I found my LTC rotation at NYPQ Internal medicine to be very interesting and informative. It was different from my previous internal medicine rotation at QHC. During the previous rotation I was with mainly physicians and residents who ran the floor, during this rotation most of my training and education was with PAs. It was really cool to be in a department that was basically run by PAs. I feel that I was able to learn a lot during the 5 week rotation. I hope that all of the PAs, and other team members, recognized that I was working hard to learn from them and see/evaluate as many patients as possible throughout the rotation. I spent 3 weeks on the IM floors during the day, 1 week with overnight shifts, and 1 week with the stroke team. It was great to be able to see how different PAs did things on different floors and different specialties, and also to compare what was done during the day versus at night.

For 3 weeks I was with various PAs on the medicine floors. It was great to be working with the team to see and evaluate patients. It was different from past rotations in that there were a lot of PAs running this department, I don’t think any of the other rotations were run that way. I was able to work with and learn from different PAs over the course of the rotation. Even though there were a lot of students around, there was no shortage of PAs willing to take a student and teach. Every day we would do chart review of our patients then round on them and monitor for any acute changes or events. Reviewing the chart was important in order to familiarize ourselves with the patients before seeing them and asking if their status is improving or worsening. It would allow us to check lab and imaging results and recent vital signs. We would often notice that labs or imaging that was required for the workup or treatment plan was not done yet and we would take this opportunity to draw the labs ourselves or call radiology to make sure the necessary imaging was performed that day. There were not a lot of procedures that we did on the medicine floor; the majority done consisted of drawing blood or blood cultures or dropping an NG tube.

For 1 week I worked overnight shifts on medicine and cardiology floors. During overnight shifts most of the action was in the early part of the night before the patients would go to sleep. Just like during the day, we would review the charts and round on our patients. At this time it was important to see who needed dietary changes or NPO status before a procedure the following day. We would also go to the ED for new admissions. The PAs working overnight were awesome and were passionate about teaching. One of the overnight PAs went into great detail teaching about ECGs. He explained why certain inflections would be seen on specific leads and not others and how we should be reading ECGs. I really appreciate the amount of time he spent explaining this topic in great detail. On top of the previously mentioned procedures done during the day, at night I was also able to draw some ABGs and rectal exam for stool guaiac test. It felt like I had not done an ABG since my first or second rotation and I was proud to be able to successfully draw arterial blood on a patient with weak radial pulses. 

The week I spent with the stroke team was very interesting and different from the other weeks of this rotation. We would round on the patients in the stroke unit, but we would be sure to remain alert for the announcement of calls for the stroke team over the PA system. We would also take a course about the NIH stroke scale (NIHSS), how it is used and how to use it when evaluating stroke patients. The stroke PA and I would use the findings from the NIHSS to quantify the severity of the stroke and monitor its progression. Many of the calls were patients who needed to be evaluated but did not end up being diagnosed with stroke.1 patient was seen and diagnosed with stroke and was within the window for tPA. It was awesome to finally see everything come together that I had been learning about throughout the week. That patient also demonstrated the importance of evaluation with NIHSS and knowing the timing in the patient history.

            I am looking forward to my next rotation in the emergency room at Metropolitan Hospital. I don’t have a ton of ED experience and I am interested in the fast paced nature and the ability to continue to work on my skills when examining and working up patients, also of course the ability to do more procedures such as suturing, venipuncture, IV placement and more.

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