Am I getting enough experience?

[OEMsrock]

I need some feed back to see if my worries about not getting enough experience on rotations is founded or just me worrying without justification. Rough background: I am in a 24 month program and just started my 5th of 12 rotations. Our rotations are set up by a clinical coordinator and although we are allowed to set up a rotation if we want to, fellow students who have done so have faced challenges.

 

Rotation 1: Titled "Family Practice" Reality = Long Term Care/Geriatrics. I had a great experience especially for a first rotation, and blew off the difference as an issue merely of semantics.

 

Rotation 2:Titled "Internal Medicine - Outpatient", Reality = 1-3 patients/day with a first year PA. Great study time with preceptor on the pathophys but no hands on time with patients. Honestly performed more procedures and did more H&P as an MA. Since the rotation did not come through until the Friday before I was to start the rotation, I felt that I was lucky just to have someplace to call home.

 

Rotation 3: Titled "Pediatrics", Reality = same day appts/acute care in a family practice. I was incredibly fortunate to get to do many, many newborn exams, but not a single well child check. The patients were 3 days to 93 years old. My preceptor did her best to get as many pediatric patients as possible but the clinic was not designed for the PAs to do the WCE.

 

Rotation 4: Titled "Women's Health", reality = family practice with a physician that practiced as a strict Catholic. I saw 6 pap smears, performed 1. Never saw or prescribed birth control, inserted an IUD or removed an IUD. Was able to observe 4 OB checks, and observe one C-section. I loved my preceptor so much and learned so much from him, that I couldn't give up on the learning experience I was having.

 

Rotation 5: Titled "Internal Medicine - in-patient", Reality = family practice with NO in-hospital work, and NO rounds. Honestly can't tell you about the experience because it has only been 2 days.

 

First and foremost I want to clarify that I do feel that I am still learning on each rotation and each rotation has had its lessons to teach me. The bottom line is that I am honestly freaking out about the lack of experiences I am having primarily as an observer but of course also in terms of hands on experience. Am I off base? If I am not off base, any recommendations on remedying the situation?

 

Thank you so much for any and all feedback. Thanks!

[VictoriaO]

Hi there, I'm just starting my R5 as well and I'm going to be frank with you...I'd be very concerned. Did you get to actually see a full day's worth of patients during R1?

Have your classmate's had a similar experience? What type of practice do you hope to pursue after PA school?

 

Not every rotation is going to be fantastic, no matter what program you go to there may be a dud or two.

However I'd be extremely concerned about the lack of procedures, patient interaction, and practice with documentation and orders.

 

Just for comparison, here's my rotation schedule thus far:

R1: Inpatient Medicine. 60hours/week, wrote admission H&Ps, prog notes, discharge summaries for teaching hospital Gen Medicine service.

We rounded with our attendings daily, went to radiology rounds, ground rounds and noon conference. I was treated no differently than the MS3 students as far as workload.

R2: Emergency Medicine: 50-60hours/week. Many procedures and suturing, wrote my own order sets, lots of radiology reading and EKG practice, was taught how to put in central line, FAST exam, intubate in the OR, trauma clearance protocol, etc

R3: Family Medicine: 40hours/week. Pretty run-of-the mill rural clinic, lots of depression, well-childs, HTN management. Did some casting, I&D, etc. About 20-25 patients/day

R4: Women's Health: 50-60hours/week. L&D, clinic and OR. Got to intubate nearly every scheduled procedure under general and do a spinal, scrubbed in on a ruptured ectopic, assisted 8 live births, maybe 18 C-sections, got to first-assist a couple. Wrote some admission notes, ultrasound practice daily, tons of pap smears, did a couple IUDs, etc. My preceptor ran the Megacode for me to get my NRP.

 

Right now I'm in Peds, I love my preceptor, it's pretty short clinic hours, but he's very interested in infectious disease and we have a lot to talk about. Being a very underserved clinic, I've already seem some sick kiddos that normally may have gone to the ED (had a syncope case today).

 

So I'm not trying to make you feel you got a bummer deal. I tend to walk the borderline make a pest of myself, asking to do and learn things, trying to make friends with the CRNAs, nurses, etc, hanging around L&D or call-rooms so I don't miss any excitement. But if you aren't placed in those situations where you have the opportunity to learn, that's where the concern lies. Being an observer does not cut it.

 

If I were you, I would talk to your program director. Talk to students who have graduated from the previous class.

It sounds like you may either have a preceptor shortage or some sort of issue with your clinical coordinator. Or just really, really, bad luck.

 

Best wishes!

[BLB]

thats absolute crap. Are you at a newer program without established clinical sites??? They shouldn't be sending you to places unless they know you will be at a site that will prepare you to be a PA IE: Dx + Tx + H&P with eyes closed + Procedures. An internal medicine rotation (arguably the most important one) that allows you to see 3 patients a day is WORTHLESS. You are not there to study. That is what didactic year and home is for. Not trying to freak you out, but people shouldn't be able to graduate without at least one inpatient component. Even the little (but hugely important things) like knowing what "sick" looks like, and becoming proficient with reading labs, and being comfortable with lines&tubes you are totally missing out on. They are SEVERELY limiting your options for jobs after graduation, because anything inpt immediately out of school would probably way to steep of a learning curve for you. I would say you needed meeting with your program director months ago, but better late than never. PROGRAMS WITH THESE TYPES OF ROTATION SITES SHOULD HAVE THEIR ACCREDITATION PULLED.

[COTA for now]

You need to talk to someone in your program about your concerns. Find whoever is in charge of clinical sites, and let them know how you feel. If you don't do that, don't expect anything to change. Things may look very good on paper, but be different in reality. It is your responsibility to provide feedback.

 

To the OP: It's been a month of two since your post. How are things working out?