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

One type of patient I found challenging during this rotation were non-verbal patients. When interviewing these patients about a fall or a complaint reported by a nurse, it was very hard to collect information from them. Some patients spoke very slowly due to conditions such as Parkinson’s, while others could only answer with 2-3 words due to aphasia. To make it easier for the patients, I learned to reword my questions to make them easier to answer, such as using yes or no questions instead of too many open-ended questions. For example, if asking about a fall, instead of saying, “Tell me where it hurts,” I would ask, “Does it hurt to move your shoulder?” This way, the patient could respond by nodding their head. It is also important to be patient and not rush or overwhelm them. Sometimes some patients would spend several minutes trying to answer my questions and that would often end up overstimulating them. I learned to reassure them instead of reasking the questions multiple times and forcing them to answer. This helps keep the patient calm and makes them more likely to cooperate throughout the rest of the interview.

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

I want to become better at performing wound care in my future rotations. During this rotation, I had the opportunity to shadow and assist the wound care specialist. She taught me how to care for pressure ulcers and I also assisted her in changing out wound vac machines for one of the residents. Since this was one of my first experiences with wound care, I realized I was very scared of hurting the patient, so I hesitated before taking any action. When we were dealing with a sacral ulcer, even though there was space for me to work, I was scared of securely packing the Kerlix into the wound. She advised me not to worry and to ensure I explain everything we are doing to the patient to minimize pain and build trust. Creating trust allows patients to let us know when they are in pain, so I know when to pause. My action plan is to do more wound care in my future rotations, such as in ambulatory care, where I will likely encounter abscesses and acute injuries. With practice, I will become more comfortable with these procedures as I gain knowledge and develop good communication with patients.

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

Initially, performing a geriatric comprehensive physical was challenging for me because this was a new patient population.All the patients at my long-term care facility had very extensive charts. I was often tasked with reviewing these charts and then conducting a comprehensive history and physical. Sometimes the patient is not able to provide all the information, so reviewing old charts is essential to gather the necessary details. Through this rotation, I became efficient at gathering information from various providers and charts. In the beginning of the rotation, when it came to the head-to-toe physical, I would miss some parts. These included things that we do not typically check in other rotations, such as checking the patient’s coccyx, heel, and buttocks for pressure ulcers. Additionally, patients do not allow you to spend hours doing a physical on them, so I needed to be quick, concise and know what I am looking for. I also created a checklist so that I didn’t miss anything. Since this was my first rotation involving comprehensive H&Ps, I definitely improved with each patient I saw. Now, when I have an older patient in my other rotations, I know what to look out for and will continue applying this knowledge in my future rotations.

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

There are two memorable patient experiences that I will carry with me. One case involved a patient I was asked to examine because the nurse reported he had a rash under his armpit. When I examined and questioned the patient, he told me he didn’t have any complaints. However, he actually did have a rash, and I should have examined him thoroughly regardless of him denying it, which I did not do before reporting back to my preceptor. I learned that older patients might not be aware of everything happening with their bodies due to functional issues, and we should thoroughly examine them even if they deny a complaint. Moving forward, I will make sure to examine the patient thoroughly and not rely solely on what they say.

Another memorable experience was with a patient who had a fall. I conducted a head-to-toe physical exam because the patient was non-verbal and unable to communicate the full story. One mistake I made was not removing the Mepilex pressure ulcer dressing on his elbow because I assumed it was there to prevent pressure injuries. However, it was actually covering multiple abrasions from the fall. This taught me to never assume and always remove any dressings if possible to check the wound underneath. Not only do we need to check how a wound is healing, but also verify the reason for the dressing to ensure it is being used appropriately.