My first rotation was Emergency Medicine at Staten Island University Hospital. It was overall a great rotation and I feel I learned a lot. I found it advantageous to have ER first because it exposed me to many procedures, which will help me in many of my other rotations. While I’m not an expert yet, I was able to do many sutures, I&Ds, IV lines, and one local anesthetic. I will still continue to ask for opportunities for procedural skills on my following rotations to ensure I master these skills, especially the more complex ones, such as instillation of local anesthesia and suturing complex wounds. Being that I am very interested in Emergency Medicine as a career, I should try to really master the basic procedures, so that I can start learning the more complex ones right away on the job.

 

I found it beneficial to see how the PAs managed patients presenting to the ER for chronic pain. They would usually start by acknowledging the pain and then following up with a management of expectations. For example, they would explain that opioids are not provided in the ER for chronic pain, however we can perhaps give a stronger NSAID, like Toradol, which may offer some relief. After the workup, if there was no acute cause to be managed, the PA would present it as good news, that there was no greater issue to worry about, and recommend the patient follow up with pain management to help with long-term management and reduce repeat visits to the ER. I find that managing expectations from the start can be a good tool for patients that are more insistent and can help decrease the frustration on both sides. This is a technique I will surely use in my future rotations and career.

 

On this rotation, I learned that I definitely like the hospital setting, specifically ER, because of its fast pace, variety, and resources available. I definitely enjoy the physical aspect of ER in which it is very procedure heavy. I also learned that I like working in a team. At the hospital, each patient would see a clerk, PCA, nurse, PA, and doctor. It was interesting to see how cohesively the team worked and I also liked the ability to bounce ideas off the doctor for more difficult patients.

 

Being that this is my first rotation, I feel I have much to improve. Firstly, I feel that I was not able to study much because of the assignments and figuring out how to do them, however, now that I am more familiar with the work, I think I can manage my time better. My goal is to have one day a week (besides for the responses)  in which I do the assignments for E-port and Online Component, so that I can focus on studying the rest of the week. Furthermore, I intend to always have something on my during my rotation so that I can study during my downtime. Additionally, I want to try to improve my H&Ps and be more thorough in my site visits with my differentials and physical exam.