My final rotation of clinical year was Internal Medicine. This rotation was a great one to finish with because I was able to put together all the skills and knowledge I had learned over the course of the year to treat a wide variety of patients with multiple comorbidities. This rotation was also valuable because the site I was at had a medicine department run by PAs. I was able to see how efficient and excellent a PA run team can be. I could see the value they offered the hospital, and the satisfaction they gave to the patients. 

I saw and treated patients with CHF exacerbations, COPD exacerbations, pneumonia, pulmonary embolism, strokes, seizures, failure to thrive, polymyositis, diabetes, STEMI and NSTEMI, acute renal failure, nephrolithiasis, epiglottitis, aortic dissection, alcohol withdrawal, and abscesses. I got to utilize procedures I had done in the past such as venipuncture and nasogastric tube insertion. I got to practice arterial blood gases. 

One of the most valuable weeks on this rotation for me was when I worked with the stroke PA. I became NIH scale certified and utilized that new skill each time there was a possible stroke that came to the ED. I learned how internal medicine and emergency medicine teams work together to identify and treat stroke patients as quickly as possible to minimize loss of brain tissue. I was able to watch a patient undergo a thrombectomy, and examine them the next day with improvement of neurological status. 

On this rotation I also honed on my skills of chart review, where I was able to learn what was important to focus on especially when a patient has been admitted inpatient for many days. I learned how to utilize holding parameters for blood pressure, how often to order certain labs for patients (such as a patient on heparin, how often to order a PTT to check if it is therapeutic), I learned how to write a discharge summary for a patient. 

Overall this rotation was an extremely valuable learning experience, and it gave me confidence in my abilities and knowledge that I am going to be a competent PA who strives for continued excellence and learning. 

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