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Kiera Robinson (first year PA student, class of 2020) shares her experience in family medicine.
What LP did you do? I did a longitudinal placement with Alison Plotzke, a PA who works in Family Medicine in St. Catharines (McMaster Niagara Family Health Centre). How did you go about contacting and arranging the LP? I contacted Alison via email. What did you learn from the LP? The placement provided many learning opportunities. I learned the clinical features, investigations, and treatment of a few common illnesses, I counselled a few patients on starting birth control, and practiced clinical presentations. What do you wish you had known beforehand to help in your LP? Overall I was happy with my knowledge going into the placement. I took what I knew from class and applied it, and Alison was able to fill in the gaps. I also emailed Alison a few days prior to each half day so that I could research the topics beforehand (she usually had an idea of what we would be seeing). How has this experience helped you clinically, in class and/or in career decision-making? The placement improved my communication skills, clinical reasoning, and overall confidence in seeing patients. I learned about when investigations are needed and the counselling involved in medication prescription (e.g. starting statins). In regards to career decision-making, I learned I would like to work in a faster paced environment. Saif Butt (first year PA student, class of 2020) shares his experience in family medicine.
What LP did you do? This was an LP with Deanna Lautenbach at Profetto Savatteri Family Medicine clinic in Stoney Creek. How did you go about contacting and arranging the LP? Deanna is my advisor and was my MF1 tutorial leader. I emailed her and we arranged dates and times that worked best via email and in-person. What did you learn from the LP? Deanna allowed me to take patient histories on my own while writing condensed SOAP notes on the computer. I then presented the case to her and she would ask me what I thought was going on. This taught me how to take a general, as well as, a focused history and then be able to present the information in an organized manner to a preceptor with some differentials in mind. Deanna also taught me some important tidbits of information for specific patients such as the GTPAL for pregnant patients and the diabetic exam/interview for patients with diabetes. I was also taught how to give simple intramuscular injections to adults and infants. I was given the chance to perform cryotherapy on a child’s warts. Deanna showed me a quick speculum exam on a newly pregnant patient. What did you wish you had known beforehand to help in your LP? I believe this is a superb introductory LP because I didn’t need to have a large amount of prior knowledge since I was mostly taking patient histories, performing simple physical exams and then observing Deanna complete visits or do certain procedures. Deanna is an amazing teacher and will take the time to explain any unfamiliar concepts with you and provide you with a basic understanding. How has this experience helped you clinically, in class and/or in career decision-making? This placement was excellent for providing history-taking practice and attempting a few physical exams which contributed to my confidence when doing these same tasks within the program or other placements. It allowed me to perform a couple simple tasks such as injections and cryotherapy. It showed me how smoothly a family clinic can run and the positive, uplifting atmosphere it can potentially have. This also provided me with a solid baseline to compare my other placements with. Even though the family clinic was a very conducive learning environment and the slower pace decreased stress, I realized I may need more excitement and higher acuity in my future job. Brittany Freud (first year PA student, class of 2020) shares her experience in Midwifery at the Hamilton Midwives.
What LP did you do? I did an LP with Daniella at the Hamilton Midwives How did you go about contacting and arranging the LP? I got in touch through the Hamilton Midwives website’s contact section. Their secretary responded to my request and forwarded my information along to one of their midwives, Daniella, who contacted me directly to set up dates and times. What did you learn from the LP? This LP was great for getting to see what a midwife does and what their scope of practice entails. Going into the placement I didn’t really know much about midwives and what they did other than that they helped deliver babies. Throughout the placement I got to observe Daniella in clinic, in hospital, and at home visits and I learnt what she did in each of those settings. I observed lots of prenatal visits where the patients would come in for a 30 minute appointment (one hour if it was their first appointment) to answer any questions or concerns that patient had as well as discuss what their current stage of pregnancy entailed, any red flag symptoms to look for moving forward, and any testing options available at that point in their pregnancy. At each prenatal visit a physical exam was also performed to check on the status of mom and baby. In the hospital setting I got to witness the triage process in the labour and delivery ward as well as observe some of the tests performed to see how far the labour had progressed. At the home visit I observed the postnatal check up performed on mom and baby to make sure that they are both in good health. What do you wish you had known beforehand to help in your LP? This placement was more of an observational than a hands on learning experience, so there was little knowledge required going in. Daniella was great at explaining everything she was doing and teaching me about the role of the midwives and the different issues surrounding pregnancy. It was a great placement to just observe and take in information. How has this experience helped you clinically, in class and/or career decision-making? This placement gave me a greater appreciation and understanding of the midwife profession. Moving forward in my career I now feel that I will be better prepared to talk about the roles of midwives with my patients should that be an option they are considering during their pregnancy. Alex Lee (first year PA student, class of 2020), shares her experience in gynecological oncology at Princess Margaret.
What LP did you do? I did an LP in Gynecology Oncology with Sandy Vuong, a PA at Princess Margaret Hospital. How did you go about contacting and arranging the LP? I heard about Sandy through my student advisor, as I was looking for a placement in an oncology-related field. I reached out to Sandy by email and she kindly accepted to have me in for an LP with her over 2 full days. What did you learn from the LP? This LP taught me a lot about patient interactions, and also gave me the opportunity to work on some history-taking and physical exam skills. Since gynecology oncology is such a specialized field and patients are seen on a recurrent basis, healthcare practitioners in this area have the ability to become very connected with patients and provide an exceptional amount of support for them. I really enjoyed this aspect of the placement, as I was able to see the truly caring nature of the relationship between PA and patient. In addition, having the chance to work on some practical skills, including taking a history, presenting a case to a physician, and applying physical exam techniques, was wonderful and really helped me grow as a learner. What do you wish you had known beforehand to help in your LP? I wish that I had done this placement a little later in the year, once we covered and learned about oncology cases in class. I went in with limited clinical knowledge because of this, but did a little bit of reading and research beforehand to help fill in the gap. Sandy was also very helpful and kind, taking extra time to teach me between seeing patients. How has this experience helped you clinically, in class and/or in career decision-making? This placement helped me realize that I would like to go into an area of medicine that provides the opportunity to see patients on a recurrent basis and get to know them well. I really value that connection and special opportunity to provide support to patients in their time of need, and this placement helped me come to this realization. Andrea Llanes (first year PA student, class of 2020) shares her experience in forensic pathology at the Forensic Services and Coroner's Complex.
What LP did you do? I completed an LP in forensic pathology at the Forensic Services and Coroner's Complex. Forensic pathologists are physicians who are responsible for determining the cause and manner of death by performing an autopsy and evaluating the patient’s medical history. How did you go about contacting and arranging the LP? I heard about the placement from a University of Toronto PA student. She kindly connected me with the assistant manager who was in charge of scheduling student placements (contact MPASA for details). Unlike most LPs that we arrange individually, this site allows 5-7 students for each shift - so they arranged two 8-hour shifts for me and six other classmates. What did you learn from the LP? Performing an autopsy requires a thorough understanding of anatomy and physiology, and our preceptors willingly answered our questions about what to look for when examining different organs. Nonetheless, despite a comprehensive autopsy, some cases may remain inconclusive, which then requires samples to be collected from the body for further analysis under a microscope. I was eager to learn about forensic pathology because it is so different from the clinical aspect of medicine, which involves a lot of patient interaction. Instead, pathologists and pathologist assistants take a retrospective approach to patient care by determining possible causes of death based on their medical history and autopsy findings. Apart from the medical knowledge I gained through this placement, I learned to appreciate the work that they do to ensure that patients and their families are provided proper care even after a patient’s death. What do you wish you had known beforehand to help in your LP? It would have been helpful to review post-mortem changes (changes that occur in the body shortly after death) and what information they provide about the patient. Apart from that, given that it involved working with deceased patients, we really needed to be mentally and emotionally prepared prior to the placement – but also understand that it is normal and acceptable to feel overwhelmed by the experience. How has this experience helped you clinically, in class, and/or in career decision-making? I learned a lot about anatomy and physiology from these two days of placement which, in my opinion, is incomparable to learning from a textbook. We also saw real examples of some conditions we’ve discussed in class (eg. pulmonary embolism, atherosclerosis, cardiomegaly, hepatomegaly). Now, every time I review a disease and its pathophysiology, I have a clearer understanding of how it may present in the human body. Ryan Runciman (first year PA student) shares his experience in critical care paramedicine.
What LP did you do? Critical Care Paramedicine, Toronto Ornge Air Base How did you go about contacting and arranging the LP? I contacted the Professional Standards office of Ornge regarding my interest in completing an observational placement. I was emailed several documents that had to be completed and returned prior to arranging any dates. What did you learn from the LP? I think the greatest takeaway I got from my time spent with Ornge is the importance of remaining calm and methodical in your approach no matter the circumstances, even in trauma situations. Clear and concise communication is important no matter what medical situation you are in, but even in times of high stress and when time is critical it is important to rely on your training and carry out a methodical approach to whatever issue(s) may be at hand. What do you wish you had known beforehand to help in your LP? It would have been nice to know more about common medications used in paramedicine, whether it be for pain control, sedation, or maintenance of blood pressure. How has this experience helped you clinically, in class and/or in career decision-making? After getting to observe the management of a trauma, I hope to complete a clerkship rotation in an emergency department whereby I can have exposure to trauma cases as well. I enjoyed observing the teamwork amongst the trauma team (physicians, nurses, paramedics, respiratory therapists, etc.), and I was impressed by how well they remained methodical and how much they stressed proper communication among care providers. It is an environment I hope to get some exposure in since I believe it will help my learning not only of medical cases, but also with communication skills. Anna D'Angela (first year PA student, class of 2020) shares her experience at Shelter Health Network.
What LP did you do? I spent four ½ days with the Shelter Health Network (SHN). SHN is a group of health care and social service providers who provide primary care to people who are homeless/vulnerably housed without a family doctor in the Hamilton community. They have 15 clinics across the city in various shelters, transitional living, community organizations and other locations. They partner with various organizations in the city, including CMHA, YWCA Hamilton and Good Shepherd.Their role is to bring health care directly to people who are facing the greatest barriers to accessing it. For my LP, I was able to go to four clinics in four different locations and follow three different physicians. How did you go about contacting and arranging the LP? The Shelter Health Network has a website (http://shelterhealthnetwork.ca) with an application section that outlines what you can do to go about applying to spend some time with them. Before me, they had never taken on a PA before, so I went through the process of originally contacting the administrator to see if I could apply, and once that was sorted out, I filled out the application and the clinic dates/physician/locations were provided to me. What did you learn from the LP? I got to visit four different clinics on four different days, and with SHN’s focuses on primary care, I saw a wide variety of clinical presentations. Being so early on in my clinical training, it was, at its most basic level, a great opportunity to see medicine in action.I also developed a greater appreciation for the complexities of providing care for people who face or have faced unique barriers to accessing care and other services. Some folks shared their stories of being discriminated against in their efforts to find housing, by other health care institutions, etc. These are all things people bring with them in their interactions with their health care provider and in many cases, can have a direct (or indirect) impact on their health. The physicians I was with had to be able to navigate sometimes very complex, bureaucratic systems to advocate for their patients. As health care providers, it is important to ask questions, be open minded and listen in a non-judgemental way. I really took that sentiment away from this placement. What do you wish you had known beforehand to help in your LP? Just a lot more medicine. Many of the patients that we saw had complex medical and social issues. Given that I did this LP towards the end of MF1, I was still very new in my training so it was a lot of new information. I also wish I had had a better appreciation for addictions medicine. Some of the clients we saw had had substance use disorder/alcohol use disorder, which I had studied many years ago as an undergraduate student from a social sciences perspective. So, my clinical exposure was limited. However, SHN does a great job sending you an information package BEFORE your first session to try to give you key information you should know. I found this really helpful to read. How has this experience help you clinically, in class and/or in career decision-making? We talk alot about the “social” side of medicine in tutorial, ProComp, and other venues; how the social determinants of health interplay with the physical health of patients and families. This LP was really a chance for me to work with folks where this is not an afterthought, but an integral consideration in the care they are providing. This is important, no matter what area of medicine you are in, but in other experiences I had, the focus seemed to be almost exclusively on the “clinical case”. It also solidified for me my interest in potentially working with underserved populations as a PA, and seeing whether there is a role for PAs like this in the future. Alex Mack (first year PA student, class of 2020) shares her experience in Internal Medicine
What LP did you do? The LP was completed on the Internal Medicine Floor, at Milton District Hospital with Physician Assistant Brent Lavin. How did you go about contacting and arranging the LP? I originally got Brent’s name from the LP sheet provided from the program. What did you learn from the LP? I learned a lot about the areas of medicine that we had previously covered in tutorial. I completed this LP at the end of MF1, thus we had covered the respiratory system, cardiology and hematology. Many of the patients on the floor had medical concerns falling under these categories. I was able to take we had learned in tutorial and see it applied clinically. By listening to patient histories, listening to heart and lung sounds and seeing the treatment in action, I was able to gain a much better understanding of class content. Brent took the time to explain any concepts that we had not previously covered. What do you wish you had known beforehand to help in your LP? As most of the patients fell under the geriatric category, most of them had other comorbid conditions including kidney disease and dementia. It would have been helpful to have gone over some of the complications associated with dementia. It would also have been helpful to have had a better understanding on the kidney function tests and their interpretation. That being said, Brent took this knowledge gap into consideration and focused on patients whose conditions we have covered in class. How has this experience helped you clinically, in class and/or in career decision-making? Brent put a large focus of practicing my clinical skills while I was at the placements. It was a great opportunity to practice my respiratory and cardiology physical examination skills. One of my favourite parts about the placement was that at the end of each placement, he would give a crash course about the content we were covering in class. He focused on details that were relevant clinically and was able to provide clinical insight into the most common presentations, the investigations that were truly ran and the best treatment options of the conditions. An internal medicine LP is unique in that provides a great overview of many different body systems. After completing this LP, I am now interested in working on internal medicine floor. Taylor Freeman (first year PA student, class of 2020) shares her experience at the Pediatric and Newborn Medical clinic.
What LP did you do? I did an LP in the Pediatric and Newborn Medical Clinic with Dr. Rick MacDonald, North Oakville Medical Center. How did you go about contacting and arranging the LP? I received his contact information from my student advisor. I’m not sure if he prefers to have his information shared so contact me first (taylor.freeman@medportal.ca). What did you learn from the LP? I learned that children can present very differently than adults for certain illnesses. Dr. MacDonald was great at explaining approaches to management for each child during their visit. During this placement, you get a lot of hands on experience. He will send you in to do the initial history and physical exam on your own right away and then have you present the case and discuss potential diagnoses in front of the patient/family. This can be a bit overwhelming at first, but it gave me an opportunity to experience what clerkship might be like and allowed me to practice skills learned in IER. What do you wish you would have known beforehand to help in your LP? I would have liked to have saved this placement for the second half of first year when I had more experiences/practice with taking a history and performing physical exams (especially in pediatric context) as this placement will give you solo experience with patients right away. How has this experience helped you clinically, in class and/or in career decision-making? This placement allowed me to see patients on my own and case-present to the supervising physicians in front of the patient and their family. I learned to take the feedback (positive or negative) provided to me to either change my approach for the next patient or brush-up on readings for the next time I went. This placement also taught me things to consider when working on pediatric cases (Ex. Common symptoms and diseases in children, red-flag symptoms in kids, how to address concerns with parents). Brooke Grant (first year PA student, class of 2020) shares her experience at IMS Rehab, an orthopedic clinic with Anne Dang.
What LP did you do? Orthopedic clinic with Anne Dang at IMS Rehab in Burlington. They primarily see rotator cuff injuries. How did you go about contacting and arranging the LP? Anne is okay with having her info shared. I received her contact info from the LP excel file in the 2nd year google drive. She is also very active on social media and has a PA blog, so it’s easy to get in touch with her What did you learn from the LP? I learned how patients and healthcare providers navigate choosing conservative vs. surgical management, which involves discussions about how an injury has affected a patient’s quality of life. For example, patients may need to take time off work and discontinue hobbies, especially when choosing surgeries that have a 6 month-1 year recovery time. I also learned a lot about clinical skills lie taking a patient history, presenting pertinent information to a physician in an organized manner, and then documenting this information in an EMR. What do you wish you had known beforehand to help in your LP? It would have been nice to have finished the MSK unit before beginning an orthopedic placement, however Anne provided documents explaining common injuries and physical exam exercises pertaining to different types of rotator cuff injuries. How has this experience helped you clinically, in class and/or in career decision-making? This was the first placement where I was able to see patients on my own and case present to the supervising physicians. This involved taking histories on follow-up patients and performing a physical exam to assess the level of injury and range of motion. I left this placement feeling more confident in my patient interactions and received helpful feedback from Anne for the future. |
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