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pa79

New to outpatient internal med

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Started a job at an outpatient Internal Medicine office a few months ago (graduated 2013, but took time off to have a baby).  The doc I work with doesn't really teach, so I'm having a hard time figuring out how to deliver the best patient care (I'm always questioning my treatments, diagnoses, etc.)  I read up on the typical things I see day to day (Uptodate, 5-min clinical consult, AAFP articles and the like), but don't feel as if my confidence is growing.

 

Is there a resource that can make the learning curve any easier?  I feel like I need to sit down with a mentor and go over all my questions.  Does it get easier?

 

thanks.

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It gets easier, but not having a good mentor of the first job is tough (I did not have a good mentor for my first couple years).  I did all the things you mentioned, but also listened to podcasts during my commute.  Study at home (it's tough after a full day's work).  Ask your employer for CME $ to go to conferences.  Maybe sit down with your SP at the end of your day and review your problem cases.

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it does get easier

12 months to stop living in fear

36 months to feel comfortable

360 months to really get it

 

 

I did the following

#1 - ask questions of doc when you need to - ie patient safety - you need to figure out how to do a real efficient presentation - no more 10 min presentations - safety of patients comes first

#2 - read every night about what you saw and did that day

#3 - in the office get this book - http://www.amazon.com/Clinical-Guidelines-Family-Practice-Constance/dp/0964615193/ref=sr_1_3?ie=UTF8&qid=1439205804&sr=8-3&keywords=nurse+practitioner+clinical+guidelines

Clinical Guidelines in Family Practice 5th Edition Edition
by Constance R. Uphold (Author), Mary V. Graham (Author) 

Product Details

 

#4 - get a subscription to Prescriber's letter - http://prescribersletter.therapeuticresearch.com/%28X%281%29S%28sxgycwbd5b5aywb3bfzkqe55%29%29/home.aspx?cs=&s=PRL&AspxAutoDetectCookieSupport=1 -  this really will help you stay abreast of what the meds are

#5 - memorize 10 drugs that you use every day - ie augmentin, HCTZ, Norvasc, Doxcycline.  Learn everything you can about them (this helps a lot in the long run)

#6 - if you have a drive, get AudioDigest CD's to listen to

 

 

Now a few more little hints - always think of at least 5 things that could cause the patients complaint (develop a Ddx on every patient) if you can't get to 5 then you need to go read a bit before you Dx the patient

MIT is an abbreviation I made up that helps with this.  Medical Infectious Traumatic (MIT) to help develop the Ddx

relaxe, time is something you have, excuse yourelf from the exam room and go read for 5 min "I want to just look up one thing" is ok to say to the patient.

 

That is what got me through the first couple years, hopefully some of them help you.

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Will your SP take time to teach you? I would book a morning for about 30 minutes once every 2 weeks or so to go over charts/cases you found you had trouble with. My first year in PC I did this with my SP. I also trained a new PA in a similar manner (after work vs morning) and she is now 6 months into the job and doing great. If not do a lot of studying. Read the docs notes on similar cases and see how he handles those cases. You'll start to find a groove after a couple years. Hang in there.

 

Sent from my S5 Active...Like you care...

 

 

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I'm about 11 months into my first job as a PA. Also in primary care. The learning curve is brutal. I think I've learned more in the past 11 months than in the prior 30 years (aka my whole life!). I don't really have any further suggestions beyond what you've been given above, but just wanted you to know you're not alone.

 

It does get better! As I close in on the year mark I find myself needing to ask my SP fewer and fewer questions, although I continue to live on UpToDate. Do you know that your SP is not willing to mentor you, or is it more of a case of him/her not reaching out to you?

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ventana is absolutely correct. If you take some time each evening to review some of your more interesting or difficult cases this is when you learn the most. I make a few notes throughout the day and referred to these in the evening to direct my learning. This is absolutely invaluable as you can actually place a patient /presentation with the information being reviewed as opposed to just attempting to learn medicine without a specific reference. The good news is that the information required to review each night shrinks as your knowledge grows. The bad news is you will never know everything so you never are able to totally stop the self learning process.frankly, to me, this is what makes medicine fascinating.

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