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Hello, I'm a new PA on my first job as a hospital PA. I have been working for approx 4 months and recently went through a work performance evaluation.

 

In summary, I received a poor evaluation and was marked as "unsatisfactory/neds improvement" in a few key areas about 2 weeks ago. A few to mention: procedural skills, clinical knowledge, and relaying pt history to next shift PA's (also known as signout).

 

I am so distraught and surprised at this evaluation (I performed well in PA school, on my boards, and did well on my rotations) and would like some advice on how to rectify these inadequacies. I did not go through a hospital rotation, and do feel like my lack in expertise may be partially related to this drawback. I work for a good and fair hospital, although the training was inadequate in my opinion (particularly in mgmt of acute issues which was also highlighted as a weakness on my eval). Of note, I have been praised by others for my efficiency and hard working nature, but was too distraught to vocalize these examples. Is it worth it to do so? I'm afraid of the worst, but still have strong hope I can reverse these issues. I am due for another meeting in approx 2-3 months, I was told.

 

Again, looking for some guidance on how I can professionally show my team that I am working to improve while also showing positive outcomes? I have no experience or knowledge in mgmt of being in such a predicament. So far, I'm trying to be more proactive about doing some procedures (mainly blood draws), taking ample to review pt chart to ensure that relaying pt info to day team is precise (apparently someone complained that I was giving incorrect, and vague details), and I met with one senior team member once to review a clinical scenario that was troubling for me. Regularly taking time to review subject material... 

 

Anyone? Thanks.

 

Please feel free to send a PM if you'd like. 

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Sit down with your boss and set up a mini-rotation schedule to learn your procedures better and gain confidence in them and work with more acute care problems.  Nobody is going to be an expert coming right out of school - you probably should have been on some sort of graduated mentorship and had a performance evaluation much sooner.  Once you've got something set up, demand an interim evaluation after about 3 months - you shouldn't be going six months into a brand new job as a baby PA without some sort of formal evaluation - it's easier to fix things early than late.

 

To take an old school army leadership principle - "Know your subordinates' strengths and weaknesses - exploit their strengths and develop their weaknesses" - apply it to yourself and then sort yourself out. 

 

SK

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Definitely sit down with your boss and ask for specific areas of improvement with recommendations.  Are you forgetting to leave sign out or are you not expressing the most important things?  If you're not leaving sign out, then make sure you leave it moving forward.  If you are, then try to focus are major points.  The purpose of the hospital is to stabilize the patient and discharge the patient to a safe environment once they are ready.  Keep these objectives in mind when you're leaving sign out and caring for your patient.  Make sure you're looking up the things you don't know, utilizing your resources and taking responsibility for your patients.  I look things up, call specialists, call pharmacists and/or call social workers for every single patient I have.

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I would talk to your coworkers as well. That evaluation came from one (or more) of them, and if they haven't brought up these issues to your face it needs to be put in the open.

 

You said you were surprised. Has no one ever said to you "Boy dallas, last night was rough because of XYZ. It would really have been helpful to know about these things before you left for the day." If no one (NO ONE) has ever said anything like that to you, my opinion is that you should say that to your boss. It's really unfair to have this stuff come up in an official evaluation if no one has ever given you the opportunity to work on it in your practice.

 

I would not leave my supervisor's office until there is a plan laid out, with clear and identifiable goals/expectations, for the next 2 months.

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I'm not in the hospital setting, though it sounds to me like their expectations for a new PA may be unrealistic. I did a hospital rotation and my preceptor said that all he expected of a new PA was for them to give him enough info about the patient that HE can formulate a diagnosis and plan. I would express your concern over your training with your boss. Do so tactfully, but emphasize that you did not go through a hospital rotation while in school, and may have very limited experience in some of these procedures. Nobody is an expert after doing something once. The main thing I have taken away from my first year in practice is that PA school really only scratches the surface. It's going to take us years to becoming highly proficient providers. 

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I'm not in the hospital setting, though it sounds to me like their expectations for a new PA may be unrealistic. I did a hospital rotation and my preceptor said that all he expected of a new PA was for them to give him enough info about the patient that HE can formulate a diagnosis and plan. I would express your concern over your training with your boss. Do so tactfully, but emphasize that you did not go through a hospital rotation while in school, and may have very limited experience in some of these procedures. Nobody is an expert after doing something once. The main thing I have taken away from my first year in practice is that PA school really only scratches the surface. It's going to take us years to becoming highly proficient providers. 

 

It's an interesting point.  First year residents/interns have little idea what they are doing in the first few months, and they have coresidents and attendings to guide them.  I wonder what they are expecting of a new PA grad who may not have guidance/support from residents/attendings.

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Unfortunately, this is a pretty common issue from what I've seen. They aren't willing to train you, but expect you to be a superstar out of the gate. When they have issues with you, they don't tell you directly, but instead go behind your back.

 

I would say that you should try to improve, but I also recommend that you start looking for a new job. They are not treating you well.

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I am over a year out of school and while things are slowly getting better, its a veryyy slow and painful process of starting out in medicine.  Trust me, every new physician / resident goes through the same thing.  I feel like I had similar struggles as you did a few months out of school, so perhaps what helped for me may help for you?  

 

 

1) Procedural skills... There are great youtube videos like Larry Mellick's channel that show the procedure done in action to give you a sense for all the steps, then consider reading up on the procedure bible textbook Robert's and Hedges to get the in-depth understanding to help you fill in all the details.

 

2) Clinical knowledge... Have you gotten into the podcast / FOAMed scene yet? That was probably the most efficient way for me to get a sense for the most important clinical concepts.  Some of my favorite podcasts related to internal medicine are Louisville Lectures (excellent resource that our internal medicine residents rave about) and On The Wards (wonderful podcast going through how to approach chief complaints and common hospital problems, from the perspective of the "on call / paged hospitalist", like how to respond to common nursing calls, etc).  

 

3)  The signout... definitely a real skill I had underestimated as a student, as there is a lot to learn to be good at it.  Its important to be mindful of the underlying structure of the signout... in being systematic each time, you won't accidentally forget to share important details.  If you're interested, one of my blog posts goes into the structure of the signout that most people use, so feel free to take a look.  

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^ Nope.  It is not a required arc-pa rotation.  I didn't have one even as an option although I tried like hell to setup one

 

It sure is:

 

B3.04 Supervised clinical practice experiences must occur in the following settings:

 

a)outpatient,

b)emergency department,

c)inpatient and

d)operating room

 

If your program is not intending to rotate your through inpatient, they are not in compliance with the standards.

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I dealt with this.

 

I'll echo what others said that---and this is something I tell every PA student that I precept or shadows me---working as a PA is NOT equivocal to rotations.

 

You could be a rock star in school, getting great marks and great reviews from all your preceptors, but there is a big difference between rotations ("hands on" shadowing) and actually being paid with expectations all across the board, many of which are not communicated until your evaluation.

 

Despite what you may hear in interviews, the vast majority of employers do NOT want to train you and in fact expect you to hit the ground running with very little direct communications about the minefield of expectations you're about to encounter. Not only institutional expectations, but individual provider expectations as well.

 

Then you get blindsided with a bad evaluation and feel about 2" tall.

 

 

Definitely get specific feedback on performance issues and do your best to correct them. And understand this will get better with time.

 

An unspoken issue in the profession.

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It sure is:

 

B3.04 Supervised clinical practice experiences must occur in the following settings:

 

a)outpatient,

b)emergency department,

c)inpatient and

d)operating room

 

If your program is not intending to rotate your through inpatient, they are not in compliance with the standards.

 

Yes, every student gets some of that, but REAL inpatient medicine (i.e. hospitalist, critical care, etc) is not required.  Rounding on post-op surgical inpatients as part of your surgery rotation does not teach you much about inpatient medicine, imo.  ARC-PA should make hospitalist/critical care a required rotation.

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...and I met with one senior team member once to review a clinical scenario that was troubling for me. 

 

This is a red flag for me. You met with someone ONCE for a clinical scenario that was troubling you?!?! As a new graduate, you should have tons of questions and be reviewing cases with other APPs or with physicians very frequently. Part of being a good PA is knowing your limits. Being over confident or afraid to ask for help puts the patient at risk and the patient's safety has to absolutely be your number one priority.

Don't be afraid to learn from your colleagues, they really are your greatest resource. 

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