Hoosier1 Posted December 20, 2014 Share Posted December 20, 2014 I've been disappointed with the quality of several of my rotations so far. My Emergency Med was the worst so far. It was a rural ED and I was lucky to see 15 patients a day. During the entire rotation I did sutures once and saw less than 10 cases that I would consider "emergent". Several other core rotations have just been shadowing experiences with no hands on, not even patient history/presentation. When I expressed concern I was told my elective could be used to make up for any deficiencies. Anyone else have experiences like this? I'm worried about the quality of my education but feel I'm stuck. My friends and family keep telling me to file a complaint with ARC-PA but I'm worried about the repercussions. Any suggestions? Link to comment Share on other sites More sharing options...
swooshie1 Posted December 20, 2014 Share Posted December 20, 2014 Sorry to hear this. There is no easy answer, especially when you are in a program that is all too happy to take your money but lacks accountability for their end of the agreement. This thread might help: http://www.physicianassistantforum.com/index.php?/topic/15191-what-to-do-with-potential-subpar-rotations/ Link to comment Share on other sites More sharing options...
UGoLong Posted December 20, 2014 Share Posted December 20, 2014 Clearly not an ideal situation but most likely you (1) aren't going to transfer or (2) get your school to change overnight. Filing grievances is fine (after you graduate) if that turns you on. The question is what to do right now. If it were me, I would: a. Talk to your classmates and see what your UPCOMING clinicals are like. b. Decide if those experiences will meet your needs c. For any that don't, get with your clinical coordinator and see if you can make some changes or find a better site on your own. d. Let the coordinator know -- without tons of emotion -- what your rotations to date have been like so they can make things better in the future. In the end, it's all what you make of it. Not ideal, but kind of a miniature version of life. Good luck. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 20, 2014 Administrator Share Posted December 20, 2014 Is there a way for students to raise issues with their schools not performing to accreditation standards with ARC-PA directly? While I would use such as a last resort, I expect your program director will take you more seriously if you note that as one of your options. Note that I didn't say "it will go easier for you", I said "take you more seriously", which can include branding you a troublemaker and kicking you out of the program on a pretext such that your complaint simply becomes that of a "disgruntled former student". Link to comment Share on other sites More sharing options...
UGoLong Posted December 20, 2014 Share Posted December 20, 2014 Just remember, your immediate job is to graduate with as good an education as you can get. Fixing your school or -- failing that -- complaining to higher authorities, should be much farther down your list of priorities. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 20, 2014 Administrator Share Posted December 20, 2014 Just remember, your immediate job is to graduate with as good an education as you can get. Fixing your school or -- failing that -- complaining to higher authorities, should be much farther down your list of priorities. All very true, but at what point does our obligation to the practice of medicine supersede our desire to do the easy, self-interested thing and not rock the boat? This is why the public is being lied to about resident work hour restrictions: no resident has any incentive to report non-compliance, because they put their own future at risk. Link to comment Share on other sites More sharing options...
UGoLong Posted December 20, 2014 Share Posted December 20, 2014 I think you have two choices: rock the boat now -- or try to blow it up -- and in the process lose your investment in time and effort, or... ...maturely bring up issues as you go, do your best to graduate, and then work for the kind of change that your school and the profession needs. To me, the first option is like shining a light on a problem by lighting yourself on fire. Link to comment Share on other sites More sharing options...
gbrothers98 Posted December 21, 2014 Share Posted December 21, 2014 This is the same argument that has persisted in the past concerning discussions ranging from clinical rotations to name change to salaries. What works best, table pounding vs behind the scenes machinations? Likely both, but repercussions of either tact have to be considered. As for the OP, anything that will come of your efforts now to change clinical rotations will likely have little effect on your current situation other than discussing with the clinical coordinator of your program the difficulties and obstacles you found on your rotations. Making a point to list what you havent been able to do and the importance of doing that prior to graduation could improve your rotations in the future. But it is likely that your program already knows about these shortcomings. I assume you have to provide a patient log. Does the log only include patients you perform a H&P with, assess and treat? Or does it include any patient you evenly remotely come into contact with? I would suggest quality over quantity. You can get involved in many patients care but it amounts to superficial engagement. Better to sink into the details of a patient because this is what will be difficult for you to do in the real world. I see students I precept get fired up to see patients during a busy time. What ends up happening is that while they are exposed to a bunch of patients, they dont get the level of involvement they need to truly understand what it is like to care for a patient from start to finish. Many limits to what a program can do concerning rotations, push too hard and could lose a site. If your program is not paying sites, they are relying on the good nature of others and a desire to pay back. That reliance can be worn thin by demands to improve anything about the site. As for your ED rotation, what was the expectation and your goals? Really what you describe is similar to what I provide students for their rotation. Small critical access hospital, yearly volume 7k, student will see 5-20 pts a day. There seems to be a concern that volume is needed to make a rotation worthwhile but the reality is that a student can see as few as 3 patients a day and still get something very worthwhile from this. As a preceptor, I can keep you working on the specifics of a patient for hours. As for suturing, whom has made this such a critical core skill overshadowing all others? After 15 years in EM, I can tell you that my suturing skill is reasonable but my most important skills have nothing to do with procedures but rather with patient and staff interactions in combination with critical diagnostic thinking. Plus the reality is that you may never need to suture a patient outside of your rotations again in your professional life. As for emergent cases, the reality is that the ED is 99% mundane and routine with 1% mind boggling. The 1% chooses it's own timeframe to appear rather than in concordance with a student's presence. What I would suggest for the OP is this. What is your goal clinical year? What area of medicine do you see yourself going into? If it is EM, then lobby now for another rotation in another larger ED to round out your experience. What students lose focus of is that a program's main goal is to get the cohort through the 2nd year with a uniform experience that meets an established standard. So being in a low volume ED and seeing only 15 patients (what is the number you think you should see?) a day will be sufficient. Many moving parts in the 2nd year and the assignment of a certain rotation to a certain student can have multiple factors behind the rationale, many that have absolutely nothing to do with the desire of what the student wants. Overall I think this common theme that presents persistently is a reason for one of 2 things to become more a norm in PA education. First, lengthen the model to more than 2 years to include more clinical experience. Second, develop more PA residency programs in different areas of medicine. As for the OP, you may be served best by viewing your program as not an endpoint in your education but as a stepping stone to get to the next level. Strive for a ?better? ED rotation and/or set your sights on a residency post graduation. Good luck G Brothers PA-C Link to comment Share on other sites More sharing options...
swooshie1 Posted December 21, 2014 Share Posted December 21, 2014 My interpretation of what the OP is concerned about is LACK OF HANDS ON time in his/her rotations. The concern has been made to the program and the response was "eh, use your elective to fix what we are not willing to address." Shadowing during clinical rotations is UNACCEPTABLE. I empathize with the OP; when prospective PA-S ask me about my program experience, I simply tell them I wouldn't recommend the program I attended. Link to comment Share on other sites More sharing options...
SocialMedicine Posted December 22, 2014 Share Posted December 22, 2014 See if you can have elective or surgery rotations geared towards EM experience ... especially if that is where you see your career going. For example pediatrics in a pedi ED, and surgery with a trauma/emergency surgical service. Link to comment Share on other sites More sharing options...
Hoosier1 Posted December 22, 2014 Author Share Posted December 22, 2014 Swooshie1 pretty much nailed my concerns. There is more I could say but I think the less that is said on an open forum the better. At this point I think the safest option is to suck it up and keep my head down until graduation. Link to comment Share on other sites More sharing options...
winterallsummer Posted December 22, 2014 Share Posted December 22, 2014 Can you take some of this into your own hands? After you shadow the doc, go back in and do a more thorough h and p. For admitted ER patients, write down their name and dob. When it's slow, go through their chart and then go visit them on the floor. If you aren't charting on your rotation, make a paper soap note and then at home compare it to your text book and see how well you did. If you aren't allowed to see the pt before the doc, offer to go in and take vitals and do a quick history then. Not saying anything of this is ok. Just trying to give some practical advice. I had a couple disappointing rotations but used the slow time to study as much as possible. If you already read everything for your current rotation then start reading ahead for your next one. And if your preceptor doesn't teach then see if you can spend time with a resident or someone else. Show up early if you must. Link to comment Share on other sites More sharing options...
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