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

In my rotation, I realized doing IV or ABG for older patient, or patient who has dark skin color are challenge for me. Generally, I could do some procedures, such as ABG and IV on the common patients. But sometimes, I need more practices and experiences if the patients with conditions to make procedures hard to be performed. For example, it usually took me a longer time to get the vein for the blood sample if the patients with very dark skin colors or older patient who has very dry or loose skin and vessels. And for most of the very sick patients who have weak pulses and very low skin temperatures, I usually have to do more than one time to get the samples. In order to improve my clinical skills, I would like to find more chances to practice with those patients who have hard conditions to make procedures and also learn from the skillful healthcare providers in my next rotation.

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

At the beginning of my rotation, I think presenting a patient for internal medicine was challenging for me. Many patients are admitted for multiple chronic disease and only one hours for me to exam the patient, call their pharmacy to verify the medications they currently taking, go thorugh previous lab and imaging reports, and also prepare my case presentation. I have to learn how to prioritize which ones are important and needed the most attention. I also have to gather a good medical history and test results in created a well throughout presentation. As I put in more effort, repetition, practice and time, I become more comfortable with oral presentation. I believe I can provide useful and effective information to my attending which will help them to build a general idea of patient’s health status and main problem.

What did you learn about yourself during this 5-week rotation?

In my rotation, I have seen patients with various medical conditions and problems, among which many are serious, such as hypertension, diabetes, pulmonary disorders, heart related disorders, kidney disorders, electrolyte abnormalities and many more.  I have learned that it is important to clear the concept by developing a better understanding of the pathophysiology of all the major disease. Because knowing the pathophysiology helps with diagnosing and creating correct treatment plan for these disorders. In addition, I learnt how to manage new admitted patients, including reading through prior notes, performing a basic physical evaluation, listing the possible differential diagnoses that need to be ruled out, setting up a basic plan including laboratory and imaging tests, interventions, and medications.

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

The knowledge I’ve gained in this rotation will definitely be applicable in my other rotation. For example, I learnt how to monitor and deal with patients with serious conditions, such as severe CHF or severe sepsis, and write related progress notes. For a possible shock patient, I learnt the specific protocol which is using necessary neurological exam and related imaging tests to rule out or rule in the shock quickly. The common used medicine I learnt here covers patients with a broad range of disease, such as geriatrics, endocrinology, respiratory medicine, gastroenterology, and cardiology. Since I have to present a case every morning including HPI, focused physical examination, diagnosis and treat varies acute and chronic medical condition that will greatly help me in my career in medicine, regardless of which specialty I choose. I have also actively participated in daily morning report and rounds, which provide me more chance to learn and see more cases.