A Guide to Surviving Your First Rotation in Physician Assistant School
You are halfway through your schooling and have spent all of your first year studying, cramming, coming up with creative ways to keep a million drugs straight for that pharmacology quiz, and passed what feels like a million lab practicals! You’re prepared, right? You are, but you may not feel that way. Here are my tips for surviving your first rotation in PA school.
First Things First, Calming Your Nerves
On the night before your first rotation, you may have a very strong urge to spend the whole evening before cramming in last minute facts about every disease you have ever missed a test question on and then stay up all night rehearsing how you will introduce yourself to a patient. It is important to remember that most preceptors have had a ton of PA students before you and they understand that you are nervous! If they haven’t had a PA student before you, then they are just as nervous as you are!
Perhaps a better way of preparing for your first day is in reading your school's rotation manual and familiarizing yourself with what is expected of you for that rotation. It is important to keep in mind how many patients you are expected to track, what assignments you are responsible for, and due dates for rotation documents.
It is alright to be nervous your first day of rotation. I would bet that most PA students are, but a good night’s sleep the night before and a healthy breakfast that morning will be far more helpful than too much cramming requiring 8 cups of coffee to make it through the day!
What is a Preceptor Expecting of Me?
This differs from rotation to rotation. The majority of preceptors are expecting you to be punctual, friendly and focused on learning. Many students enter rotations thinking that the preceptor expects them to always have the right answer. Instead, they expect you to try your best at answering the questions that they ask of you and to show improvement as the rotation progresses.
Additionally, the amount of responsibility expected of a student varies from rotation to rotation. It is important to be independent and try to challenge yourself. Do the best you can and don’t be afraid to ask for help!
Your First Day
It is best to familiarize yourself well with your surroundings on the first day. Get to know how the office is run, where things are kept, and where paperwork goes. Ask what hours you are expected to work and whether you will be responsible for weekends or call. Inquire about the dress code early on. If you question your outfit choice, don’t wear it! You are questioning it for a reason. Also, you should ask about the policy on jewelry, nail polish, perfume, etc.
Contrary to popular belief, even PA students get genuinely sick sometimes! On your first day you should ask about how best to notify the office should you become ill. It is also important to have a strong understanding of your school’s policy on sick days.
Each office may have a unique way of charting, whether it be EMR or paper charts. While you were taught how to write SOAP notes and document H&P’s, each office is unique and may require minor adjustments to your documenting style.
In my experience, most preceptors start students out shadowing the first few days of a rotation. This may not be true in all instances though. Being asked to see a patient alone on your first day is not the end of the world! Use your H&P skills and get as much information as you can. Even if you don’t know 100% how to handle the chief complaint offer the preceptor your thoughts. This opens up room for discussion and learning.
Things to Bring on Your First Day
- Your short white lab coat
- School nametag
- Pen light
- A small spiral bound notebook
- Plenty of pens!
- Pocket references – see the list below for some of my favorites and where to find them
- Snacks for your pocket
- A textbook for downtime
Questions You May Be Asked
- What do you hope to get out of this rotation?
- What do you feel your strengths are?
- What things would you like to work on this rotation?
- What area of medicine are you most interested in?
- Which conditions are you most interested in?
Getting Good at Presenting a Patient
Good patient presentations have a number of qualities:
- They follow a SOAP format: Subjective, Objective, Assessment, and Plan.
- They should be succinct, yet thorough. While traditional written patient presentations include all of the facts, oral patient presentations only include those facts essential to understanding the case currently. With that said, be sure not to omit essential information.
- Succinct means less than five minutes. Ideally, patient presentations should be less than three minutes. Many preceptors will cut you off or stop listening when they have had enough, so get all the essential info in quick.
- The natural pattern of attention during a presentation fluctuates with the listener paying the closest attention at the beginning and end of a presentation. Resultantly, place emphasis on H&P early and conclude with an assessment and place.
- Always include pertinent positive and pertinent negatives, but make sure they are actually pertinent.
- No preceptor is alike. Each preceptor has their own preferences in how they wish to have patient information presented to them.
- It's all about confidence. Make eye contact and have at least one suggestion for treatment and even a question to ask to further your understanding of the case.
Here Are Some of My Tips
- It is okay to admit that you don’t know the answer. It is not okay to still not know the answer after you have been asked the same question three times. Respond to preceptors with, “I am not sure about that, but I will find out for you." Offer to give a presentation on the topic the following day, or, during downtime, ask the preceptor if you can have a follow-up conversation about the topic.
- It is easy to forget to study on rotations. After having spent every waking moment on medicine during your didactic year, it is easy to get caught up in taking evenings to yourself, but don’t forget to study. That end of rotation exam is coming up sooner than you think!
- It is okay to ask questions or to admit that you need help. In medicine, a patient is putting their trust in you even though you are only a student. Now is the time to learn and ask questions. Help is always around!
- Remember to be assertive, but not pushy. In some situations, there are multiple students at the same facility and it is important to be heard, without being overbearing.
- Ask for a progress report. Halfway through the rotation, ask your preceptor about your strengths and weaknesses and how they feel the last few weeks of your rotation can be spent most effectively.
- Keep a log of the patients that you see during the day. Most programs require patients to track a portion of the patients they see via an online database.
- Be succinct yet thorough when giving patient presentations.
- Always send a thank you note to the preceptor at the end of the rotation. They have just let you into their workspace and taken time to help you grow as a practitioner.
- Get eight hours of sleep a night!
- Be confident!
- Most importantly, smile, and enjoy the experience!