1. Interpersonal challenges and how you addressed them

Some of the interpersonal challenges I still 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, since I was following the internal medicine attendings there were very few procedures that they would be performing themselves, so I had no other choice but to make sure I approached the nurses or PAs on the internal medicine floors. Initially it was rough and there were instances that were frustrating but towards third week of the rotation I pushed myself to take every opportunity and eventually became more comfortable at approaching the PAs that I encountered and asking them if they had any procedures that I could help out with. Another interpersonal challenge that I encountered was one in which I was very hesitant in asking questions for the fear of sounding unintelligent. An instance of this occurred when I first heard about the coronary artery calcium score and did not properly understand what it was or why it was used.  I eventually overcame this after working up the courage to ask one of the attendings and they admitted to me that they did not know much about it initially but that it was more frequently used at this rotation site since it was specialized in cardiac cases. This helped put me at ease because it made me realize that not everyone is going to know everything and the point of asking questions was to help fill in the blanks of knowledge that you would otherwise not encounter.

 

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

Despite having already finished one rotation, I still find it that there are areas that I still need to work on. One of the areas that I still seem to struggle with is taking a proper history and performing a focused physical under pressure. An example of this occurred when I was asked to go see a patient in the ER and take a history and physical.  I believe that I can improve upon this by having a plan of action before going in to see a patient. I can also ask for more chances to take a history and physical. There were additional skills that I feel like I need to work on such as presenting under a short notice. When asked to present a patient randomly, I get flustered and I am unable to properly formulate a proper presentation. I can improve upon this by taking a few seconds to compose myself and properly formulate a HPI.

 

3. Managing new types of patients and the challenges that arise from that

During this internal medicine rotation, I encountered a verity of patients. One such type of patients were drug seeking patients. These patients posed various challenges to the practitioners. The attendings genuinely wanted to help the patients but with every different drug seeking patient that the attending encountered a new balance and plan of action on how to best help those patients had to be thought of. The attendings showed me that sometimes the best way to manage these types of patients was to stand your ground and work around their drug addiction and still try to help and advocate for them. Another new type of patients that I encountered were the elderly that were severely ill. One specific challenge that they posed was deciding upong whether further treatment should be pursued. Fortunately, this decision was not just left on the clinicians only the families helped guide us. There were instances where patients’ families were not fully comprehending the options and made the process even more challenging. Once such instance was with a patient that was in the medical ICU and had several comorbidities that prevented them refractory to several treatments and the clinicians tried to broach the subject of palliative care with the daughter. The daughter was more focused on feeding her father food despite the patient being obtunded and having a higher disposition for aspiration which could have worsened the patient’s condition. Fortunately, the clinicians and the patient’s family were able to come to an agreement.

 

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

For the following rotation, I would like to be less hesitant when I see an opportunity that can help to further my experience and knowledge. For this I will make sure I approach more of the staff and introduce myself properly and see if they would be willing to allow me a chance to learn. Additionally, I would like to take more chances and ask the preceptors for more opportunities to interview and practice my physical exam skills more.