Internal Medicine Rotation
Mixture of inpatient and outpatient
During this rotation, I had the opportunity to complete 3 weeks in inpatient and 3 weeks in outpatient internal medicine. I loved having both of these settings because they were both very different and it gave me different perspectives of the role’s physician assistants have in internal medicine.
Inpatient – during this rotation, I worked about 5 days straight, 6 am - 6 pm, then I would rest for another 3-4 days. My days were really long, but somehow the more patients we had and the busier we were, the faster time would go by.
Outpatient – For some reason, I though outpatient was going to have a more flexible schedule, but I still felt like I was still working a lot of hours. I worked from 6:45 am – 5 pm Monday - Friday and Wednesdays we had a half day.
Role of a PA in inpatient Internal Medicine
Your experience may be different. I’m not going to lie, during my inpatient experience, I came to the conclusion I did not like the role the physician assistants had here. Other hospitals may utilize physician assistants differently, but in the hospital where I worked, I was not a fan of it. Basically, our role was to admit all of the patients from Emergency Room and do consults from other specialists around the hospital who wanted the department of Internal medicine to see their patients. The PA’s role was to go to the ER or individual patient’s rooms and gather an entire history and physical exam, write the admission note, present it to the attending, and order what was needed. PA’s did not get to have a list of patients to follow up on, make rounds, and really make a difference in patient’s lives in my opinion. The attendings got the majority of the work and to me it felt like there was not much growth in knowledge and autonomy here. Some people may enjoy it, but I felt like we were basically scribing, documenting long history and physicals and the ones left with the medical decisions were the physicians. This was so different from outpatient internal medicine.
Role of a PA in Outpatient Internal Medicine
During these three weeks, I worked with one of the smartest Physician assistants I have ever met. Not only was she bright, and amazing at what she did, but patient’s preferred to see her vs seeing their own physician. She had so much autonomy, she saw so many chronic conditions and critically ill patients and she knew exactly what to do and how to approach everything. This is what made me realize the different roles you can have as a PA.
Big learning curve
This rotation is probably the most anticipated for all PA students. If you are starting with this one, I’m sorry, it can be very overwhelming, but you will get through it. Luckily, I had this rotation towards the end, so I had seen a lot of the topics already and felt comfortable dealing with patients and their one million chronic conditions. You will learn so much during this rotation, everything will fall into place. It will also help you for your future rotations especially for family medicine.
Writing admission notes
Be ready to write long admission notes, full H&Ps, and progress notes. This rotation will significantly help you with your note writing skills. This was the first rotation where I felt like my notes had significantly improved. I wrote about 3-4 admission notes every day in inpatient medicine. At times, I would look at them at the end be so proud of them. You may also get to use a dictating machine, which greatly increased my speed in finishing my notes. If you have this opportunity, take advantage of it, once you learn to dictate a note, you never go back to typing one, its extremely effective. This is also a great skill to have once you become a practicing PA, it will make your life so much easier.
Labs, medications, and imaging
- Know the different laboratory tests to order and what they mean, knowing the normal ranges will also help you significantly. The most common tests used were CBC, CMP, electrolytes, and BNP.
- When there are orders for imaging, make sure to make the effort to look at these images and try to learn as much as you can. During my PA education, we did not have much CT scan lectures, so use this time to absorb as much as you can from your preceptors.
- You will have patients with an endless list of medications. Make sure you get into the habit of understanding the patient’s medical health history by simply looking at their medications. At first you may not know all of them, but I promise as you get further into rotations, you will gain so much knowledge from simply looking over their medication list.
Preparing for the EOR
This EOR exam will stress you out, just like it has stressed every PA student in rotations. If you have it towards the end of your rotations, YOU ARE LUCKY. If you have it at the beginning, I’M SORRY, but you will pass. Just focus on all of the NCCPA topics and study your butt off. A good strategy a friend told me to do was, if you don’t see it in clinic, make sure you review it at home. Every day, come home and check off the topics you saw in clinic, and those that you don’t see are the ones you should focus on at first. Make sure you review a lot of EKGS and chest X-rays, this was something we did in weekly clerkship meetings. Complete the Rosh Internal Medicine exam, use PANCE pearls, and smarty pants to review topics. One week before the exam complete the High Yield Internal Medicine Youtube vide from Emma Holiday. This will give you a good idea of how prepared you are for this exam and what your weak points are. The majority of the content is related to our EOR exam, but some of it its for just medical students. I highly recommend it, I will share the link below.
Anything can be in this exam, so don’t let this freak you out. Pace yourself for 6 weeks studying all of the topics and just go in to take the exam, take a deep breath and you will get through it.
Resources
POST EXAM CELEBRATION, HOUSTON TX
