Alena Rakhman PA-S
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Self-Reflection

Since this was my first rotation, I was exposed to many new techniques and I took full advantage of it. On my first day I was fortunate enough to suture a laceration, which I really enjoyed. I kept telling myself to stay calm and to take my time, and by remembering the newly learned knowledge from the clinical skills course, I ended up doing a decent job. I learned to take every opportunity to perform any type of procedure, no matter how big or small. If I wasn’t comfortable to perform something on my own, I usually asked first, and when I was confident enough, I asked if I could do the procedure under supervision. Placing an IV turned out more difficult than expected, finding a good vein is an artform, but the nurses at Brookdale Hospital were always helpful and I learned a lot of tricks from them. At this point, my IV draws have significantly improved with practice and I am sure will continue to improve especially when I utilize and tips and tricks that I have learned. Another procedure that I thought would be more difficult was a pelvic examination, and when faced with an opportunity to perform one under supervision, I quickly said yes. Soon enough, I performed several pelvic examinations which will be very handy when I start my ObGyn rotation. Overall, on this emergency medicine rotation, I was able on several occasions to perform CPR, obtain an EKG, perform a venipuncture, place a nasogastric tube, obtain a fecal occult blood sample, obtain a throat culture specimen, perform a urinary catheterization, perform suturing, splint an extremity and obtain a blood culture. Additionally, I assisted residents with high level procedures like intubation, central line placement, etc. I believe that learning these skills on my first rotation have given me enough experience to perform them on other rotations with more confidence.

I really enjoyed emergency medicine because it is always busy, with almost no down time, which gave me an opportunity to try to learn as much as I could. With each rotation, I noticed that I was able to think of more pertinent questions to ask the patients that could be helpful in coming up with the most relevant differential diagnoses. The way I presented to my preceptor of the day also became more organized and I did it with more confidence. However, it was still difficult for me to come up with a plan for the specific diagnosis. I always tried to listen to the resident presenting to the attending to try to utilize their style in my future presentations. If at any point they were occupied, I would look in the patient’s chart to either read the notes or to see what plan has been utilized in order to learn and put it through my thought process.

The most challenging patients in this rotation were patients that were not receiving care from a primary care provider and that had several comorbidities. I had to learn to guide the conversation that focused on the specific complaint that has brought them to the ER. By observing residents and attendings I was also able to polish this skill as well.

During this 5-week rotation, I learned to take initiative, because the outcome of this rotation depended on it. Since I didn’t have a specific preceptor, I was able to work with different people. If I saw a new patient on the board, I asked to see them first to obtain a history and perform a physical. If I heard a resident ordering any labs, I would ask them if I could obtain them. I approached nurses and patient care technicians and asked if it was okay if I helped them or if I could perform any particular procedure. Twelve-hour shifts started to fly by as long as I was moving and participating in some way.

As per my site preceptor evaluation, I should continue to work on formal clinical presentations and formulating plans, which I agree with. I think this is something I will get better at with more practice and experience. In the future, I will come up with a plan for each patient that I see, and if I need any assistance I will either ask questions, consult pertinent texts or research the topic after the shift.

 

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