PA STUDENTS • WITH HARRISON, PA-S2

Hi My Name is Harrison, I’m a 2nd year Physician Assistant student at University of Toronto. Here are some things that helped me succeed in clinical year!

Make sure to buy comfortable professional clothes for clinic and make sure to ask about the dress code. When in doubt assume professional attire in clinic.

Make sure to have a lot of pens and be the  person with a spare pen and gum, it’ll build some rapport. I always carry a clipboard/folio with a pad of paper and a folder to jot notes and instructions from preceptors about anything – how to navigate the EMR, clinical tools/pearls, sometimes you’ll be seeing patient right away and will need something to document the visit.

Always bring lots to eat, water granola bars, ensure. You never know when you’ll need to skip lunch and sometimes you’ll want to stick around if there’s an interesting case (My first trauma came in after a 9 hour shift with no lunch!).

I always carried around a small notebook to for jotting notes and recording each case you see (as simple as: diagnosis, tests ordered, treatment, any interesting info about the case).

Definitely bring something to study, your laptop or a prep book, there might be slow days where you have a lot of spare time.

You’ll look good if you’re spending that time wisely and learning about cases specific to your rotation.

Finally, be able to introduce yourself and explain your role as a Physician Assistant confidently. Practice your PA elevator speech! Patients are genuinely interested about your role, and will trust you more if you are confident. If there’s something a patient asks that you don’t know – tell the patient you don’t have that information but will find it out for them (and then do it.)

I found it helped to be eager to learn, and to show that eagerness to your preceptors: Explain to them that you’ll be studying every night, ask them how you can an excellent student for them, be the first to volunteer to see the next patient, ask relevant questions about cases you see.

Make sure to step up and ask to get hands on early, ask if you can suture, ask if you can do the injection, the worst they can say is no, and they’ll usually try and get you involved at the next opportunity.

Always try to be in the action without getting in the way, this can mean helping in a trauma or code by being an extra pair of hands for the team, by grabbing towels, saline, tubes, and helping to move the patient. I always tried to put gloves if my preceptor did, this was the easiest way to move from watching to doing – if you are ready to dab blood and cut sutures you might get to do the next stitch or lesion removal.

Make sure to introduce yourself to everyone, including the nursing and secretary staff. Always be polite, they can be a huge help when you need to find something, need help with the EMR, or need some guidance.

When your preceptor asks you for information you missed  just admit that you missed it, resist the urge to get defensive  or overexplain (even if you had a good reason), instead just say “I did not get that info, but I’ll go get it now”.

Take feedback seriously and try not to make the same mistake twice, show that you’re learning and capable of receiving constructive feedback. Remember you’re not being punished, you’re there to learn, you will miss things but you can learn from those experiences.

Make sure you clean up the room fully after any procedures and fully dispose of any sharps – this will earn you big points with clinic staff.

Try to prep for each rotation. I found Online Med-ed to be a great resource with rotation specific sections that give you concise info. There are some excellent podcasts (eg. EM Clerkship, Surgery 101, EM Basic, Peds Soup) that you can research and listen to before starting your rotations and to help prepare for end of rotation examinations.

Before and during any rotation I would also read the chapter for that specialty in a prep book (eg. Toronto Notes now called Essential Med Notes) to refresh my memory on the most common conditions.

As you go and start seeing patients, make sure to jot down all the cases you see and then after clinic every night read up on any new diagnoses or cases you felt unprepared for.

Let your preceptor know you’ll be reading up on cases you see in clinic. They may suggest topics that they want to discuss with you, or quiz you on. You’ll earn points with your preceptor if you come prepared to discuss the next day.

Another idea if you’re comfortable is to ask preceptors what conditions you should study before your rotation starts, and what the most common conditions are that they see in their clinic/department. You may be surprised what they suggest (For example: Before my pediatrics rotation, they suggested I read up on pediatric mental health – depression, anxiety, ADHD, OCD).

I also found it really helpful to search and browse forums to find how other PA students/Med students have prepped for their rotations. Reddit is a great resource for this r/medicine, r/medschool, r/physician assistant. Google search “how to prepare for ______ rotation” to get more advice!

Sometimes it is good to have a pocket reference like Toronto Notes clinical handbook, or Oxford manual (see: Oxford Handbook of Clinical Medicine and Oxford Assess and Progress: Clinical Medicine, Oxford Handbook of Clinical Medicine, and Oxford Handbook of Emergency Medicine) .

I found it helpful to have PDF versions of these where you can put them into your phone or tablet (on iPhone: the “Books” app) to have them at your fingertips during clinic.

Same goes for PDF versions of guidelines which sometimes come in 1-2 page summary booklets like the Canadian HTN guidelines or Diabetes Canada guidelines.

There are lots of good apps to have on your phone:

• I especially liked Core Clerkship which was designed by med students to help during rotations, it has lots of note templates, pictures, and tips for  rotations.
• Sublux is an app with step by step Xray interpretation guides, especially helpful for emergency medicine.
• Some other apps that I found helpful were MD Calc (for clinical formulas), App versions of BMJ, UptoDate, medscape, lab tests, diagnosaurus, rxtx, drugs/com, prognosis.

One really important thing is to know which notes you’ll be expected to write for each rotation (consult notes, SOAP notes, admission/discharge, progress notes). Having a template for these will help you hit the ground running and be able to see patients on your first day.

Make sure each is specific to the rotation you’re in, for example: inpatient peds will require a very different set of information to document than adult emergency medicine.

Look up what a comprehensive history looks like for the rotation you’re going into and make sure to tailor it to the site you’re at (inpatient, outpatient, emergency etc).

Make sure to know how to document a physical exam completely and concisely and know how to document lab work.

Work hard on keeping things organized, concise, and complete.

Make sure you’re keeping track of the things you do and see! Jot down cases you see in a notebook, write down procedures you’ve seen and done, and keep track of the settings you worked and the professionals you worked with. This will help with case logs, but also with interview preparation where you may need to talk about your experience.

It will also help for asking preceptors for references and letters of reference (LORs) if you can remind them a bit about your rotation with them and specific interesting cases you saw.

LinkedIn is also a great place to document your clinical year. You can create an entry for each rotation describing the setting, the cases you saw and the skills you learned.

A screenshot of how Harrison documented a clinical rotation in 2nd year PA school on LinkedIn

Try to keep connections with your preceptors and update them periodically about how your education is going. This will help with asking for LORs or references because you maintain rapport and they’ll remember you from your rotation.

I found it helpful to provide resources on how a physician can hire a PA at the end of each rotation because many of them want a PA but haven’t tried yet or don’t know how.

Finally make sure to ask for feedback if you haven’t been receiving enough – or ask your preceptors if there is anywhere you could improve or what you should be working on. They’ll usually provide some good advice, and by following that advice you show your dedication and ability to take constructive feedback.

I hope some of these tips help with your clinical year!

Harrison is currently a second year Student at PA Consortium, University of Toronto’s BSc PA Program.