The ambulatory care rotation was a valuable experience for me. With my previous rotation being in the emergency department, I was familiar with the more serious disease processes that patients can present with. The challenge of ambulatory care was feeling comfortable diagnosing the more common, benign processes that patients present with. ENT is something I have struggled with in didactic year, as so many symptoms and signs are similar in various diseases. Ambulatory care allowed me to see many different ENT presentations and differentiate between them as well as decide what treatment is best.

Another aspect that has challenged me is the use of physical exams as sole diagnostic tools. There are no CT scans, Ultrasounds, or bloodwork that can be done in an urgent care. Diagnosis relies solely on physical exam, a urinalysis, and rapid tests that are not accurate. Not having a lab that could turn around CBC and BMP results within a couple hours or a CT scan that can narrow down abdominal pathology makes the use of physical exams incredibly important. In many cases, an extensive physical exam and history allowed me and the provider to rule out dangerous conditions and pinpoint the most probable diagnosis. My physical exam skills have definitely improved thanks to the circumstances that naturally come with working at an urgent care.

Something that I was excited about rotating at an urgent care was getting to practice more procedures. I already felt comfortable with suturing lacerations, but I was glad to have gotten the opportunity to practice more. In this rotation I got to suture a 5 cm laceration on the forehead which allowed me more practice with finer sutures and a much smaller needle, both being more difficult to manipulate and use. Another procedure I was excited about was an incision and drainage. This was the first time I got to do this procedure and I now feel more comfortable with it. I also got to do many EKG’s, throat cultures, nasal swabs, venipunctures, and injections. Overall, this rotation was great for practice with procedures.

As a student, I have the freedom to take more time to evaluate patients than a hired provider would. Even though that’s something I take advantage of in order to practice my skills, I tried to make my encounters with patients concise. While still doing everything necessary to properly evaluate the patient, I tried to match my time spent with patients to that of the providers. This allowed me to get a better feel of what its like to handle such a large patient volume while still ensuring every patients wellness. It has been a challenge as I am still learning which questions are most appropriate and which exams yield the most accurate diagnoses, but I am slowly adjusting to stepping up my pace.

Rotating at an urgent care has taught me how to manage time wisely, deal with an extremely large patient volume, and diagnose patients without the use of most diagnostic modalities. It has been a challenge and a great experience. The pace of the urgent care kept me on my toes, running from patient to patient, but it also had me thinking quickly and relying on my physical exam skills. My goal for future rotations is to apply the timeliness and reliance on physical exams that I have learned in this rotation to other specialties, as these skills can be useful in all specialties and rotations.