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

  In the women’s health clinic, many patients were getting pap smears and STD swabs done that required them to be undressed from the waist down. Obviously these procedures put many patients in vulnerable positions and sometimes they might feel uncomfortable with a student looking at them as well. Same concept during vaginal deliveries when they might not want a student in the room along with 8 other people watching them give birth. In my first rotation the patients were never in these situations so it was easier to just be in the room. Through the rotation, I learned how to make them more comfortable with having me in the room with them during these procedures. I learned to first always introduce myself and ask for permission to be in the room during their delivery. I also let them know that I will be assisting the providers. After that I make sure to maintain eye contact with them. I talk to them during the procedure as well which helps the patient know that you are there for them if they need any support. Once the patient feels more comfortable, I feel better being in the room and I can focus more on learning instead of feeling like an inconvenience to the patient. 

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

In the following rotations, I want to improve on asking to do/assist on more procedures. Sometimes I tend to wait for the providers to call me over and ask me to assist because I felt like I was in their way if I go up to them and ask them myself. I stand in the room during the whole procedure waiting to be called over. But, when I did approach them one day during a vaginal delivery, they let me deliver the placenta. In my previous rotation, the provider would usually have me watch until they asked me to assist. Going forward, my plan is to speak to the provider doing the procedure beforehand and ask if I can assist in any way. I can even ask to do certain things in the procedure. This way they know that I am aware of how the procedure will be performed and want to help. 

3. 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

In the beginning of the rotation, I had a hard time obtaining a focused HPI from the OB patients who came into triage. Taking HPI on an OB patient is very different from taking history on other patients, like a patient in an ER. We have to ask specific questions about their previous deliveries; such as how big the baby was, history of abortions, c-section etc. There are a separate set of questions to ask patients in labor as well such as when their water broke and how their contractions are. The strategy I used to get better at unique H&Ps can help me in my future rotation. When I presented the HPIs, the providers helped fill in questions I missed. Along with seeing more triage OB patients and practicing, I made a template of these specific questions. I also watched some providers take history as well. When I walked into the rooms, I would have the questions on one page of my notepad while I wrote down the answers to the questions on the other side. By seeing and asking these questions a few times, I was able to memorize them. Toward the end of the rotation, the questions were like second nature to me and I was able to present the information better as well. Going forward I can do use this same method in my other rotations. Since I have psych next, those patients also require more focused specific H&P question. 

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

I will always remember assisting in my first c-section. Seeing the rush after cutting the uterus and bringing the baby out was a very unique experience. The first day I assisted, the provider let me cut sutures, suction and retract so I really felt involved. I will also remember how to take good OB history at a first prenatal visit and the timeline of genetic testing/blood work during pregnancy. Seeing bedside sonograms being done and the patients so happy to see their baby was always memorable. Other experiences I will remember is how to do fundal height and listening to baby heartbeat on handheld doppler. Sometimes I could not find the right spot to hear the heartbeat but I learned to be patient and keep trying. When it comes to patient experiences, I learned how to talk to patients during vulnerable times such as telling them when they have a nonviable pregnancy. Sympathizing with the patients and not rushing to the next patient is very important. I watched the provider take their time explaining their options in a very understanding manner as well.