About a month ago I finished what I thought was the greatest rotation I could possibly have had. It was my hospital rotation in which I worked with four of the best preceptors a guy could ever ask for. I worked in a medical/surgical unit with an ICU on the side. The service was responsible for 6-10 patients on any given day, though we averaged closer to 6 - so it was a small service. But the size of the service was PERFECT. I had plenty of time to interact with my preceptors while not keeping them from their work and I got to help in the care of some very sick people. It was incredible.
In the first week, my lead preceptor discussed her expectations with me. I was a bit unnerved when she said that she expected me to be able to operate at the level of a 4th year medical student or medical intern (the intern year is the year after graduation from medical school - so she expected I would perform on par with a new graduate MD). Another of my preceptors said the same thing, so it was confirmed that I would need to step up to the plate on this one.
The thought that I would be able to operate at the level of a 4th year med student or intern was, in my opinion, setting the bar a bit high. I didn't exactly understand what that entailed, nor did I expect that I would completely meet that standard. As it turned out, though, I enjoyed the rotation and was able to step up in a way that worked out well. I actually wanted to get to the hospital early to pre-round on the patients so that when we did actual hospital rounds I was ready to go. I rounded by myself, got the labs/imaging compiled from the night before and presented my patients on morning rounds to my preceptor. I got "pimped" plenty and learned volumes about that management of really sick patients. I could have spent the remainder of my clinical year at that site and been plenty happy.
As it turned out, it was recommended to me by two of my preceptors that I go to medical school - one noted that I think more like a doctor than PAs he's worked with in the past. In all, it was a really gratifying experience. A very high bar was set and I was able to step up and get the job done, even though I didn't think I'd make it at first. But I'm curious about something... Do PAs and NPs think in a different way than doctor's do? My take on this is that NPs might think a little bit differently given their basis in the nursing model, but in the end they gather information the same way toward the same end - they have to make the diagnosis and treat the same as anyone. PAs are trained in the medical model so I would definitely expect that all PAs would think the same way as doctors. In the end, "mid-level" providers need to think the same way MDs/DOs do - we all have to come up with the same conclusion which means gathering the same type of information and applying the same type of decision making tree to the clinical problem so that the patients don't suffer. Thus I was really surprised at my preceptor's comment that I think more like a doctor than a PA - I thought we were all supposed to be on the same page. So, to everyone who comes along after me please take this to heart: be diligent about your information gathering and apply sound clinical decision making in order to 1. better represent our profession and 2. ensure that your patients are getting solid medical care.
In the end, the biggest thing that this rotation showed me is just how far I've come. A year ago, I was busting my tail to get through my last set of finals, struggling to maintain motivation in order to better regurgitate simple information onto a page. After just a year I have come a long way. Thinking back, if I had thought a year ago that I would be expected to be doing the job of a 4th year medical student I would have laughed at the idea. But I made it... Now on to family practice.
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