This emergency medicine rotation was my first one in clinical year. This rotation was especially meaningful to me as I am very interested in working in emergency medicine as a physician assistant in the future. This being my very first rotation, I was equally excited and anxious. I faced many challenges but also learned a lot and gained skills that I will carry with me into rotations moving forward.

The greatest challenge I faced was properly presenting to an attending physician. With barely any experience in this, I was expected to present on the same level as second- and third-year medical residents. This was very intimidating and underlined just how deficient I was in this aspect. As terrible as I felt about my lack of skills, I was determined to learn, improve, and gain as much knowledge from my preceptors as possible. A few attendings acknowledged that I needed much help and explained all parts of the presentation, what is important to include, and in what order each part should be presented. Some days I felt I was improving but ended up being drastically criticized. Other days I felt I was missing some information but was told that everything pertinent was included and there was no need for extraneous detail. I practiced presenting as many patients as an attending was willing to listen to, and I noticed my skills improving drastically by the end of the rotation. I feel confident that I can present adequately going forward and will continue to ask for feedback and help in each rotation until I can master this skill.

I had the opportunity to perform many procedures in the emergency department. I made it a point from day one to be persistent and on the lookout for procedures that staff would allow me to perform. Whenever I would see a nurse preparing supplies to start an IV, I would approach them about letting me do it and would ask if they could watch to give me any feedback or help with a tougher IV start. After many botched tries and many successful ones, I feel more confident about this skill now and intend to keep practicing. I also got the opportunity to place multiple foley catheters, obtain a few ABG samples, perform CPR and bag-valve-mask ventilation, and place a nasogastric tube. The procedure I was most excited to practice was suturing and I got the chance to perform it multiple times, along with instilling local anesthesia. I feel confident in simple suturing as well as stapling and would love to gain experience in placing more complicated sutures in the future. That will be something I will actively pursue in future rotations, specifically in surgery and ambulatory care rotations.

I genuinely feel that the knowledge I gained rotating in the emergency department will be applicable to all rotations going forward. The ED is fast paced, with patients of all ages, presenting with a plethora of different complaints. The ability to think quickly, bounce between patients, and keep your thoughts organized is a necessary skill in the ED. Prioritizing tasks is a major component of that organization. Critical patients require immediate attention and management, but patients that have been waiting on a diagnosis or treatment for several hours also require consistent attention and thorough follow-up on labs and results. Efficiently balancing time between tasks allows for better outcomes for all patients and I got a glimpse into how providers manage multiple patients. This is a skill that takes time to develop but I feel that I can start implementing it into my rotations.

A part of my experience in the ED as a student was the non-medical part of medicine. Being a student with more time on my hands than attending physicians, I was able to speak to patients in more detail and learn about them outside of their presenting complaints. With the hospitals being packed due to so many patients admitted for COVID-19, there were many patients that were admitted to the hospital but waiting for a bed for two or three days. I would see these patients day after day and get to know them. We got to discuss their concerns, fears, and what they were looking forward to after getting discharged. Many patients were scared and lonely as no visitors were allowed in the ED. I tried my best to comfort them, bring them food and blankets, and listen to their concerns. This was a unique and rewarding experience as ED providers do not usually get to spend that much time with a particular patient. I feel that its easy to keep moving on from patient to patient, but taking the time to check in can make a difference in a patients experience.

I really enjoyed my experience in the emergency department. Coming from a background of EMS, I always believed I thrive in chaos and the unexpected. I loved suddenly hearing the notification phone ringing and rushing to the trauma room. While I did not get to perform any major procedures such as central lines or intubations, I got to observe many advanced procedures and got a good understanding of technique and concepts behind them. I also loved how on any given day patients would present with something peculiar that stumped even the most experienced of attending physicians. I loved the environment of the ED and how it took so many different people working together to provide care to patients. Providers, residents, nurses, social workers, technicians, and students were all involved in different ways, ensuring patients were properly taken care of. I also benefited from the fact that my rotation took place at a teaching hospital. Everyone I asked to allow me to perform a procedure was open to it and provided any help I needed, from detailed instructions with my first try to an approving nod when performed correctly.

Going forward, I have many aspects to improve on. Firstly, I will keep practicing presenting patients and organizing my thoughts into an appropriate assessment and plan. Listening for feedback on strengths, and more importantly, weaknesses is key to my growth and improvement. Taking criticism and applying it has allowed me to learn a lot in this rotation, and I will keep doing so in future rotations. I intend to keep being persistent and confident in performing procedures to gain as much experience as possible. I aim to keep practicing procedures I have experience with as well as try out new ones. My goal for the next rotation is to keep asking for feedback in order to improve my current skills as well as increase the amount of research I do into disease processes, diagnostic modalities, and treatments that I am less familiar with in order to improve my assessment and plan.