I  completed my eighth rotation in family medicine from September 30 to November 1, 2024. This rotation provided me with the invaluable opportunity to follow patients over several visits, enabling me to track their progress and adjust treatment plans according to their evolving needs. For instance, I worked with a patient with hypertension during routine follow-ups, where we observed his response to medication adjustments, discussed lifestyle changes, and monitored blood pressure trends. Additionally, I encountered patients transitioning from acute care back to primary care, such as one individual discharged after hospitalization for pneumonia. Ensuring proper follow-up appointments and medication reconciliation was critical, as it illustrated how continuity of care prevents gaps that could lead to complications.

During my rotation, I performed routine screenings for conditions like diabetes (using HbA1c tests) and colorectal cancer (utilizing FIT tests for eligible patients). I identified pre-diabetic patients and initiated discussions about diet and exercise interventions aimed at preventing progression to diabetes. I also provided vaccinations to both children and adults, emphasizing the importance of the influenza vaccine for children to reduce hospitalizations during flu season. Engaging patients in discussions about smoking cessation and weight management was another key aspect of my practice. For example, I assisted patients in developing personalized plans for quitting smoking, incorporating counseling, nicotine replacement therapies, and regular follow-up. Management of chronic diseases involved ongoing assessment, treatment, and support for conditions requiring long-term care, such as diabetes, hypertension, and asthma. Effective management significantly improves quality of life and reduces complications. In managing a patient with chronic obstructive pulmonary disease (COPD), I coordinated care with respiratory therapists for pulmonary rehabilitation and pharmacists for medication management.

I utilized the teach-back method to confirm that patients understood their health conditions and treatment plans. After discussing an asthma management plan, I would ask patients to explain how and when to use their rescue inhaler to ensure comprehension. Throughout my rotation, I made it a habit to reflect on each patient encounter. I assessed what went well and what could have been improved. There were instances when I felt uncertain about my clinical decisions and diagnoses. These moments presented valuable opportunities to seek help or consult with more experienced providers, such as Dr. Devicka Persaud. In future rotations, I plan to be more proactive in seeking guidance when needed.

I completed my family medicine rotation at Devicka Persaud PC from September 30 to November 2024, I participated in a comprehensive site visit evaluation conducted by PA Fahim Sadat. This evaluation session included several classmates and required us to present complete History and Physical (H&P) reports, engage in pharmacological drug discussions, present patient management cases, and review a journal article.

PA Sadat provided constructive feedback on our cases, emphasizing areas for improvement while also taking the time to inquire about our experiences during the rotation and whether we felt it was going well. One of the case discussions prompted us to explore the mechanism of action of GLP-1 receptor agonists, highlighting their increasing off-label use for weight loss among patients.

We discussed how GLP-1 receptor agonists slow the gastric emptying process, leading to reduced rates of glucose absorption and lower postprandial blood sugar spikes, which contributes to better overall glycemic control. These medications enhance glucose-dependent insulin secretion from pancreatic beta cells; when blood glucose levels rise, they stimulate the pancreas to release more insulin, thereby helping to lower blood sugar levels. However, we also acknowledged potential risks associated with GLP-1 agonists, including an increased risk of aspiration and pancreatitis.

Additionally, we examined the clinical challenge of spinal tumors, which are often missed in patients presenting with back pain. PA Sadat encouraged us to include this condition in our differential diagnoses when evaluating back pain complaints. We also highlighted that taxi drivers are particularly prone to constipation, which can lead to hemorrhoids and lower back pain. He underscored the importance of performing a rectal examination when patients present with chief complaints of back pain, as this can help identify underlying issues that may otherwise be overlooked.

In our journal article discussion, I presented findings that demonstrated significant benefits of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing all-cause mortality, cardiovascular mortality, non-fatal myocardial infarctions, and kidney failure. These discussions not only enhanced our clinical knowledge but also underscored the importance of comprehensive patient evaluations and the consideration of lifestyle factors affecting health outcomes.

Overall, the site visit provided valuable insights and reinforced the significance of thorough clinical assessments and ongoing education in managing complex patient presentations.

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.