Beryle Roach (first year PA student, Class of 2018) goes through her experience working in a labour and delivery unit during her longitudinal placement. What LP did you do? This LP was in the Labour and Delivery Unit at McMaster Children's Hospital. How did you go about contacting and arranging the LP? Like most teaching hospitals, many of the departments at Mac have a specific individual in charge of scheduling learners. A classmate happened to have the contact information for this OB/GYN individual, I sent her an email and had my first shift scheduled within the week! What were the two main things you learned from the LP? The most exciting thing I learned was through observing a scheduled C-section; watching the procedure allowed me to see which professions were involved, roles in the OR, how the procedure is performed, and next steps for baby and mom. I also learned more about the complex role of health care in child birth, and just how many different specialties (e.g. generalist OB/GYN, nursing, PAs, maternal and fetal medicine, thrombosis) can be involved in the care of any given patient. What do you wish you had known beforehand to help you in your LP? Looking back, I wish I had known more about the reproductive process as a whole and what the most common complications of pregnancy/birth are. How has this experience helped you clinically, in class and/or in career decision-making? Overall, my time in Labour and Delivery was a wonderful experience that not only honed my knowledge of specific topics like child birth and reproductive health, but also of the inter-professional network that must exist for hospitals to provide comprehensive care to their patients. Furthermore, I was able to gain some valuable skills in terms of the medical interview and building a relationship with patients. What LP did you do? Of the 4 LPs I completed this year, my Hospitalist LP in Sault Ste. Marie, ON sticks out the most and was probably the biggest learning experience clinically that I had this year. How did you go about contacting and arranging the LP? I arranged this LP through the Sault Area Hospital (SAH) and Northern Ontario School of Medicine (NOSM) coordinators. They were happy to have me complete a longitudinal placement within their facility. What were the two main things you learned from this LP? There were many experiences I had while working with the Hospitalist team at the SAH. Two of those experiences that are at the top of the list would have to be: 1. Seeing how the multidisciplinary teams work together to accomplish the task of getting patients back into the community with the proper support networks. 2. How to successfully navigate and work in a hospital. How has this experience helped you clinically, in class and/or in career decision making? I was able to see how social work, OT, PT, nurses and physicians go about treatment plan goals and discharging the patient. While being with the Hospitalist team, I was permitted to see patients on the wards, in the ER and in the Psychiatric areas of the hospital. Working with this type of team enabled me to see different areas of the hospital as well as become familiar with computer systems and proper documentation of patient encounters. I completed two rotations with the Hospitalist team in SSM: one during Christmas and the other during March break. Although I had very limited training for my Christmas rotation, and months later in March I still lacked certain medical knowledge, these placements made me realize how valuable Problem Based Learning (PBL) is for continuing to develop your skill set as a PA. PBL gave me the tools to efficiently and effectively research specific medical topics as they pertained to the patients with which I was interacting which facilitated and maximized my learning experience. What LP did you do? I did my LP with a Physician in a Child Maltreatment Assessment Program. How did you go about contacting and arranging the LP? At our Interprofessional Education Day I met the head of the program and started chatting with her about pediatrics and her maltreatment assessment program. I asked if I could do an LP with her and she was very excited to have a PA since they had never had one before. She gave me her e-mail and phone number and we coordinated weekly half days for 4 weeks. What were the two main things you learned from this LP? 1. How one approaches the various assessments. For example the physical exam, observing family interactions, interviewing parents, and debriefing with the team. Also always keeping an OPEN mind. 2. How a multidisciplinary approach is very important, particularly in this domain. I was able to observe the interaction between pediatricians, psychologists, nurses, and child life specialists (I had never met one before so this was VERY exciting!). What did you wish you knew to help you in your LP? We had not done our psychiatry unit yet and I think that would have helped when sitting in on interviews to understand the types of questions asked and the flow of the interview. Also being familiar with the different types of maltreatment (physical abuse, sexual abuse, emotional abuse, and neglect), the warning signs, and the major repercussions would have helped a lot. How has this experience helped you clinically, in class and/or in career decision making? This experience showed me how to go about addressing such a touchy subject in clinical practice, as I was able to see the different approaches taken by each of the staff. I think it also helped emphasize the importance of a humanistic approach to healthcare, which can sometimes be forgotten when you are pulling your hair out trying to understand the pathophysiology of the illness with which you are presented. I was also able to see how Children’s Aid Society referrals worked, meeting a few case workers throughout the observership. I found this helpful because we discussed it briefly in our Professional Competency class, but I think it is something you should be comfortable with for practice. Any other comments? I have always been fascinated with children and I love their brutal honesty and humor. One of the main reasons I wanted to do this LP was to see if I was able to handle the challenging, serious and sad side of pediatrics. The cases were definitely heartbreaking, but this group works hard to help children escape these incredibly vulnerable situations, and that to me was the most amazing thing to witness. First year student Matt had a really great experience observing a trauma team earlier this year. Keep reading to learn more about what Matt got out of this placement. What LP did you do? I was with a trauma service! How did you go about contacting and arranging the LP? At a MacMed Trauma Interest Group event, I met a 5th year emergency med resident doing their fellowship in trauma. I asked if I could follow them around to learn about trauma, and they said why not! So I emailed them to get their availability and shadowed them after that. What were the two main things you learned from this LP? 1. Trauma is awesome and really interesting (there’s a lot of neurology and musculoskeletal stuff involved in trauma) 2. The whole trauma team is really diverse and you can see the whole interdisciplinary team in action; the team consists of an emerg doc, a general surgeon, an orthopaedic surgeon, a neurologist, an anaesthesiologist, nurses, among others. What did you wish you knew to help you in your LP? Ideally, I would have finished learning about neurology and MSK before jumping into trauma. I had no background in anatomy so I didn’t have a strong understanding of all the broken bones or affected brain structures that patients presented with. Nevertheless, it definitely sparked my interest in learning about MSK and neurology in the future, as I found that when I finally started learning about the material, it was fascinating, since I saw it in real life already. How has this experience helped you clinically, in class and/or in career decision making? As I mentioned earlier, it definitely helped me connect the content I was learning in tutorial to real life situations I’ve encountered already with the trauma service. It made learning a lot more interesting and memorable. In terms of career, I think it solidified my interest in emergency medicine, trauma and surgery. I’m definitely hoping to end up on one of these paths in the future! Any other comments? Trauma is cool for sure -- but in Hamilton, it’s unlikely to see any of the crazy stuff that you see on TV (gunshot wounds and such). More often, there’s blunt force trauma, falls off high places, MVCs (motor vehicle collisions), stabbings, and other miscellaneous things. Overall, it’s fascinating to see how cool, calm and collected the trauma team is at handling emergent situations. I've had this Q&A in my files for just over a month...It's been a very busy June for all of us, hence the neglect of getting some of these posts up! But have a read about Mandeep's placement in an ER! What LP did you do? I did my placement in Emergency Medicine during the Winter break. How did you go about contacting and arranging the LP? I contacted the PA office and the office staff helped me arrange my ER placement. What were the two main things you learned from this LP? 1) I gained a better understanding of the continuum of care. It was interesting to observe the interaction between EMS officials and the ER team. Often, EMS officials would call into the ER for medical advice and directives before bringing the patient into the hospital. This would then allow the ER team to prepare for the incoming patient, or they would request the patient be taken to a different facility. 2) I learned the importance of good history taking. In most cases, the ER team does not have much medical information about the patient, and as such, they often have to consider a wide array of differential diagnosis. It was apparent that a good history can help narrow down the differentials. What did you wish you knew to help you in your LP? Many patients that came into the ER had some orthopedic-based injury so a primary understanding in orthopedics would have been beneficial. How has this experience helped you clinically, in class and/or in career decision making? During my placement I was able to conduct histories and physical examinations for lower acuity patients which helped reinforce my patient-communication skills. The physician assistant that I was observing was very approachable and provided numerous suggestions to help improve my history-taking skills. What LP did you do?
I did an EMS ride along with paramedics! How did you go about contacting and arranging the LP? I emailed Nancy Weller (the PA program Program Administrator) three dates when I was available for 12 hours straight. She contacted the EMS Staff Scheduler who agreed on one of the dates! What were the two main things you learned from this LP? I learnt the process of how it is determined which EMS attends to which call and prioritize the severity of the patient. I also learnt how much work is put in by paramedics before the patient even arrives to the ER. Often times, triage nurses expect the patient history, situation at the scene where patient was picked up from, health card information and other paperwork when the paramedics arrive. I realized how much work is actually put into before the patient arrives at the hospital. What did you wish you knew to help you in your LP? I wish I knew a little bit about the coding system used by paramedics. Different numbers signify different categories and the severity of the patient (emergency, urgent, non-urgent, etc.). When the paramedics started using the coding system, I was a little lost at first. However, they were both extremely helpful and patiently taught me things along the way. How has this experience helped you clinically, in class and/or in career decision making? If I ever want to change professions in future, I would definitely consider being a paramedic. I have a new found respect for EMS personnel and would value their presence when I work in ER and during my ER clerkship next year. Any other comments? I loved the experience. To those who are interested in learning more about what happens to a patient before they arrive to the hospital, definitely consider an EMS ride along! Some members of the class of 2014 were fortunate enough to have placements with midwives here in Hamilton. Shannen was the first to complete her placement and writes about her experience. What LP did you do? I did my LP at a Midwife Clinic in Hamilton. How did you go about contacting and arranging the LP? Our class had a Registered Midwife as a guest speaker during our obstetrics and gynecology module. I expressed interest in learning more about the profession and she was open to arranging LPs for a couple of the PA students with midwives in the community. What were the two main things you learned from this LP? I learned how to palpate a pregnant woman’s abdomen. I also learned how to use a doppler ultrasound. It was amazing having the hands on experience. The midwives were welcoming and great teachers. What did you wish could have been different? During my time at the Midwife Clinic I did not have the opportunity to see a newborn check-up. Mothers and their babies come in for post-partum visits at 2 weeks, 4 weeks and 6 weeks. It would have been beneficial to see what is done during these visits. How has this experience helped you clinically, in class and/or in career decision making? I have a better understanding about what is involved in prenatal care. For example, what a prenatal check-up consists of, documenting prenatal appointments, labs and tests ordered during pregnancy and when they are ordered. Also, I developed a better understanding of midwifery and will be able to educate future patients on their prenatal care options. Lots of our students take advantage of their breaks to do observerships with doctors from their hometowns. 1st year PA student, Kim took some time during our March break to shadow a general surgeon in Dunnville where she had some great hands-on learning that left her really excited about getting to practice as a PA as well as share her experience! What LP did you do? I did my LP in general surgery in Dunnville. How did you go about contacting and arranging the LP? I know the surgeon in my hometown and in the past, he offered to let me shadow him, so I called his office to get in touch with him. What were the two main things you learned from this LP? I learned a ton of things during my four half days with the doctor, but the two main things were how to suture and how to properly present patient histories. The doctor allowed me to suture various wounds and observed my technique in order to give me helpful tips along the way. He also had me see many of his patients in his office to take histories and then had me present them back to him before going to see the patients himself. He gave me helpful tips to think about when presenting which allowed me to get better and more comfortable with each presentation I did. He also taught me various questions that were important to ask patients and how the answers to those questions could help you in your differential. What did you wish you knew to help you in your LP? I wish I could have had more knowledge with dermatology topics since many of the patients I saw in one of the clinics had skin cancers or suspicious moles/lesions. More knowledge in this area could have helped me recognize exactly what different lesions were. How has this experience helped you clinically, in class and/or in career decision making? The doctor taught me a lot of things that I can use as clinical knowledge later on. He had many patient cases that reflected what we have already learned in tutorial and he was able to explain to me what is done for the patient in a true clinical setting, as well as what to look out for when making diagnoses. Any other comments? Overall, my experience was amazing. I was able to take various skills, such as recording and presenting patient histories and suturing, which we have learned in a simulated setting, and apply them to the real clinical setting. I also gained a ton more knowledge in a variety of topics to take with me for future placements and clerkship. Alifiya of the class of 2014 writes about her placement at the beginning of the school year in pediatrics. She shares a lot of really interesting insights with us! I must also apologize to Alifiya who sent me this a couple weeks ago and I am just sharing it now!!! Enjoy :) What LP did you do (i.e. family, peds, ER, EMS ride along, etc.)? I did an LP in Paediatrics, it consisted of two weeks in General Paediatrics and two weeks in a specialized Paediatric Oncology clinic. How did you go about contacting and arranging the LP? During orientation week, the academic director of our program mentioned that she practices as a paediatrician; since I’ve always had an interest in Paediatrics I emailed her immediately about looking to gain clinical experience in this field. She was glad that I took initiative so early in the program and so she agreed to take me on for an LP. What were the two main things you learned from this LP? This LP was a great learning opportunity for me. Before doing this LP I was under the impression that working in Paediatrics mainly required the desire to work with children. However, one of the first lessons I learned was that Paediatrics involved working more with overly anxious parents as opposed to children. My preceptor allowed me to take the patient’s history independently, through this experience I gained confidence in regards to patient interaction and also learned how to conduct specific birth and paediatric nutrition histories. What did you wish you knew to help you in your LP? What did you wish could have been different? I wish I had done this LP a bit later in the year. I feel that since I did it at the very beginning of the year I wasn’t as prepared as I should have been. Especially since my preceptor liked to ask a lot of questions I felt that I should have done a bit of more reading before going to the placements. How has this experience helped you clinically, in class and/or in career decision making? I was always interested in paediatrics and after this experience I am certain that I would like to pursue my interests further in both paediatrics and oncology through my clerkship electives. Any other comments? Overall, this LP was an eye opener for me since I now have a much better understanding of what the practice of Paediatrics entails. Also, through patient interaction at the Paediatric Oncology clinic I have developed immense respect for cancer patients and have emerged with a better understanding of not only the medical aspects of cancer treatment but also the social and personal impact it has on the patients and their families. As we are just about to hit the half-way mark of our 1st year of the McMaster University PA program, we continue to have great learning experiences with different observerships. Check out Kim's experience with Hamilton EMS... What LP did you do (i.e. family, peds, ER, EMS ride along, etc.)? I did my LP with Hamilton EMS. How did you go about contacting and arranging the LP? I set up a meeting with Nancy Weller in the PA office and gave her three dates that I was available for the ride-out. She then contacted the Hamilton EMS and they chose a date that worked for them. What were the two main things you learned from this LP? First of all, I learned just how important our first responders are in terms of assessing the situation and then treating the patient(s) on-scene. Secondly, I learned just how hard it can be for first responders to obtain the information that many healthcare professionals in the hospital setting expect to receive when they arrive with the patient. Often times, the circumstances do not allow first responders to obtain adequate information about the patient’s state and therefore, other healthcare professionals need to be sensitive to this. What did you wish you knew to help you in your LP? OR What did you wish could have been different? Since first responders attend to such a large variety of situations you cannot expect to understand the various treatments and procedures that they conduct on patients. Therefore, you can either take this LP as an awesome learning opportunity, or you can wait a little longer to do the ride-out so that you have a bit more medical knowledge under your belt. But either way, you are really just an observer in this LP. Personally, I would not have changed anything about this LP because the experience alone was amazing. How has this experience helped you clinically, in class and/or in career decision making? This experience has helped me to understand exactly what first responders are faced with in their careers. This awareness I’m sure will serve its purpose in the future when I begin working alongside them in a healthcare setting. I also learned small tidbits of information that I have been able to apply to what we have been learning in tutorial, which has contributed to my understanding of certain topics. Any other comments? My EMS ride-out was a truly fun-packed, amazing experience that I think is important for all healthcare students to experience, even if only to gain a better understanding of what other healthcare professionals do to serve their patients. |
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