products during one of our sessions. This discussion provided valuable insights into the indications and potential complications associated with transfusion therapy, enhancing our understanding of its clinical relevance. As part of our evaluation, we were tasked with creating pharm cards summarizing key information about ten drugs on index cards. This exercise not only enhanced our retention of pharmacological knowledge but also honed our ability to prioritize essential information within limited space. PA Pizarro’s guidance throughout this process facilitated a deeper understanding of pharmacotherapy principles.

Importantly, PA Pizarro took a genuine interest in our overall learning experience, inquiring about our enjoyment of the rotation. This personalized approach fostered a supportive learning environment, encouraging open communication and collaboration. I am committed to incorporating the valuable lessons learned during this evaluation into my future clinical practice and educational endeavors.