Wednesday, July 26, 2017

7 Days of Thoughts on My First Clinical Rotation (Endocrinology)

Recently, I began my journey through PA school clinical rotations. I have to say, the transition from didactic year to clinical year was not nearly as terrifying as transitioning from working full time to starting PA school (maybe that can be attributed to my absolute exhaustion that I accumulated through didactic year? haha). However, I was still anxious, nervous, and feeling like I was not prepared for clinical rotations. Luckily, I only had a weekend to dwell on this, and was subsequently thrown right into my first rotation in Endocrinology! It's actually considered an Internal Medicine rotation (my program requires 2 IM rotations throughout clinicals), but I expressed interest in endocrine, and my advisor had an amazing Endocrinologist in mind for my preceptor. I am super glad that I mentioned this in my meeting, and I am really loving endocrine and learning a ton!

As I started rotations, I decided I'd write down my thoughts throughout the first 7 days, and I am glad I will be able to look back on these thoughts and see how far I've come even in 7 days.

Day 1: I am absolutely terrified. I am not ready for this. How did a year of classes already fly by? Did I learn enough...did I retain enough of the material? I hope they don't think I am dumb. I hope I know enough to pass the rotation. After Day 1: Well, I only answered 1 pimping question right! Out of many. I definitely feel like I barely know anything.

Day 2: Okay, I just have to remember that I know more than I think I do, and to not psych myself out. This is a learning process (after all, I am still in school!) and I should not expect myself to know everything I am asked or encounter. After Day 2: I answered 2 questions correctly, and got a "correct!" as a response! Wooo! I also can see that I am following along with the patient cases more easily than I was yesterday. Plus, I heard my first murmur and was able to identify it based on my preceptor saying "I want you to identify the abnormal finding on this patient's exam and tell me what it is". My preceptor knew I got overly excited when I confidently stated "it's a systolic murmur!" and proceeded to poke fun at me every time we had another patient with a murmur during the rest of the day.

Day 3: I was with another provider today, and got to see/hear/feel a fistula! Also learned about an insulin sensor, which is a device that continuously senses a patient's insulin levels throughout their day (and night!), and can warn diabetic patients when they might be getting into dangerous glucose levels. What a cool life-saving device! In all honesty though, after day 3 I felt overwhelmed again because I spent the day with a different provider who had a completely different style, but they were really thorough with patients and definitely knew what they were talking about! Also, I am still terrified that I am not good enough to be here/that no one will like me.

Day 4: I was with 2 different providers today, and was able to see a whole lot! I learned how to calculate insulin needs/calibrate insulin pumps, which makes SO much more sense now than it did in the classroom! Plus, I am super excited that I was following along with the providers' thought processes and actually came up with the same differentials on a pretty challenging case (pending labs to find out the patient's actual diagnosis). I don't feel as terrified anymore and actually feel like I am opening up a little more (anyone who knows me knows that I typically take some time to observe situations first and then open up and act more myself). I made the conscious decision to be myself and open up today (quicker than the norm, but time to step out of my comfort zone!!), and it actually worked!

Day 5: I'm completely exhausted from this past week, but I learned a ton. I saw my first 2 patients alone today and presented the cases to my preceptor. I am pretty proud. My preceptor was impressed with my physical exams, and I only missed 1 question that they wanted me to ask on one of the patients. They were both relatively easy-moderate cases, so it was not challenging in that aspect. But it is pretty terrifying seeing an actual patient and not simply practicing on your good friends in a simulated exam room! I was given a ton of endocrine/internal medicine topics to read up on and keep me busy for the weekend.

Day 6: I was with 2 providers again, and went to the hospital with my main preceptor in the afternoon. It was a fun change of scenery, and I got to see the inpatient side of endocrinology. While we were in the office, I answered 2 (!!!!) questions correctly in a row. Woo! I honestly don't know where they came from (one of them I didn't even realize I knew haha), and I actually answered several other questions correctly throughout the day, although I still definitely had a few swings and misses. I am hoping with time and experience, it'll get easier, which at this point that definitely feels like a possibility. I am not as exhausted as I was after last week, and I am starting to get into the swing of things with of course a lot of work to still do.

Day 7: This is actually possible. I am feeling more confident than I have been, and am not sweating up a storm (as much) when I am asked a medical question (I should've mentioned this earlier, but we so lovingly call them 'pimping' questions, as in questions that our preceptors either want us to know, expect us to know, or don't expect us to know and are just testing our depth of knowledge). I am really liking endocrinology and all of the providers I am working with.

End of Rotation: This has seriously been an absolutely amazing rotation, and far exceeded my expectations. I received my preceptor's evaluation of me, and it said that they expect me to do well in my clinical year! That is a HUGE relief, since I honestly didn't feel like I had any idea of where I was at. Preceptors often take on multiple students, so it is a nice complement when they think you'll succeed.

Real talk: clinicals aren't as scary as I thought they'd be. I was not once yelled at or told to do something I was completely uncomfortable doing, but was definitely pushed out of my comfort zone in a good way. Guys, rotations are totally do-able! Plus, if you are positive and put in the time and effort to do well, get to know patients and your preceptor and the staff in the office, it makes your time so much better! Be nice to everyone, and take on every opportunity - you won't regret it!

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