Emergency Medicine/Surgery Block

Books used during this block: First Aid for the Emergency Medicine Clerkship, Pestsana’s Surgery Notes, Online Med Ed Videos

Emergency Medicine

Words cant describe how excited and nervous I was to begin my Emergency Medicine rotation! This rotation had been much looked forward to since clinicals began. My rotation was at a University Medical Center that had many different students at various medical and PA schools rotating through.

The ER schedule is shift work, and this system had providers working ten hour shifts at four days per week to reach a ~40 hour week. PA’s and NP’s were able to work in a “low acuity” environment as well as the “high acuity” environment alongside the physicians.

Throughout the month, I was able to perform multiple pelvic exams, suturing of various body parts, some minor splinting and I&D’s of abscesses.

By the end of this rotation, I felt like I truly learned the most of all of my rotations thus far. The ER is a very different approach to clinical medicine due to its fast paced nature, but it really keeps you on your toes of critical thinking. The ER is definitely a front runner of specialties I’m interested in practicing after graduation.

General Surgery

General Surgery for me can be summed up as long hours and little food intake LOL. I never thought I would be very interested in the surgical field before PA school, and although it was an interesting experience, the lifestyle of working in a general surgical specialty is truly not for me.

Days began at ~5:30am to round on patients with the attendings, fellows, residents, and medical students. Surgical cases started around 8am and could last until 9pm or so with an average end time around 5-6pm. 12 hour days for 5 days a week wore on me pretty quickly but every once in a while we would have an open case (instead of laparoscopic) or something out of the ordinary that would catch my attention.

Because it was an academic institution, I only first assisted 2-3 times. There is definitely a hierarchy when there is training of fellows and residents in these hospitals. Even though this was the case, I always helped “close” the patients with sutures.

Surgical cases I assisted and observed in were laparoscopic cholecystectomies, laparoscopic hernia repairs (hiatal, umbilical), laparoscopic gastric sleeve or bypass, and laparoscopic appendectomies.

Orthopedic Surgery

My school allows for us to rank surgical specialties to see for another four week rotation. I ended up ranking plastics as my number one, and orthopedics as my number two and ended up with orthopedic surgery. Ortho has been a subject I’ve struggled with in didactic year. It truly is pure memorization of bones, nerves, vessels and understanding of what muscle groups do. So I came in with some mild hesitancy.

This private practice I rotated with had ~3 clinic only days and ~2 surgery days. I preferred clinic days to surgery days but I think I just don’t love surgery. As my time at the office went by and I became more comfortable, I realized how simple ortho can really be. I’m glad that I ended up with that rotation because I believe it’s important to one be well rounded, and two have confidence in my ortho physical exam, differentials and treatment.

Throughout this rotation clinically, I was able to administer steroid injections in the shoulders and knees. I was also able to drain a knee with excess fluid (more likely to be seen in an ER setting). In surgery, I assisted and observed rotator cuff repairs, meniscus repairs, ACL repairs, humoral fracture repairs, total knee and total hip replacements, and some hand surgeries like carpal tunnel release and trigger finger release.

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