Sarah Floyd (first year PA student, class of 2020) shares her experience at the Southlake Hospital within the pediatric outpatient clinic for one of her longitudinal placement.
What LP did you do? The LP I completed was at Southlake Hospital with the Pediatric Team (Newmarket, On). How did you go about contacting and arranging the LP? Sandy is one of the many working PA’s who acts as an advisor to PA students at McMaster. One of my classmates has Sandy as her advisor and gave me her email, I contacted her and picked two Fridays that worked for both of us. Full day placements worked better for this LP because of the travel time from Hamilton to Toronto. What did you learn from the LP? The hospital and outpatient clinic pediatric LP I completed was very helpful in informing me on how to assess and treat babies, youth, and adolescence. I learned how to perform a full newborn exam to ensure a baby is healthy upon discharge from the hospital – I listened to fetal heart rates, checked reflexes, and much more. I learned how to be comfortable holding a baby and how to speak with parents who have had very easy or somewhat complicated pregnancies. What did you wish you had known before hand to help in your LP? I wish I had known more about pregnancy, labour and delivery, and typical newborn laboratory measurements (ie. bilirubin for hemolysis). It would have also been helpful to review differentials on pediatric fever. How has this experience helped you clinically, in class and/or in career decision making? The LP has helped me with my clinical application of the concepts and medical conditions in the reproductive unit for both Medical Foundations and Clinical Skills. I am more comfortable communicating and performing clinical skills with children as well as communicating with parents. I observed the pediatric team delivery quality and compassionate healthcare and it was inspiring. Sam Parmelee (first year PA student, Class of 2019) shares her experience at the Princess Margaret Cancer Center within the Gynecology-Oncology Clinic for one of her longitudinal placements.
What LP did you do? I did an LP with Sandy Vuong, a Physician Assistant who works in the gynecology-oncology clinic at Princess Margaret Cancer Centre in Toronto. How did you go about contacting and arranging the LP? Sandy is one of the many working PA’s who acts as an advisor to PA students at McMaster. One of my classmates has Sandy as her advisor and gave me her email, I contacted her and picked two Fridays that worked for both of us. Full day placements worked better for this LP because of the travel time from Hamilton to Toronto. What did you learn from the LP? I learned so many things on this LP! At the time of the LP, we had not started our reproduction or oncology units in tutorial so I was really going in with not much knowledge. I learned a lot about gynecological cancers – how and when you would get referred to the gyne-onc clinic, common presenting symptoms, investigations performed and treatment options, as well as guidelines for screening for cancers. I also got to see and assist in physical exams and pelvic exams. I gained knowledge about what types of history questions are relevant to ask in this setting, as well as how to deliver information and treatment options to patients who are going through an emotional diagnosis. What do you wish you had known before hand to help in your LP? I wish I had known how (and was comfortable with) performing pelvic exams beforehand so I could have used this LP as an opportunity to practice, instead of a first exposure to it. General information about cancer screening guidelines would’ve been helpful to know. Sandy suggested I read the gynecology-oncology section of Toronto Notes beforehand which was helpful to understand the different types of cancer I would be seeing. How has this experience helped you clinically, in class and/or in career decision-making? I now have some knowledge and clinical skills around topics we have not yet covered in class, which is always helpful when we start new units. In terms of career decisions– this was a great opportunity to see a PA work in a specialty that has a narrow scope in comparison to a family practice PA (which I have shadowed in as well). It has made me contemplate if I myself would prefer to have a broad or narrow scope of practice and patient cases– I still am unsure because I like aspects of both! I chose this placement because of my interest in gynecology and women’s health and it confirmed that it is something I really do enjoy. I found the oncology aspect very interesting as well and am looking forward to this unit in MF3. Paige Lockshaw-McClintock (first year PA student, Class of 2019) goes through her experience working in a family medicine clinic during her longitudinal placement.
What LP did you do? The first LP I chose to do spanned over two full days at Profetto Savatteri Family Medicine in Stoney Creek with a practicing Physician Assistant. How did you go about contacting and arranging the LP? Deanna, the Physician Assistant I shadowed, is my tutorial preceptor for Medical Foundations 1. I figured a family medicine practice would be a nice way to ease into placement because you get to see a variety of patients, all seeking treatment for something different so I sent Deanna an email with a list of dates I was available and we ended up scheduling a full day for me to come the next week. What were two main things you learned from the LP? After getting comfortable watching and understanding how to take a snapshot of what brought the patient into the practice that day, I was able to do patient histories and exams on my own before consulting with Deanna about possible causes and treatments. Through this, I learned that patients love to talk, especially to students who are eager to learn so by going in confident in your abilities and just listening to your patient, they will tell you (mostly) everything you need to know, making your job fun and seemingly easygoing! This also helped me with my history and exam skills. We did quite a few well-baby visits so it was really interesting to do exam on the baby and take a history from the parent. We practice both of these on classmates or other adults for the most part so it was cool to learn how to do an exam on a much smaller person and observe the differences between adults and babies/children. What do you wish you had known before hand to help in your LP? I wish I had a better understanding of child development, including the milestones they should be meeting. Although everything you needed to know was in a check list or charts on the computer in front of you, I think it would have been more of a conversation rather than scripted with the parents if I had background knowledge and I would have been able to answer more of their questions. How has this experience helped you clinically, in class and/or in career decision-making? I absolutely loved the diversity of patients and patient problems that came through the door each day and the connection you made in getting to know each patient. I think this experience helped me to think more clinically in tutorials by drawing from different patient encounters as well as learning as well as taught be tips and tricks for different patient encounters. Katrina Pullia (first year PA student, Class of 2018) goes through her experience working in an addictions psychiatry unit during her longitudinal placement. What LP did you do? I completed four half-days with Dr. Jennifer Brasch at St. Joseph’s West 5th campus in Addictions Psychiatry which included the inpatient concurrent disorders ward as well as a half day at the methadone clinic. How did you go about contacting and arranging the LP? I met Dr. Brasch at a meet and greet event I attended which was hosted by the Federation of Medical Women of Canada. I contacted her after the event about arranging a placement due to my interest and previous experience in psychiatry. What were the two main things you learned from the LP? I learned a lot about concurrent disorders and co-morbidity in psychiatry and how the presence of multiple disorders changes your treatment approach. I also learned about the dynamics of inpatient psychiatry as a patient and clinician which differs significantly from outpatient psychiatry. What do you wish you had known beforehand to help you in your LP? I wish I had more knowledge about psychotropic medication, specifically anti-psychotics and their effects as well as how to modify treatment for concurrent and co-morbid disorders. How has this experience helped you clinically, in class and/or in career decision-making? It really helped me remove pre-existing stereotypes I had about patients in addictions psychiatry. The half-day at the methadone clinic was very eye-opening about biases I didn't realize I'd be carrying and helped to dispel myths about what I thought I was going to encounter versus the patients I was seeing in front of me. It also helped solidify how much I enjoy working in psychiatry and the complex cases that come with it. 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. Janine Maloney (first year PA student) goes through her experience working in an urgent care clinic during her longitudinal placement. What LP did you do? I did an LP at an Urgent Care Clinic in my hometown. How did you go about contacting and arranging the LP? I contacted my uncle, who works as a physician, to see if he could recommend anywhere to do an LP. He got me in touch with the clinic and we went from there! What were the two main things you learned from the LP? 1. I learned what tools are used to diagnose urinary tract infections. One day, it seemed as though every second patient was presenting with urinary symptoms - I had some good practice reading urine dipsticks and analyzing the different components of urine. 2. I learned different ways of calming crying, sick children long enough to have a look in their ears with an otoscope. Some were okay just sitting on their parent’s lap, while others were more content with the idea of holding a tongue depressor with a smiley face drawn on it. This taught me that as a PA, not only will I need to be knowledgeable, but creative as well! What do you wish you had known beforehand to help you in your LP? I wish I had been more familiar with the names of some common medications. It was a bit daunting when a patient would pull out their list of medications, and I had to try to determine which ones were relevant when I hardly recognized any of them. I have since realized that this is something that is going to take time, and the more clinical experience I get, the more comfortable I am beginning to feel. How has this experience helped you clinically, in class and/or in career decision-making? I find I continue to draw on this experience as new patient cases come up in class. Because the patients I saw at this placement were so diverse, many of the problems I encountered were ones I had not yet learned about in class. Now, when similar cases come up in class, I find I am better able to understand them after having some exposure to them at my LP. Share your most memorable experience from the LP! On the second day of my LP, a patient came in with a large laceration that required suturing. Having never sutured before, my preceptor and I agreed that it would be best if I administered the local anesthetic to the wound, and then watched as he did the suturing. About ¼ of the way through the job (with the patient’s consent, of course!), he handed me the needle and forceps and talked me through the remaining sutures. I was definitely nervous at the start, but as the wound came to a close I felt like I was actually getting the hang of it! Having that experience has given me more confidence in new situations, and made me even more excited for clerkship. Sarah Hoffer (first year PA student) goes through her experience working in the Radiation Oncology department during her longitudinal placement. What LP did you do? I was in Radiation Oncology with Dr. Wright at the Juravinski Cancer Center. Specifically, I attended follow-up clinics with head and neck cancer patients who had completed radiation and/or chemotherapy treatments. How did you go about contacting and arranging the LP? I knew that I wanted to do an LP in radiation oncology because in my Masters program I studied DNA repair, and I felt that it would be a good place to see the clinical side of this (radiation therapy works by breaking cancer cells’ DNA to kill and stop them from growing). I used the McMaster directory to find Dr. Wright’s contact information and he kindly let me join his team for four half days! What were the two main things you learned from this LP? At this LP I had the opportunity to observe laryngoscopies. This allowed me to look at patient’s vocal cords through an endoscope, which was very exciting and fascinating! A very important thing I learned was that treating illness isn’t just giving a patient therapy – it's also monitoring the patient to prevent recurrence, and helping them manage complications of their treatment. For this LP, I attended clinics with follow-ups for head and neck cancer patients who had completed their radiation and chemotherapy. Common complications of radiation therapy that I saw amongst patients were a loss of saliva (and consequent dry mouth, tooth decay, and difficulty swallowing), tinnitus (ringing in one’s ears), and a loss of sensation of taste. These problems can persist for years and in some cases indefinitely. In addition to providing radiation therapy to cancer patients, practitioners must help them cope with the side effects of radiation and monitor patients’ improvement over time. What did you wish you knew to help you in your LP? Unfortunately, we had not covered oncology in class before I did this LP. However, I felt comfortable doing it with my background knowledge about biochemistry and cancer from my undergrad and Masters degrees. I also wish I had known more about interpreting CT imaging prior to this LP. How has this experience helped you clinically, in class and/or in career decision making? As mentioned above, this LP gave me the opportunity to talk to many patients whose lifestyles had been affected by their illnesses, long after they had been treated. Some patients no longer enjoyed their favourite foods and others’ voices had changed permanently. It really gave me an appreciation of the factors that patients must overcome after treatment as well as the importance of following up with patients once treatment is complete. Until I did this LP, I would break up my notes for each illness into a subheading for “Pathophysiology”, “Causes”, “Risk factors”, “Investigations”, and “Treatment”. Now I’ve added a very important subheading: “Follow-up”. I would definitely consider a career in Oncology and think that PA’s could be very helpful with oncology follow-up clinics. If a PA is working in a follow-up clinic, the physician could have more time to make radiation plans for new patients and to see more patients in the day. Hannah Peace (first year PA student) goes over her time doing a longitudinal placement in Obstetrics and Gynecology (OB/GYN). What LP did you do? I participated in four days with an OB/GYN in the McMaster area and one day in Labour and Delivery with this same doctor at McMaster. How did you go about contacting and arranging the LP? It was recommended to me both by my advisor and our academic coordinator to contact the person who organizes these placements for our program to help me connect with local OB/GYNs. She reached out of my behalf to find an interested physician. What were the two main things you learned from the LP? Something that is simply bewildering that I wasn’t aware of before this placement is the fact that you can press into a pregnant woman’s “tummy” and physically feel where the head, back, feet and hands of a baby are once it becomes large enough. By showing me over and over again the process of locating a fetus, the physician helped me begin to develop a skill set in “baby finding” and subsequently, how to perform an ultrasound to listen to the heart! After a few sessions with this physician, we built a relationship of trust and amicability! As he began to become more familiar with myself and my skill set, he let me help and eventually perform pelvic exams. This is something that can only be perfected by practicing, so having someone look out for me, my technique, and the comfort of the patient while I performed exams was unbelievably valuable. What did you wish you knew beforehand to help you in your LP? I wish I had saved this LP for after we had finished (or even started) the reproduction unit in class. I could have started from a more advanced position if I had waited until the summer to undertake this LP. How has this experience helped you clinically, in class and/or in career decision making? The very young, the very old, and pregnant women are three populations that have unique requirements when dealing with them clinically. I think it’s very important to spend some time with each population because, no matter where you work, you will be dealing with all three! Appreciating diversity is essential to success as PA. |
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May 2019
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