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just looking for some reassurance!


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Hey all!

I'm on my 5th clinical rotation (graduating in JULY!!) but I need to ask... how long until you REALLYYY feel comfortable? I love seeing patients, and I think I have a fairly good handle on knowing what the next step will be (labs/films/etc), but I'm really starting to struggle with actually treating someone. I feel like each rotation I go on there is a provider who does things their way, so when I leave and go to my next rotation, things there are handled completely different. Is this something I'm going to have to get used to during rotations - a "take it all in and decide for yourself" thing or is there any advice out there? I feel super confident going into my rotation, and then different providers like different things and I'm thrown off track again. It's really starting to make me feel like I'll never get a handle on this. PLEASE someone tell me this is normal? 

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Very normal.  For each rotation, do things the way your preceptor wants, and file their "style" away.  Eventually, you will develop your own - perhaps a mixture of what you've seen.  I'm a year and a half into practice now, and finally starting to feel really comfortable 95% of the time.

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A better Idea of your dismay might include what it is you want to do. I am personally 4 years into the game (all Emed) and still get hit with curve balls.  But, I am feeling  more comfortable, though not totally.  There are definitely others out here who can provide more astute insight. I think being a PA is a lot like being a doc. Learn how to document, and then document again, and learn when to punt.  my cherry opinion.

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welcome to medicine

 

your experience level will increase as will your comfort level and those moments of panic and dismay will become less frequent

 

BUT - this is medicine... at 11+ years out I am very comfortable but the highs and lows still come, a great catch here but then a missed thing or bad outcome there.... things cycle, but the good times get longer and the hard times get shorter

 

as a student and even the first few years of practice realize these challenging times are when you are going to learn the most - try to not repeat mistakes, but realize you are going to make some......  learn learn learn.....

 

on a great note!!! by you having this type of reflection right now you are likely going to become a great provider as you are a thinker and you care.....

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Once someone starts feeling like they know it all, they scare me a little. As you mature into your career you will become more comfortable dealing with uncertainty. And as you gain experience, you will encounter less and less uncertainly. But it will always be there. 

 

I have always thought that the pre-PA curriculum we take does a disservice to a career as a clinician. We all take courses like chemistry and physics and math where things are very black and white - two moles of this and two moles of this give you two moles of that. But suddenly when you get into medicine everything turns gray all of a sudden.

 

Every shift you will encounter new things and learn things. That is one of the great things about a career in medicine. Don't sweat it!

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Rotations are interesting. You start out feeling really out of place, gradually get to feel that you make a small contribution from time to time, and then are whisked off to another chance to feel stupid all over again. I described my experiences in my book.

 

As a practitioner, you are always learning. In my practice, I was paired with a more experienced PA for about 60 days and then started seeing patients by myself. I spend a lot of time on the phone with my SP and the other PA. As time went by, it was less and less. I am now the senior man and I usually talk to my SP once or twice per day. Newer providers call me now and being the one who asks the questions has added to my opportunity to grow.

 

You will continue to learn new stuff; I know that I do nearly every day. You will also be amazed at how much you will be able to remember from school. Patients come in with noncardiac complaints at my place and I have to deal with URIs, UTIs, digestive disorders, skin problems, dysfunctional uterine bleeding, DVTs, etc. I also have to describe noncardiac procedures that patients come in for clearance for. Surprisingly, it all works. 

 

Don't stress during rotations. Learn what you can and also see what different practice models are like. Do you like one SP or many (like in an ER)? Do you like being on your own a lot or being with your SP most of the time (like in surgery)? Do you like learning hands-on skills (like surgery) or solving puzzles (more like medicine)?

 

In other words, you learn more than the technical disciplines during your rotations. You might also find your unique place in medicine.

 

Good luck!

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THANK YOU ALL SO MUCH! Such a relief knowing this is normal. I have friends in my class that say they could go out and practice tomorrow if they were allowed and I'm over here in the corner like, uhh. So its so reassuring knowing this is normal. My books and I will continue to bond and my contact hours will grow - which I know will continue to help a lot as well. THANK YOU

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The bigger danger isn't thinking you have more to learn but thinking that you know all you need to and that you're ready to practice with live ammunition. Some of your classmates might be a bit too confident at their stage of development. 

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  • 2 weeks later...

As a practicing clinician that works in remote locatons as a solo provider and one that probably started before you were born, I would suggest that the better providers are those who are never really "comfortable" to their role. Becoming comfortable is the first step in becoming complacent which then leads to lack of growth and mistakes.  Rather you will or at least should become aware of the more you know, the more you don't know enough and that whatever you do know  will never be enough.  Always keep in the back of your mind these 2 thoughts.  #1) am I missing anything? and #2) am I providing the type of care to the person before me as I would like to receive it?

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I have friends in my class that say they could go out and practice tomorrow if they were allowed and I'm over here in the corner like, uhh.

These types are in every class. They're usually more insecure than they lead you to believe. I'd prefer somebody like yourself that knows they have more to learn, rather than somebody who thinks they've got it all figured out. Keep up the good work. The very fact that you're asking means you care and take it seriously. That's a great trait to have!

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As a practicing clinician that works in remote locatons as a solo provider and one that probably started before you were born, I would suggest that the better providers are those who are never really "comfortable" to their role. Becoming comfortable is the first step in becoming complacent which then leads to lack of growth and mistakes.  Rather you will or at least should become aware of the more you know, the more you don't know enough and that whatever you do know  will never be enough.  Always keep in the back of your mind these 2 thoughts.  #1) am I missing anything? and #2) am I providing the type of care to the person before me as I would like to receive it?

Im glad to see this thread. I remember those rotations. (Thanks for posting OP) also knowing im not alone. I sometimes wonder if that uneasy feeling I get here and there will ever leave completely. Tonight for example, conscious sedation for <4 yr old for large lac repair. It went fine t/o and chid left as scheduled. But I founf myself gritting my teeth or stressed even after he left. Wears on me at times.

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I've been a PA for nine years and currently I am working up a patient for a  new complaint.  It makes me nervous and I am calling and consulting with radiologists regarding his symptoms, plus spent time at home last night looking up and studying literature on the complaint and differentials.

 

(My collaborating physician is up in a tree stand somewhere in the woods)

 

PAs  no matter how much experience one has should have a level of discomfort with patients and never assume anything!  I agree with Derbingle, Corpsman2PA and bnewberr.  

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