1) Interpersonal challenges and how you addressed them

Some of the interpersonal challenges I faced included believing that the preceptors and other providers would be guiding me through the rotation step by step. An example of this occurred during the first week of rotations when Professor Melendez asked me to interview a postpartum patient. I was caught off guard by this because I did not realize that I would be expected to do the interview by myself. However, I addressed this by making sure I studied beforehand and making sure I was prepared for. Another challenge that I faced was being too fearful about approaching other providers and asking them for the opportunity to observe or even attempt a task I had never done before. It was not later on that I realized that I had limited time at this facility and I need to take charge and stop being fearful of annoying or getting shot down. I improved upon this challenge by being more upfront when I saw an opportunity that I was interested in. An example of this occurred when I was shadowing a preceptor in the clinic and was watching the preceptor perform pelvic exams and pap smears on several patients that day. Being too hesitant and fearful of being of offending the preceptor I did not ask the preceptor if I could perform a pelvic exam. It was not until I came to the realization that I was missing out on valuable opportunities that I overcame my fear and started approaching all the preceptors that I was able to shadow if I could perform the pelvic exam under their supervision and consent of the patient.  

 

2) Skills or situations that are difficult for you (e.g. presentations, focused H&Ps, performing specific types of procedures or specialized interview/pt. education situations) and how you can get better at them

 

This rotation was an eye opener for me as to my strengths and weaknesses. One of the weaknesses which I was caught off guard by was my ability to take and perform a proper history and physical. There were instances when I was taking a patient’s history and would not be able to recall the relevant questions, I should ask them. This was especially true when I was trying to figure out which associated symptoms to ask about to help narrow down the diagnosis. This also occurred as well while I was performing a patient’s physical. I was not able to properly determine which physical exams to perform in order to perform a focused physical exam. I was deeply disturbed by this weakness I had in my basic skills. I decided that the best way to strengthen this was by repeated practice and so I searched up sample cases and practiced writing down questions and all the associated symptoms that I can ask the patients. Additionally, I made sure I studied the signs and symptoms of basic and most prevalent diseases such as pre-eclampsia and abnormal vaginal bleeding. After this learning experience, I feel that for every rotation studying up on the diseases and disorders and practicing H&P skills is necessary to ensure that I develop this weakness into a strength.

 

3)  What was a memorable patient or experience that I’ll carry with me? 

 

A memorable patient that I encountered during this rotation was a 6 week pregnant women who had recently fallen on some hard times and had come into the clinic seeking an elective abortion. Already having 3 children, the mother did not think she would be able to handle another child especially with the situation that she was going through. I was the first person she encountered when she came into the room and while taking her history, the patient broke down and started crying. Unsure of what to do I stayed silent until she was able to speak, I asked her if she was ok and she replied by telling me what she was going through. Even though we have taken Interviewing and Counseling as a class and learned skills pertaining to situations like this, I still felt I was not quite ready to handle this by myself and felt helpless. Luckily, I was able to notify the preceptor who was able to convince the patient into seeing the social worker in the clinic. This patient experience has also helped me realize that being able to properly care and connecting with a patient is a necessary skill to be able to deliver proper care. I decided to rectify this by watching videos and reviewing my interviewing and counseling notes and practicing with some classmates on how to deal with situations like these. I believe for future rotations not every situation can be accounted for but observing how my preceptors deal with sensitive situations.

 

4) What do you want to improve on for the following rotations? What is your action plan to accomplish that?

For the following rotations, I would like to improve upon my patient interviewing skills as well as patient communication. Additionally, I would like to be less hesitant in approaching preceptors and asking them about learning opportunities. I believe that I can become less hesitant and afraid if I get to know the staff there especially the nursing staff. The nursing staff can help a lot when it comes to practicing techniques that they do every day such as blood draws. Lastly, I would like to improve on the time that I allocate between doing the assignments and studying for the end of rotation exam. I believe that I was not as prepared for the exam as I had hope to be. By studying more and doing more practice questions I believe it will help prepare for the rotation as well.