Although my Long Term Care rotation was completed on the Internal Medicine service at NYPQ, my site evaluation was determined heavily by my ability to evaluate a geriatric patient and discuss the different aspects of the geriatric patient/case including a full geriatric exam. For my first site evaluation, I presented to Dr. Davidson, my site evaluator, and my classmate. I also got to hear my classmate’s presentation, on a patient from a very different patient population since she was rotating at a completely different hospital in a different area of Queens. For the first evaluation we both presented a complete H&P on patients we saw and on drug cards we wrote. I found it pretty challenging writing up a geriatric HPI that included the different parts of geriatric care, but I think it was definitely great practice for me. It was also great practice writing up a full geriatric assessment, which I had never done before. Additionally, Dr. Davidson gave me great feedback on which areas of the case to focus on, and which areas to mention but not dwell on. She also discussed the importance of noting in the very first sentence of the HPI whether the patient lives alone and requires assistance ambulating, because it helps create a better picture of the patient and a lens through which the rest of the HPI is read. 

For the final site evaluation I had a one-on-one session with Dr. Davidson where I presented one H&P and journal article by myself. Although being in a session with another classmate was a great way for me to hear about and learn from her experiences at the site she was at, and her style in assessing and writing up a geriatric case, I think it was definitely extremely helpful being able to spend more time breaking down the work I did and really pinpointing different areas that I did well with and the other areas that I needed to work on. For instance, in my final site evaluation, Dr. Davidson and I got to spend more time working through my Plan, as she was able to provide me with more extensive feedback since we had more time. Additionally, the patient I presented had a venous stasis ulcer, however a full workup was to be done to rule out peripheral artery disease and infection (such as osteomyelitis) since the ulcer formed from an unhealed wound. Dr. Davidson helped me expand on certain areas that were lacking in my physical exam, such as the skin and musculoskeletal exam. She explained that it’s important in an elderly patient with a lower leg ulcer to check all reflexes and note any differences in pulse, sensation, or reflexes between the right and left lower legs and arms even if they feel pretty similar. Additionally, she explained that to really rule out osteomyelitis an X Ray of the effected area is not enough; rather a bone biopsy or bone scan should be done in addition to the other routine lab tests that should be done. 

Overall, I really enjoyed learning from Dr. Davidson! I think her feedback is detailed in a way that really helps me understand the exact changes I could make. Her attention to detail is definitely beneficial for me as a student, since although the geriatric H&P can be challenging to write, I now know the specific areas I should work on and what I could do better, which I really appreciate!