SERENITY NOW Posted November 5, 2015 Share Posted November 5, 2015 Hi Gang, I tend to do some reflecting on this crazy process of learning medicine and every once in a while I come to a realization I think is worth sharing. The past few months I've been thinking about rotations... There is really so much that goes on during rotations. You try to learn your way around a new hospital, you try to learn the job/responsibilities assigned to you, and you try to learn the basic textbook medicine related to that specialty so that you can cram it in your head for your EORs. Now that I have graduated, however, it has become abundantly clear that when practicing on our own and making our own decisions, it requires much more than those things. Since I am doing a residency program, I still have to opportunity to do rotations and I have found myself changing the way I approach my learning while on a rotation. More and more I am asking myself, 'what will I need to know about this once I am in practice in my own specialty?'. The basic outline is as follows: General Learning Goals for Rotation on Specialty X... -What are the most common chief complaints and diseases for this specialty. Learn textbook knowledge about these. -The perspective/approach with which the specialist thinks about and works through the chief complaint. -Really practice the ddx, widen it, and internalize it by seeing as many cases as possible. -The history questions that really target the ddx, and what is the best way to ask these questions (learn this by listening to the way the specialists ask questions). -The systematic physical exam, the technique, and getting a feel for what pathology looks like and feels like. Also, how do they objectively describe and document their exam findings? -The orders for workup. Getting a sense for sensitivity and specificity of these tests. How much weight does the specialist actually put on the results of these tests? What is the systematic approach to reading the studies (ekg, cxr, head CT, etc) and practice practice practice with the specialist while you still can. -The most common treatments used in this specialty. What are the things that the specialist has in the back of their head when they order this? Chart checks they do before ordering (pmh, labs, etc), C/Is, interactions important enough that they bother memorizing, common side effects and worrisome adverse reactions they know to look out for. -How to perform the most common procedures of this specialty, and lots of practice doing them. -When is it appropriate to refer these patients, what do they want us to do first, and how do they want to hear the consult/presentation? As you can imagine, its not possible to learn it all when you are on your rotation. So, its really important to prioritize, and this is the second part of my realization: the most important things to learn on rotations are the things that you'll have the most difficulty learning while practicing on your own. You'll be able to look up the majority of the above things like ddx, history questions, orders, etc. However, reading 10 articles won't come close to the experience of having your hands on a patient with a peritonitic abdomen, an extremity with compartment syndrome, etc. With this in mind, on my current rotations I have been focusing much more on honing my physical exam skills and truly trying to internalize what abnormal looks and feels like. Another example: if you want to commit to memory the most important "take away" points for a given drug, good luck searching a textbook or uptodate... you'll just find lists of side effects and contraindications a mile long which will be next to worthless. With this in mind, I now realize that my preceptors/specialists have 'lived and breathed' these medications for years, and have internalized the most important take-away knowledge about these meds. All it takes is a few good questions and they'll share this invaluable knowledge with you. In essence, you should realize the value of being immersed in a wealth of specialty knowledge and being in a position where you are allowed/encouraged to ask questions... take advantage of it! You likely won't ever get this chance again! So, in the outline listed above, I have italicized the things that I consider knowledge you'll be able to obtain MUCH easier while on your rotation than when you are out in practice. These should be the things you really try to seek out and prioritize while on your rotations. As I said above, with these realizations, I've been approaching my rotations much differently and I think my learning experience has become much more productive as a result. Instead of passively scanning through a review book, I now have an outline of things I am actively seeking to learn and my retention is much better. In the past, when my preceptor and I would have down time, I'd try not to bother them and couldn't think of good questions anyways. I now always have a framework of high yield questions ready for moments of down time and I've been able to learn invaluable information as a result. I wish I would have made this realization before starting rotations in PA school, since I think I would have gotten a lot more out of my school rotations. It is what it is, I suppose. At the very least, I hope I can pass some perspective on to you students going through it now so that you can make the most of your journey! Any other PAs out there have any advice to offer students going through their rotations? What realizations do you wish you had made before graduating that would have made your learning experience even better? -SN Link to comment Share on other sites More sharing options...
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