For my site evaluation in my family medicine rotation, Professor Herel was our site evaluator. This evaluation was particularly interesting because we were all from different rotations, unlike my previous site evaluation where everyone was from the same rotation. The variety of cases was especially helpful for me since family medicine EOR exam involves numerous complaints about various body systems. For our mid-rotation evaluation, we were required to present one patient case and five drug cards. Professor Herel asked us to write about our drug cards as if we were talking to the patient. Simplifying the drug cards helped us understand them better and remember them in the long run. I presented a case about a 56-year-old female who came in to establish care with the doctor and complained of left knee pain for two months. The diagnosis was a possible meniscal tear. I had four differentials and had to explain why we could rule each one in or out. This process helped me think more critically about each differential and learn more about the conditions rather than just listing them. Some feedback I received was to better structure my HPI so the information flows more smoothly and to include a few lines mentioning that the patient was there to establish care with a primary care provider. Since I mentioned routine blood work in the plan section, it was important to address that in the HPI as well. Additionally, I mentioned that we advised the patient to avoid foods high in saturated fat, sugary foods, and foods with added sodium. Professor Herel suggested breaking this down further for the patient so they know exactly which foods to avoid. Other students in my group presented cases about stroke, pelvic organ prolapse and cellulitis.

For my final site evaluation, we needed to prepare two reports, a summary of a scholarly article, and five more drug cards. I presented a case about a 61-year-old male with a fast-spreading, worsening painful rash on his left thigh and lower back for four days. The patient was diagnosed with Herpes Zoster (shingles). The patient was prescribed acyclovir and advised to stay home from work due to the rash being contagious. As a group, we discussed that his rash was probably spreading very fast due to his immune system being very weak. Overall, I received good feedback for the presentation of the report. After that, I presented an article about the use of lidocaine patches to reduce the pain of shingles. The article concluded that applying the lidocaine patch in the earlier stages of shingles reduces pain and the need for rescue painkillers, along with reducing progression to postherpetic neuralgia. However, even though it might be a useful adjunct to antivirals, the article had a limited number of participants, so we do not know how applicable it is to the general population.

Overall, I learned a lot from discussing a mix of cases from the group. Hearing about my classmates’ drug cards taught me about other drugs besides the ones I am likely to see in family medicine. I received a lot of feedback that I will carry into my future rotations. Going forward, I will be more aware of how I structure my HPIs and make sure the information flows better. I will also remember to be more specific with my patient education in the plan section of my report.