- Interpersonal challenges and how you addressed them
Some of the interpersonal challenges I faced were similar to what I faced in my first rotation. It seems that I was still hesitant in approaching some of the staff in my first few weeks at the rotation site. For example, I had a hard time speaking up and involving myself in the discussion of a patient or even asking questions in terms of a specific diagnostic study they chose or choice of treatment. Initially it was rough and there were instances that were frustrating but towards last few weeks of the rotation I pushed myself to take every opportunity and eventually became more comfortable at approaching the nurses, residents, and attendings. Another interpersonal challenge that I encountered was being able to properly recall all that I have learned when questioned or put on the spot. An instance of this occurred when I had recently seen a patient and did not expect to present the patient but was asked to by the attending or resident. I would become very intimidated and forget my train of thought. I eventually overcame this after I started to treat each patient’s history and physical as something I would be presenting in front of other medical professionals. This helped me remember the patient’s H&P better as well and my presentation skills improved drastically to the point where I was complemented on having such a through and chronological story. This essentially taught me a lesson that instead of doing things that you are good at, I should identify the weaker points and work on them until I feel confident with skills in it.
- 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
Despite this being my fourth rotation, one of the main skills that I believe need work is my presentation as well as my interviewing skills. More importantly, I believe that my presentation skills need to include a proper assessment and plan of care. This is complicated because each provider/preceptor you work with will want you to have a slightly different personal preference for how you present to them. For example, on this ER rotation some attendings wanted evidence based differential diagnosis such as a diagnosis for PE which is supported by the PERC criteria for how you would rule in or rule out diagnosis of PE. I believe that at the start of each rotation it will take some getting use to but eventually you can adapt to specific types of presentation skills depending on the specialty you work in. This skill can be worked on by essentially taking each presentation opportunity as a learning moment and improving or incorporating it in your presentation.
- Managing new types of patients and the challenges that arise from that
One of the new types of patients that I learned to manage were patients that would go off on a tangent and find it hard to stay on track when answering certain questions about their history or the reason that they came into the ER. Some of the challenges that occur from this are that it becomes harder for us as providers to differentiate what their primary reason for seeking emergency care is. It also causes delays in providing lifesaving diagnosis and treatments to the patients. After observing the residents and gaining guidance from the attendings, I was able to learn how to redirect the patients properly while also being respectful and empathetic.
- What do you want to improve on for the following rotations? What is your action plan to accomplish that?
For my next rotation I would like to improve on being bit more resilient and accepting of the criticism that the providers provide. Even if I believe the criticism to be true or not, I should be able to take in into account and see if there is any way for me to incorporate it into my future learning experiences. Additionally, I would like to improve on my time management skills during intense rotations such as ER and surgery. Being able to complete the work that needs to completed regardless of if it is my best piece of work or not will help me stay on top of my assignments and studying.
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