After reflecting on my Emergency Medicine rotation I completed this past month, I’ve been able to truly appreciate just how much I learned and gained from the experience. My rotation was a total of 5 weeks long and took place at the Metropolitan Hospital Center ER in New York City. First off, the type of hospital and location itself contributed greatly to my experience in emergency medicine. The hospital is considered a community hospital that serves to an underprivileged and diverse population. Not only was I exposed to many different disease states (e.g. rhabdomyolysis, Dengue fever) I gained a better understanding of just how important patient education was. 

Aside from the patients I encountered, the PAs, residents, and attending physicians I worked with also taught me a lot. They helped me learn how to think quickly and work meticulously, which is important in an ER setting. I learned to always try to think of a wide differential before even encountering the patient I was going to evaluate. This helped me organize my thinking and what questions I should ask the patient, so that something important isn’t missed. For example, I was asked to see a patient with the chief complaint of “nausea and vomiting.” Instead of creating my own differential before assessing the patient, I let the patient guide my questioning. When the PA I was working with asked what my differential diagnosis was, I not only presented a narrow list, but I also placed gastroenteritis at the top of my list. The PA had a broader differential in mind, and therefore ordered a urinalysis and many other tests that I did not think of. When the UA and other tests came back, we discovered that the patient not only had COVID-19, but was also in rhabdomyolysis. That experience alone, and the many other patients I worked with, helped sharpen my knowledge and critical thinking skills that will definitely help make me a better PA. I also gained a lot of practice working on my clinical skills. For instance, I got to do many venipunctures and place IV lines, which definitely require a lot of practice to improve on. The providers I worked with also taught me how to do different types of ultrasounds (e.g. renal ultrasounds, ultrasounds to check for abscess vs. cellulitis vs. cyst) and how to interpret other types of imaging, such as CT scans, which I definitely need more practice and experience with. 

During the 5 weeks I spent in the ER, I spent a few days working in the “Fast Track” section. This section of the ER was where patients with lower level acuity complaints were sent for quick “in and out” evaluations. For instance, I saw a lot of patients with UTIs, chronic back pain, and fractures. Although encountering higher level acuity patients in the main ER was often more interesting, I learned how to navigate this ambulatory care type of setting, similar to how I did during my Urgent Care rotation. I also got to spend time working on the notes I was writing, which in emergency medicine are typically meant to be more focused. Overall, both working in the main ER and Fast Track gave me a great experience learning how to approach a wide range of cases and patients in the ER setting. Additionally, the providers and hospital itself was a great learning and teaching environment, as everyone I worked with was patient, understanding, and eager to teach all aspects of medicine!