LP - ICU at Juravinski Hospital with Sara Nolte

What LP did you do?
Juravinski Hospital Intensive Care Unit

How did you go about contacting and arranging the LP?
My preceptor is a tutor for the Med students; I was recommended to shadow this person by some Med students, and obtained his contact information from them. I reached out via email, explained that I was a first year Physician Assistant Student from McMaster looking to do an LP, and indicated the general time line I was looking to shadow him. He replied back with his availability, and we went from there!

What were the two main things you learned from the LP?
1.     How the ICU functions both as its own department, and with the rest of the hospital. I had the opportunity to follow the ICU routine from handover to rounds (note taking and orders) to procedures to family meetings. I was also able to attend a new patient consult, and learn how (and why) the ICU becomes involved in inpatient care.

2.     The details around ventilation and the “go-to” ICU antibiotics. I hadn’t really spent much time thinking or learning about this on my own, and since both of these things were a big part of each patient’s care, it was a great opportunity to learn more about them!

What did you wish you knew beforehand to help you in your LP?
All the short forms and “nicknames” the staff had for diseases, procedures, and medications! On the first day, I found it hard to follow along with the fast-paced rounds with all the jargon flying around. However, all team members were open to chatting about things afterwards, and I found looking stuff up on my own before I came in the next time to be helpful.

Sara Nolte (left) at Hamilton General Hospital on National Physician Assistant Day, November 27, 2014.

How has this experience helped you clinically, in class and/or in career decision-making?
The first thing that struck me was how each bed seemed to be a different MF1 case. It was very interesting and helpful to see these cases in real-life. 

This placement also demonstrated the importance of trying a wide variety of different LPs before settling on an area of medicine. While you might have something particular in mind, trying it (and other fields) out will provide invaluable insight for future career and elective decisions! 

Share your most memorable experience from the LP! 
I was able to sit in on several family meetings (family members of an incapacitated patient and the medical staff gather to discuss care options). The differences in level of understanding and socioeconomic status between families were striking. It really emphasized the importance of being a good communicator, by being able to adjust your explanations according to the audience. Presenting a caring, yet informative, persona was imperative for every patient/family encounter. While communication skills might not be everyone’s favourite class, it really is one of the most important – what good is knowing all the pathophys or clinical guidelines if you can’t communicate it to those who need to know? Time in the ICU really highlighted the importance of this skill, as your ability to communicate will dictate the care your patients actually receive. 

Any other comments?
If you do any sort of ICU, or other ward, placement, I would recommend staying for the whole day, or coming in at different times if you can only commit a half day at a time. Things operate very differently in the morning compared to the afternoon. And sometimes things come up (e.g. new consult) that requiring deviating from the original plan. 

Also, come up with some learning objectives before you do any placement, and share these with your preceptor. These will help focus your learning in an overwhelming environment, where the learning opportunities are everywhere!