During my internal medicine rotation, my evaluation was done by PA Shu. For our mid-evaluation, I presented a case involving a 72 y/o patient with stroke-like symptoms. Through this case, I learned about using the NIHSS score, interpreting imaging and bloodwork to rule out stroke and working efficiently with the ED, stroke and CT team. Gathering a quick yet thorough history from the family was also important to ensure we had all pertinent information for a possible diagnosis that can be time sensitive. After my presentation, PA Shu provided feedback on including more details in our H&Ps that we usually do not include in our previous write ups. For example, rather than listing CKD in the patient’s history, she advised us to ask for the stage if the patient is aware. She also noted that in the medications section, specifying the time of day medications are taken is also good to include. Additionally, she reminded us that in internal medicine, we address not only the acute issue but also the patient’s chronic conditions. She recommended always including management of chronic issues in the assessment and plan since some medications, like metformin, may need to be stopped during admission. This approach helps us learn to manage chronic conditions when a patient is hospitalized. My classmate then presented a GI bleeding case and PA Shu further guided us on relevant questions to include in the HPI for GI complaints.

In the final evaluation, we first started by going over our article. I presented an article on the outcomes of undergoing FlowTrieve mechanical thrombectomy vs. anticoagulation medications in high-risk pulmonary embolism patients. PA Shu discussed the importance of reading the limitations section of the article to better assess how much the results can be applied to the general population. Then I presented my case about a 69 y/o patient who came in for shortness of breath, chest pain, cough and was found to have a PE on CT chest along with bacteremia. Patient was also found to be hypoxic with a spO2 at 92%. With this case I learned when to consult cardiology, pulmonology and infectious disease after admitting the patient. PA Shu told us that if the patient is hypoxic, when we write out the vitals, we should include how much oxygen the patient is receiving and if their spO2 improved after that. This way we can see how their oxygen was when they came in and if the intervention is helping or not. She also mentioned to include labs in the plan section that rules in the acute diagnosis and what bloodwork or imaging needs to be repeated/pending. 

This site evaluation taught me many valuable skills that I will carry forward into my career as a PA. I learned to focus on details I hadn’t previously considered, such as asking patients with hypertension about their usual blood pressure. This helps us gain a deeper understanding of the patient and make more informed decisions. I spent more time with my patients and reviewed charts thoroughly to be as detailed as possible. This might not be possible in every field but can be done for patients who are admitted. Moving forward, I will make sure to ask more in-depth questions about patients’ past medical histories. In an inpatient setting, I will also take the time to perfect my assessments and plans, including important details such as  whether patients are discharged to a shelter or home and their code status.