Site Visit Evaluation.

During my OBGYN rotation at Woodhull Hospital from May 20 to June 21, 2024, I underwent a comprehensive site visit evaluation conducted by PA Carlos Melendez. This evaluation included two key meetings: one midway through the rotation and a final assessment. During these sessions, I presented two complete History and Physical (H&P) reports, a pharmacological drug card, and one journal article. PA Melendez provided constructive feedback aimed at enhancing our clinical skills, particularly in patient assessment and medical documentation. He reinforced the critical elements of prenatal and postnatal care, including routine checkups, managing complications, and providing support for new mothers.

One of the cases I presented involved a patient experiencing left lower quadrant and suprapubic pain for one day. Through this case, I learned how to respond to obstetric emergencies such as ectopic pregnancy, preeclampsia, and postpartum hemorrhage. This experience enhanced my ability to act swiftly and effectively in critical situations using ultrasound imaging, Bhcg results, and blood work such as CBC and CMP. Additionally, we discussed the stages of labor and the various pharmacological agents used to induce labor, as well as the appropriate timing for their administration.

I also had the opportunity to discuss an article on the efficacy of medical management of leiomyoma-associated heavy menstrual bleeding (HMB). The article emphasized that medical management is typically the first-line approach for treating HMB associated with fibroids. Various options are available, including nonsteroidal anti-inflammatory drugs (NSAIDs), tranexamic acid (TXA), hormonal contraceptives (COCs), the levonorgestrel intrauterine system (LNG-IUS), and gonadotropin-releasing hormone (GnRH) agonists/antagonists. These treatments aim to alleviate symptoms by reducing menstrual bleeding and, in some cases, shrinking fibroid size.

In particular, I expanded on tranexamic acid (TXA), an antifibrinolytic agent. TXA is a synthetic lysine analogue that works by blocking the lysine binding sites on plasminogen molecules. Normally, plasminogen binds to fibrin clots and converts them into soluble fibrin degradation products through its activation to plasmin. By competitively inhibiting plasminogen activation, TXA prevents the breakdown of fibrin clots, thereby stabilizing clots and reducing bleeding. TXA is important in the treatment of heavy menstrual bleeding and the short-term prevention and control of bleeding in patients with hemophilia.

Overall, this rotation significantly enhanced my understanding and skills in OBGYN, particularly in managing obstetric emergencies and heavy menstrual bleeding. The constructive feedback from PA Melendez and the practical experiences at Woodhull Hospital have been invaluable in preparing me for a career in healthcare.

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.