The following are links to documents that I have created throughout my seventh rotation.

The following is a link to a History and Physical I presented during my site evaluation on a monthly evaluation for a 90 yo male veteran with PMHx of hyperlipidemia, brady-arrhythmia, BPH, and SCC and BCC: LTC_hp1

The following is a link to a journal article and summary (first page of attached document) that reviews over 20 articles in an effort to understand the effect of probiotics on the alleviation of symptoms of depression and anxiety: Norman_et_al-2016-Cochrane_Database_of_Systematic_Reviews

The following is a link to a report generated via Typhon that lists my hours, diagnoses I saw, and some of the procedures I did: tally

The following is my site evaluation summary:

During my site evaluation, I met with my site evaluator and one other student at the facility at which we were both rotating. We sat outside and discussed our patient presentations. Our site evaluator did a great job at emphasizing important clinical signs and pathologies regarding our specific cases. She spent a great deal of time going over differentials and providing useful tips on how to make our H&Ps better.

The following is my reflection of this rotation:

Exposure to new techniques or treatment strategies.

I removed a PICC line for the first time. It was an interesting process, but my preceptor walked me through it very effectively. We started by sterilizing the area with alcohol prep pads. I then removed the sutures and cleansed the area again to ensure this could not be a point of entry for infection.  Before I started removing the PICC line, my preceptor told me to pay attention to and recognize where the PICC line ends. In our case it ended in the proximal right atrium. He warned me that that I must educate the patient on placing pressure after we remove the PICC for at least 5-10 minutes. My preceptor also told me to pay attention to the changing levels of resistance and how it would dramatically decrease as it got closer to the point of entry. This is important to recognize, because gauze must be applied as soon as the tip is removed to ensure there is not excessive bleeding from the site. Following his instructions, I effectively removed the PICC and immediately recognized the decrease in resistance. I ensured that the catheter tip was present (to make sure it was not left behind), and then threw out the line in the sharps container.

How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc)?

The geriatric population is very unique because of the high reward a clinician receives for not so much input. For example, one of my patients asked if I could write down his medications and explain why he’s on them. I quickly agreed, and shortly after, gave him the list, and a lengthy explanation. He was extremely appreciative, and told me several times how grateful he was for taking the time to explain his medications. I was taken aback by how such a small action resulted in such profound appreciation.

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

It is very interesting how the knowledge we’ve gained throughout clinicals quickly comes out when it’s required in practice. One day when I was in wound clinic, and I heard a loud thud. I immediately stopped what I was doing and checked out the situation and noticed that a patient had fallen out of his wheel chair. I was the only one tending to this fall. I quickly stabilized the patients neck and first tried to get the patients feet from being strapped into the wheel chair. I called for help, and one of the nutritionists helped me untangle the patient. I was surprised by how quickly I took control of that situation and didn’t get nervous or flustered.

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

This rotation has taught me to take a thorough history of the patients. Knowing a patient’s living situation, the people they live with, etc. adds a great deal of knowledge and understanding about the patient’s situation. It’s easy to gloss over these details and see a patient as just a compilation of their diseases; however, I will never do that because of the firsthand experience I had with taking thorough patient histories and seeing how much that changed my relationship with my patients.