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Long Term Care Site visit Summary.

During my long-term care/geriatric medicine rotation at Metropolitan Hospital, I underwent a site visit evaluation by PA Arti Ramkumar, marking significant milestones in my learning journey. Both the mid and final evaluations, conducted via Zoom for nearly 3 hours and in person at NYPQ, respectively, offered comprehensive opportunities for assessment and feedback.

Throughout these sessions, I not only presented my History and Physical write-ups but also engaged in insightful discussions with peers like Emmanuel Ikealugo-Dennis, Fionna Du, and Anja Glumicic. PA Arti Ramkumar’s feedback played a pivotal role in shaping our understanding of patient care, stressing the importance of critical thinking and thoroughness in our assessments.

A notable aspect of our evaluations was the presentation of drug cards, where PA Arti Ramkumar not only highlighted the serious side effects of medications but also encouraged us to explore emerging uses of pharmacological agents. Moreover, during my presenting case involving symptoms suggestive of pancreatic disorders, PA Arti Ramkumar’s feedback prompted me to delve deeper into any missed labs or imaging studies that could enhance my diagnostic skills and enrich my approach to patient care.

The feedback provided was comprehensive, covering various facets of patient management. PA Ramkumar emphasized the inclusion of pertinent information in History and Physicals, such as medication dosage adjustments based on renal function, and ensuring that all medical problems were addressed in the treatment plan. This underscored the holistic approach to patient care, emphasizing that we are not merely treating isolated conditions but caring for the patient as a whole.

During my article presentation on the impact of CPAP on respiratory capacity in CKD patients undergoing hemodialysis, PA Ramkumar offered valuable insights, further deepening my understanding of the topic. Additionally, the challenging case scenarios brought forward by PA Ramkumar, such as the interaction between fluconazole and Plavix leading to a stroke, underscored the importance of vigilance in medication management and understanding potential drug interactions.

Overall, the feedback and discussions during the rotations with PA Arti Ramkumar were invaluable learning experiences that will undoubtedly shape my future practice as a PA. They equipped me with the skills and knowledge necessary to provide comprehensive and compassionate care to my patients, emphasizing the importance of continuous learning and patient-centered approaches in healthcare.

Reflection on Long term Care/ Geriatric Rotation

Name: Abd-Manaaf Bakere

Rotation 3: Long term Care/Geriatric

Reflection on Long term Care/ Geriatric Rotation

During my third geriatric rotation at Metropolitan Hospital, from March 11 to April 12, 2024, I gained invaluable insights into the complexities of caring for elderly patients. One key lesson I learned is that effective geriatric care extends beyond addressing immediate medical concerns. For instance, Mrs. Ortiz, an 80-year-old patient with multiple chronic conditions, taught me the importance of understanding her social support system. Despite her physical limitations, Mrs. Ortiz thrived with the support of her daughter who ensured she attended appointments and adhered to her treatment plan. This experience highlighted the significance of considering patients’ social circumstances when devising care plans.

Managing multiple chronic conditions in elderly patients requires a nuanced approach. Mr. Mendez, a 75-year-old gentleman with hypertension, diabetes, and osteoarthritis, exemplified the challenges of prioritizing treatment goals. Collaborative decision-making with Mr. Mendez and his family allowed us to tailor his treatment plan, focusing on interventions that improved his quality of life while minimizing adverse effects.

Geriatric syndromes, such as frailty, fall, pressure ulcers, polypharmacy, and cognitive impairment, are prevalent among elderly patients and can significantly impact their well-being. Mrs. Rodriguez, an 85-year-old woman with frailty and recurrent falls, underscored the importance of a multidisciplinary approach to management. Working closely with physical therapists, social workers, and pharmacists, we developed a comprehensive care plan that addressed Mrs. Rodriguez’s mobility issues, ensured home safety modifications, and optimized her medication regimen to reduce fall risk.

Effective communication is essential in geriatric care, particularly when addressing sensitive topics such as end-of-life care. End-of-life care discussions are often challenging but essential in geriatric medicine. During my rotation, I gained experience in initiating conversations about advance care planning, discussing goals of care, and providing support to patients and their families as they navigated complex decisions surrounding terminal illness and palliative care. By actively listening to patients’ wishes and involving their families in the decision-making process, we were able to ensure their preferences were respected and their end-of-life care were aligned with their values.

Interdisciplinary collaboration is fundamental in providing holistic care for elderly patients. Through my rotation, I had the opportunity to work closely with nurses, social workers, pharmacists, and other healthcare professionals to coordinate care and optimize outcomes for patients. Overall, my geriatric rotation provided me with a deeper understanding of the unique challenges and rewards associated with caring for elderly patients. By incorporating a comprehensive care approach, prioritizing treatment goals, addressing geriatric syndromes, communicating effectively, and collaborating with interdisciplinary teams, I am better equipped to meet the diverse needs of elderly patients in my future practice as physician assistant.

Typhon Case log

Summary of Article

Final Evaluation 3

Final Evaluation

Mid

History and Physical Write-Up

Rotation 3 Long Term Care/Geriatric

Site Visit Summary.

During my psychiatry rotation at Queens Hospital Center, I had the opportunity of participating in site visits with Dr. Manuel Saint Martin, an MD, JD. The evaluations, conducted over Zoom, involved presenting cases alongside my colleague, Abbas Aslam, during both the mid and final assessments. Dr. Saint Martin’s engagement and feedback proved to be invaluable, showcasing his genuine interest in our learning and development.

Throughout the evaluations, Dr. Saint Martin consistently encouraged critical thinking and a comprehensive approach to patient care. For instance, he highlighted the importance of checking specific labs such as calcium level in a case involving psychosis, schizophrenia, and hyperparathyroidism. This emphasis on thorough evaluation significantly enhanced our ability to present relevant information. Dr. Saint Martin’s thought-provoking questions went beyond the routine, challenging us to consider alternative treatments for conditions like depression and suicidal ideation. While acknowledging Selective serotonin reuptake inhibitors (SSRIs) as first-line options, he prompted us to think on our feet about immediate interventions and in treatment resistant patients , leading to discussions on treatments like Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS).

One standout aspect was Dr. Saint Martin’s interest in our personal growth. He took the time to inquire about our key takeaways from the rotation, fostering a reflective practice that enhances learning. I particularly appreciated the opportunity to delve into my research on Repetitive Transcranial Magnetic Stimulation (rTMS), which he encouraged and engaged with.

Overall, the time spent with Dr. Saint Martin was not just a routine evaluation but a rich learning experience that will undoubtedly shape my future practice as a PA. His mentorship, emphasis on critical thinking, and encouragement to explore beyond the standard approaches have left a lasting and positive impact on my professional development.