pas2017 Posted January 18, 2016 Share Posted January 18, 2016 Hi everyone! I am 2 weeks into my very first rotation. I'm at a small community hospital doing internal medicine. It's just me and an internalist who has been practicing for a loooong time...40+ years. I am very lucky for it to just be me and the doc, as many of my classmates are at larger hospitals and have to compete with residents in order to get time with patients. My doc is possibly the most brilliant man I have ever met. He knows everything about everything and his patients love him because he takes the time to give them the best medical care possible. I get a lot of independence...I see new admits, do comprehensive H&Ps, write up notes, present cases to my preceptor, along with my assessment and plan. My problem is how long it takes me to write up the assessment and plan. I am frequently consulting UpToDate, my old powerpoints, google, etc to remember everything. I made really good grades during didactic year because I could commit a lot of things to memory pretty easily. Now, I'm finding clinical rotations really hard because I can remember learning about a particular disease/drug/patient presentation/whatever, but the details are completely lost and I have to go back and look it all up. It is just so much different when the patient is right in front of you and you are trying to figure it all out rather than just pick the correct answer to a question on a test. I know that as I get farther along in rotations, the more I will remember things and the easier this will become. I am really good at history and physicals, but I am just feeling so discouraged and can't stop beating myself up when everyone around me seems so much better at knowing what drug to prescribe or what lab to order or what treatment plan to go with. I look at this topic list for my EOR exam and spend my entire 7 days off (my schedule is 7 on 7 off) trying to study but feeling like it is just not sticking. So I guess what I am looking for is a little encouragement from my fellow PA students in their rotations. Talking to my classmates about these issues is hard because I was a CNA throughout undergrad and not a paramedic or a lab tech and it feels like they have so much pre-PA experience that I don't have and aren't struggling like I am. I've never even worked in a hospital so figuring out electronic medical records even took some time for me. Even ordering IV fluids has been a task for me. You see 'IV fluids' all the time as a solution to many patient problems but on the ordering page on the computer there are 82478374 different types of fluids all at different rates at different times...there is just so much I don't know and it's hard when you feel like the only one out there who feels like this. Thanks in advance for any replies! Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 19, 2016 Administrator Share Posted January 19, 2016 Not on rotations, but an FM preceptor here. Based on your description of your strengths and weaknesses, you're right where I would expect you to be on your first rotation. Right now, you're in the process of organizing a jumble of memorized facts present inside your brain into a clinical problem analysis and solutions generating whole. Charting gets easier once you can narrow down on a) what matters and b) what billing needs, and then you can eliminate anything else. Yes, more and better HCE would have made the process easier... but no one, no matter what their HCE, has had to function as a PROVIDER before. (well, except for IMGs who make it into PA school...) It's a different and awesome responsibility. Relax. You'll get used to it and less overwhelmed with each rotation. Link to comment Share on other sites More sharing options...
lanime Posted January 20, 2016 Share Posted January 20, 2016 You sound as if you are really aware of your strengths and areas of weakness and what you need to do to overcome the things you are struggling with... So, as Rev said, you'll get used to it and I'm sure you'll start picking things up quickly once it starts to click! I have just been accepted to PA school, so I don't know exactly what you are going through. But, I have had many years of experience in all types of healthcare jobs, some of which have held a great deal of responsibility and required a steep learning curve, so I know the feeling to some degree. And sometimes, being the one who has to work a little harder in the beginning can be beneficial in the long run because you won't miss crucial information, as you will be very thorough! Hang in there and enjoy the experience... I know I'm looking forward to my (fast approaching) time! Link to comment Share on other sites More sharing options...
lanime Posted January 20, 2016 Share Posted January 20, 2016 ... And I doubt you are the only one feeling like this (everyone has a hard time with something). So don't be afraid to speak up and ask if you don't know something... Better to learn it now than make mistakes later on. Link to comment Share on other sites More sharing options...
pas2017 Posted January 20, 2016 Author Share Posted January 20, 2016 Thanks you guys! I definitely don't have a hard time with admitting I don't know something...I say "I'm not sure, let me go and look that up" or "I don't know, could you explain that to me?" to my preceptor a million times a day...haha! I know this is just the beginning and things will get easier, but it's nice to get my thoughts out there and have some responses. I appreciate the encouragement! Link to comment Share on other sites More sharing options...
winterallsummer Posted January 20, 2016 Share Posted January 20, 2016 I recommend getting a good app (agileMD or wiki EM alone) for those quick fact checks. What you're experiencing is totally normal. If your classmates are claiming to be that much faster than you they're either 1) lying or 2) may be fast but not accurate. Hang in there. The most important tool of any astute clinicians bag of medicine is humility. You will get there in time. Link to comment Share on other sites More sharing options...
anewconvert Posted February 7, 2016 Share Posted February 7, 2016 I am not on rotations yet, but spoke with my advisor a few weeks back about this topic and this is what she told me: Your first year is really about planting flags in your head. You plant a lot of flags and then forget about most of them as you move on to the next test. Your clinical year is about hearing certain things that cause a flag to go up in your head. That flag helps guide you to what you need to look up and reinforces the fact that this particular flag is important. The rest of your career is about actually learning and utilizing the information that is important to your work. To me it sounds like you did a great job planting flags. You know that you know something about the problem in front of you, which seems a heck of a lot better than being clueless. :) Link to comment Share on other sites More sharing options...
adru373 Posted February 10, 2016 Share Posted February 10, 2016 What you're experiencing is totally normal! To be honest, I think you're in the most challenging rotation right now. Internal hospital medicine requires you to think of a lot of different things at once and recall many diverse topics. Take this as a great learning opportunity. Get an app, pocket book or online resource to help you look things up that you don't know. I think you'll be surprised how much you learn at this rotation and how much better equipped you will be at your next rotation. Lastly, don't feel discouraged by feeling like you don't know many things. When you think you know everything, that's when you should be worried! Good luck and keep your head up! Link to comment Share on other sites More sharing options...
theredcliche Posted February 10, 2016 Share Posted February 10, 2016 What you're experiencing is totally normal! To be honest, I think you're in the most challenging rotation right now. Internal hospital medicine requires you to think of a lot of different things at once and recall many diverse topics. Take this as a great learning opportunity. Get an app, pocket book or online resource to help you look things up that you don't know. I think you'll be surprised how much you learn at this rotation and how much better equipped you will be at your next rotation. Lastly, don't feel discouraged by feeling like you don't know many things. When you think you know everything, that's when you should be worried! Good luck and keep your head up! couldn't have said it better myself. totally normal. your first few rotations are especially challenging. i use UpToDate on my phone alllllll the time and i make notes in a small book that I carry around....which I have to pull back out ...all the time. you will see in further rotations that most providers get into a routine and generally order their same favorites over and over again. don't be too hard on yourself - you're always learning! good luck! Link to comment Share on other sites More sharing options...
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