During my surgery rotation I met with Professor Rachwalski, our Pathophysiology teacher, to present for two Site Evaluations. It was really great having Professor Rachwalski as my Site Evaluator, because he actually works at NYPQ as a General Surgery / Trauma PA, which is where I rotated. This was beneficial because he understood some of the challenges I might have encountered, and he was also familiar with some of the patients I was presenting on and some of the cases I was assigned to in the OR.

For my first Site Evaluation, I presented 1 H&P, 2 SOAP notes, and 5 drug cards. Professor Rachwalski gave me great feedback on how to make my SOAPs more focused and cut out the more extraneous and less relevant information, which helped me learn how to narrow down the more important aspects of the cases. He also taught more pointers on how to organize my H&P in a way that was more logical and with better flow. It was especially helpful that since I was the only student doing my evaluation on-site, I got to have a one-on-one meeting with him where I got to have a more extensive discussion with him that was more focused on improving my skills and expanding my knowledge. 

As an example, this is the HPI from the H&P I presented during my first evaluation: “VS is a reliable 57 y/o Caucasian Russian male, English-speaking, with no significant PMH and a PSH of open appendectomy and hernia repair, who presented to the ED complaining of diffuse abdominal pain x 8 hours. The patient states the pain began suddenly and woke him up from his sleep. He states the pain gradually worsened throughout the morning and remained constant throughout the day. The pain is sharp and diffuse in all 4 abdominal quadrants, is the most severe in the epigastric and periumbilical areas, and does not radiate anywhere. The patient took 2 Tylenols (unknown dose) when the pain began to try to alleviate the pain, but his pain continued to worsen. The patient states the pain feels better for a few minutes when he moves onto his left side or passes gas, and that nothing makes it feel worse. He states the severity of his pain is 8/10. Patient states he has never felt pain like this before. The patient admits to mild nausea with one episode of bilious vomiting 4 hours ago that was green/yellow in color with liquidy consistency, with no hematemesis. He admits to regular flatulence and bloating sensation. Last bowel movement was at 4AM this morning, with regular amount of soft, nonodorous dark brown stool. Last food patient ate was dinner at 8PM last night (does not recall what food) with no nausea or pain following his meal. The patient denies any changes in bowel habits, including diarrhea or constipation, blood in stool, or abnormal color/odor of stool. He denies any dysphagia, heartburn, acid reflux, or eructation. He denies any flank pain, dysuria, urinary frequency, oliguria, or changes in urine color/consistency. He also denies any fever, chills, night sweats, chest pain, shortness of breath, headache, dizziness, generalized weakness, fatigue, unintentional weight loss, or changes/loss in appetite. He denies any recent injuries or trauma, recent travel or sick contacts. Patient denies seeing a PCP.” Professor Rachwalski gave me a lot of positive feedback, and then suggested that I expand on the type of hernia repair the patient had. This was very important to the case since the patient presented with an SBO, and both surgical adhesions and hernias are common etiologies of SBO. 

During my Final Site Evaluation, I presented a second H&P, 5 more drug cards, and a journal article on COVID-related genitourinary infections. For the second H&P, I used all of the feedback Professor Rachwalski had given me for my first H&P and SOAP notes, and received only positive feedback on my organization and overall presentation. I also used Professor Rachwalski’s feedback for the presentations I had to give to my preceptors, which definitely in that way too! Overall, I think my Site Evaluations went really well; I learned a lot about how to narrow down the most relevant and important information, how to construct a proper differential diagnosis, and how to create a plan that is extensive, organized, and covers all aspects of the patient’s care in a way that prioritizes the most important and urgent aspects first!