Starting my second rotation with emergency medicine allowed me to gain a lot of knowledge in managing critical patients, high volume of patients, and creating differentials and plans to decide the course of the patients’ stay. Throughout this rotation, I gained the ability to manage a diverse population of patients with multiple presenting complaints, performed focused physical exams, and practiced several procedures. 

Something new that I was exposed to during this rotation was how to manage higher acuity patients. During my previous rotation in ambulatory care, patients with more severe complaints were referred to the emergency room. Now that I was in the emergency department, I was able to see how these patients were fully assessed, stabilized, and worked up. I learned how to obtain focused, yet thorough histories from patients, allowing this to establish what labs, imaging, and medications to order. Through these experiences, I learned the importance of recognizing red flag symptoms, monitoring vital signs closely, and escalating care when a patient’s condition worsens. Additionally, I was exposed to several cardiac arrest cases, where I was able to firsthand experience a code. These patient cases allowed me to observe the team dynamic in managing an acute patient. It also reinforced the importance of rapid evaluation, early imaging, and developing a high index of suspicion for potentially life-threatening conditions. I learned a lot from these experiences, especially in understanding my role as a future PA in helping the physicians, nurses, and other team members in treating an acute patient. 

This rotation also helped me improve my ability to develop more comprehensive differentials and treatment plans. In the emergency department, patients often present with vague or overlapping symptoms, requiring the need to consider multiple diagnoses. Initially, I found it challenging to develop a broad, yet appropriate list of differentials. However, with guidance from my preceptors, I learned how to organize my thoughts more effectively, prioritizing the most likely and dangerous differentials. Furthermore, I had the opportunity to present several cases to my preceptors. Doing this several times a day for each shift helped strengthen my ability to present relevant patient information and also assess what my plan for the patient would be. As the rotation progressed, I became more confident in presenting patients, proposing appropriate testing, and suggesting treatment plans. I also received valuable feedback from my preceptors that helped refine my clinical reasoning and decision making skills. One area I worked to improve was creating management plans for each patient. I had difficulty choosing what I wanted to give to manage each patient’s pain and my reasoning in doing so. Over time, I learned what medications would be most appropriate based on the patient’s clinical presentation. 

Another important aspect of this rotation was gaining more exposure to procedures. I had the opportunity to interpret EKGs, chest x-rays, and CT scans, place IVs, do pelvic and rectal exams, perform laceration repairs, and even assist in CPR. Practicing these hands-on skills helped me to build my confidence and improve my ability to perform these procedures in upcoming rotations. It also taught me how to work efficiently in a fast paced environment. 

Overall, this rotation was a very rewarding experience that significantly strengthened my clinical skills and confidence. Emergency medicine being my second rotation was very intimidating at first, given its fast paced and unpredictable nature. However, it allowed me to think critically and work efficiently as part of a healthcare team. I gained exposure to managing both low and high acuity patients and developing differentials, treatment plans, and also practicing procedural skills. I believe this rotation has helped prepare me well for my upcoming rotations.