EM Self-Reflection

How did it go? What have you learned? What can you improve? How do you plan to improve these new skills?

This experience in the emergency department provided such an enrichment to my learning in the process of becoming a well-rounded PA. I’ve learned an immeasurable amount of information from the incredibly talented and intelligent staff in the ER, but I will discuss a few here. I’ve learned that even if your suspicion for a life-threatening emergency is low, you will likely have to order diagnostic testing to rule out these conditions because missing such a diagnosis may increase chance of morbidity/disability in your patient and may be detrimental to your career. I also learned that MANY evidence-based calculators exist and will help guide decisions on whether or not to pursue certain testing or treatment for a patient based on their risk. Some skills that I’ve improved and learned better techniques on include venipunctures, suturing, and IV starts; however, I can definitely improve on these essential skills and I believe the best way to do so is with practice and asking for advice from experienced colleagues. This approach to trying to become better at something not only applies to these skills but also many others that come with being a PA.  

How could the knowledge I’ve gained here be applicable in other rotations/disciplines?

A piece of knowledge I’ve gained during this rotation is that the concept of a team is really emphasized in the emergency department. The nurses, techs, radiologists, attendings, residents, mid-level providers, scribes, social workers, all work so closely and every single person’s role is vital to the cohesive operation of the ED. It was nice to see how the PAs interacted with their surrounding staff, especially when the PAs would approach an attending to review a case and discuss what the best management for a particular patient was. I know that this will not be the last rotation where I see staff in various roles working so close in conjunction with one another, so I expect this lesson to be applicable in my future rotations and career.

Types of patients you found challenging in this rotation and what you learned about dealing with them

Of all of my rotations thus far, I believe that this rotation in the ED exposed me to the greatest portion of patients who may be labeled as “poor historians.”  This included a wide range of cases, including those with cognitive disabilities, speech deficits, psychiatric histories, acute intoxication, etc. I believe the outstanding lesson I received from this group of patients is the importance of obtaining collateral information/history. Especially in the elderly patients who may have dementia and are not able to provide a very useful history, I found it challenging to interview these patients because the emergency department did not allow for visitors to accompany the patients (due to the COVID-19 pandemic). So I would start with getting the information I could from the patient, then seeking the family in the waiting room or instead getting information from a phone call to a family member because of how valuable collateral histories are. I also learned that if the patient is likely capable of answering questions, sometimes the best thing to do is to repeat yourself or rephrase your question/statement until it is properly received and answered as intended.

What is one thing would you want the preceptor or other colleagues to notice about your work in this rotation?

One thing I would have wanted the preceptors to have noticed about my work in this rotation is the tasks I did for patients when the preceptors were not looking. Certain efforts I made for patients, such as changing dirty sheets or placing bed pans, may be considered by some as tasks which are outside their scope of responsibilities. I believe my role as a PA student there is to learn and help patients, so I was willing to help in any way I could, not only for the patients but also to relieve some work off of the already overwhelmed ED staff.