Elective rotation in Orthopaedics

Filed Under (Rotations) by Dave on 06-05-2010

So for my elective rotation I went with orthopaedic surgery.  More specially orthopaedic hand surgery.

Well to be clear the doctor I was with was a hand specialist, but saw patients with any type of orthopaedic problem.

I was really caught off guard by how much I enjoyed this rotation. There was a good balance between clinic work and time spent in surgery.

I actually got to assist in many hand surgeries such as carpal tunnel and trigger fingers and also got to do total knee and hip replacements.  There were actually a few times I got to assist other doctors with things like ACL repairs, clavicle repair and amputations.

The one thing I can say about orthopaedics is that it is a field of its own.  Like a lot of fields in medicine, there is a whole different language for orthopaedics.

I have to say, I went into this rotation thinking I was pretty good at reading x-rays, but quickly found out there was a lot to learn.  I think I came out of this rotation being able to quickly and effectively read x-rays.

One of the tricks that I learned was to look at the site of injury last.  For example, if you know that the patient hurt their right wrist, look at the fingers and distal forearm first and then look at the wrist.  I was told this is a good way to make sure you don’t miss anything.  Lets say you get really focused on the wrist injury and only look at that on the x-ray.  There may have been a secondary break somewhere that isn’t hurting yet that you missed on the x-ray but could have found.

Anyway, so i’m now sure that orthopaedics is where I want to end up!

OK now for books and things that are a real help for orthopaedics:

http://www.wheelessonline.com/ -Not really a book, but it has everything you will need as a student and then some.  There are many pictures and everthing is in an outline form that is easy to read and understand.  Best of all you can click on a bone of the skeleton and learn about anything you could ever want to know about it.

Psychiatry Rotation

Filed Under (Rotations) by Dave on 07-03-2010

So for the past month I have been on my Psychiatry rotation at the Medical College of Georgia.

One of the first things I can say about this rotation is that you are always working with Residents.  I get more into that in a moment.

I was actually on this rotation with another of my fellow PA students.  The every first day of the rotation we were split up and put onto different teams.  There were actually 3 teams on the Psych ward.  There was a team dealing mainly with schizophrenic patients, a team dealing with personality disorders, detox and the such and a team that dealt only with geriatrics.

I was placed on the team that dealt with schizophrenic patients first.  On this team I was working with two residents and a medical student.  The man role that we, the students played was collateral gatherers.  On this team we were to arrive at 7am and starting seeing our patients, type up a note and start calling people to get collateral information.  The residents would arrive around 8am and then we would round with the Attending physician at 9am.  All and all I really only saw the Attending physician for 30 minutes a day on this team.  Pretty much the Attending did all the interviews during rounds.

This team also required us to read journal articles each week and to present them to the attending and other medical student.  Actually this wasn’t a bad thing as it did help in the learning process.

After two weeks on that team I was moved over to the team dealing with personality disorders, detox and the such.

I think I actually liked this team better.  Again, I worked with one resident and a medical student on this team.  The hours were a little easier was we didn’t have to arrive until 8am and we didn’t round until noon.  The intersting thing about this team was that the attending physician was really cool and laid back.  During rounds he had us interview our own patients in front of him.  If he had questions that he thought we forgot to ask he would chime in, but most the time he just sat back and would give feedback to us after the patient had left the room.

I think this was a great learning experience.  I really learned what to ask and how to respond to patients when they put you on the spot or some type of conflict arises.  Again, a large part of this team was getting collateral and sitting in on family meetings.  So lots of calling family members and talking to patients outpatient doctors.

All and all this was a fun rotation.  I think the residents are some of the easiest people to work with, at least where I was.  They were more than willing to help in anyway and were really willing to help teach things.

The only problem I ran into was with one of the attendings.  It seems that he forgot I was a PA student and kept comparing me to a medical student.  Which is fine, don’t get me wrong, but he has a little bit of a grading problem.

I was told early on that this attending did not give medical students high grades.  I was told me thought a “C” was good or average for a medical student and unless the student did something really really great then they would get a C.  I was also told that he usually took it easier on PA student and gave them a higher grade, usually a mid to high B.  He did this because he said he expected the medical students to know more then PA students.

Well, my grade reflected the fact that he thought I was a Medical students as I was given an AVERAGE grade.

Lucky for me, I talked to the other attending and he gave me a much higher grade.  So the two averaged out to be an OK grade.

Now, you may ask why I didn’t go and talk to the first attending who gave me the AVERAGE grade.

Well, he got a new job in Texas and filled out my grade on the afternoon that the left.  So when I actually saw the grade, he was already on a flight to Texas.
Fair?  I don’t think so, but it all worked out.

Now for books that were good…

1) Psychiatry Blueprints- this ended up being the only real book that I used and it was a good one!

Have you done a Psych rotation?  When Where?

Pediatrics Rotation

Filed Under (Rotations) by Dave on 07-03-2010

So I actually have some free time…so I thought I would update the site with a few post about my past few rotations.

So at the beginning of this year, 2010, I did my Pediatric rotation with Dr. Renew of Augusta Georgia.

I have to admit that I was really unsure about my Pediatrics rotation.  This being so because I was not sure how well I would be around kids.  See, i’m an only child so dealing with small children is something new for me.

Little did I know that I would end up liking the rotation as much as I did.  And i’m sure a lot of that has to do with having such a great Doctor to work with.

One of the first things that I noticed was that the children did not cry nearly as much as I had anticipated.  Actually the Doctor pointed out how none of her patients were crying or misbehaving while I was in the room.  Be it a tall man figure in the room or whatever…it was nice to have them not cry and to be calm.

If I remember right, one parent noticed how well her child was being and stated to me “well you know children can sense how kind of a person or how caring a person you are and they respond according.” I think that may actually be quite true.

No on to the material of the rotation.

Pediatrics is like another world.  I really had to remember how to use all of my physical exam skills, especially auscultation.  I really got a good idea of how to listen for pneumonia and different heart murmurs.

I will agree that you do get your runny noses and common child injuries a lot, but you also get cool things every once in a while.

All and all Pediatrics was quite fun and I really enjoyed it.

I am actually thinking about looking for a pediatric surgery job.  So if you know anyone in Savannah GA looking for a new PA let me know!

I want to end by talking about which text books were the best for this rotation, as I just took the end of rotation test this past week.

1) Pediatrics Blueprints- this book was just great.  Had everything in an easy to read format and was straight to the point.

2)Pediatric Lange- Ok, this book is huge and has way too much Info, but it did come in handy when I saw something during the rotation and wanted to read more about it.  It also had the information that was asked of me, not really pimped, during my rotation

Have you done your Pediatrics rotation?

When? Where?  How was it? What books helped you?

Reproductive medicine conference patient presentation

Filed Under (Rotations) by Dave on 19-11-2009

So every Thursday I have to pick a patient that I saw in the past week and present the patient in front of the reproductive medicine board.  Board being the 3 or 4 doctors in the department as well as a resident and at least one medical student.

I presented a patient last week, but one of the doctors seemed to have thought I didn’t provide him with enough or THE information that he wanted. Hence I was “wasting his time.”

Now I have gathered said information that he wants and am to present the patient again today at 1:30.

I even went over the information with another of the doctors this morning who said I needed to still find the dosage for Bi-est.  I repeated that I had already called the local compounding pharmacy and was told twice what the dosage was.  He still felt I was missing some information.  At that point I pulled up a google site created by a compounding pharmacy and showed him that the dosage was as I was told.  If the bi-est is 40/60 2mg then its 40% estriol to 60% estradiol. Just that simple.  So he then seemed to agree that I had the information I needed.

I guess we will see what the other doctor who wasn’t pleased with the presentation last week thinks today.

And since the online pharmacy site was such a help, at least at this point I hope, I want to post a link for others.  So here it is…

http://www.thecompounder.com/hormonesprescribed.php

OB/GYN Grandrounds

Filed Under (Rotations) by Dave on 18-11-2009

I’ll be attending my first OB/GYN grandrounds in close to an hour.

I’ll update later as to how it went.

Update:

So grandrounds was covered by the NICU.  It was a discussion about preterm birth complications.

Actually they presented a patient who was born at 22 weeks with some complications, but is now doing fine.

The odd thing I noticed while at grandrounds had nothing to do with the discussion.

I felt a little out of place as I was the only PA student there.  Actually everyone else was an M.D.

The odd part comes when everyone looks at my white coat to read who I am.  I guess its because my patch or the patch for PA student’s white coats is different than that for the medical students.

Again, it was just odd to see every M.D. that walked by my seat look down to read my jacket.