Brooke, McMaster PA-S2
Brooke is a second year PA Student at McMaster’s PA program who excelled at her four week clinical rotation in Radiation Oncology at Princess Margaret Hospital.
Second year PA students have to complete mandatory rotations in different specialties such as Family medicine, Emergency Medicine and Internal Medicine, etc. There is also the option of doing elective rotations where students pick where they would like to do their rotations, such as Orthopaedic Surgery, Dermatology, Oncology and more.
Brooke opted with an elective rotation in Radiation Oncology, a high specialized field at one of the premier Cancer Centres in Canada alongside a Radiation Oncology PA.
Brooke started her second year of PA school in an elective rotation
In the second year of PA school, PA students complete clinical rotations for several weeks at a time in different areas of medicine including Family Medicine, Emergency medicine, Internal Medicine, Surgery, Psychiatry, and more!
Some second-year PA students begin with a core rotation like family medicine, however, Brooke started her clerkship year by choosing to complete a rotation in a very specialized area – Radiation Oncology at University Health Network in Toronto.
“I felt nervous about coming into a really specialized field like Radiation Oncology without a lot of background that comes from doing core rotations like Family Medicine, Emergency Medicine, etc.. first. But during this elective I established a good foundation of knowledge because it was a really great place to learn.”
What is Radiation Oncology?
Radiation Oncology is the treatment of malignant cells with x-ray treatments.
There are 3 different divisions of oncology practice:
Radiation oncology medical oncology, which deals more with chemotherapy and immunotherapy, different types of systemic therapies
Surgical Oncology
Radiation Oncology is the treatment of malignant cells with x-ray treatment.
Choosing a Subspecialty for your first placement
She chose this rotation based on an interview she had seen on Canadian PA with Maitry Patel, a PA working in Radiation Oncology. In first-year PA School, Brooke completed a longitudinal placement and had a positive learning experience. She appreciated the welcoming environment with staff and patients and she received excellent mentorship and teaching for the preceptor. She also expressed interest in potentially pursuing a career in Oncology, so this placement would be an opportunity for exposure to working directly with this patient population.
“Starting your second year of PA school with an elective rotation in a specialty can present its own challenges.”
Usually, PA students have the strongest clinical skills towards the end of their second year of PA school, but Brooke knew she was going into a specialty that she wanted to potentially pursue as a career later on, so she set high expectations on making a good impression on staff physicians, PAs, and other health care professionals.
How to build competence on rotations
Start with setting learning objectives
To keep from being overwhelmed, Brooke set learning objectives as milestones to hit to navigate through the rotation:
She would start with basic objectives around functioning as a clinician/PA like getting exposure to different types of patient interactions, taking histories, performing focused physical examinations and get familiar with different types of important questions to ask during a patient encounter. This also included technical aspects of being a clerk, such as how to dictate, and navigating the electronic medical records (EMR) system. Learning all these base skills was a big objective for her.
She then focused on specialty-specific objectives set around Radiation Oncology: Tumor staging, how the radiation oncologists work with medical oncologists and surgical oncologists, patient management of complex conditions, as well as how to read imaging.
“I was exposed to PET scans, and MRIs. I learned how to differentiate blood vessels in a scan from tumors or nodules when you are looking the basic anatomy of scans in terms of a PET scan, trying to figure out where the common sites of uptake were in differentiating that from an actual metastatic nodule.”
You meet your learning objectives by gradual exposure over time to patients, clinical cases and teaching from staff.
In this elective rotation, Brooke saw and assessed patients who were new intakes to the practice which provided her more exposure and experience compared to her first year placement.
“I saw a lot of new patients was able to spend time looking at their histories and doing a full comprehensive look at the story of their diagnosis and what brought them into clinic.”
She also participated in teaching and patient rounds, where she learned how the different oncology subspecialties work together to come up with a comprehensive treatment plan. Brooke has also had the opportunity to present a complex patient case to Tumor Boards, which was followed by discussions between surgeons, radiologists, radiation oncologists and medical oncologists to formulate a treatment. She appreciated exposure to interdisciplinry teamwork during tumor boards and felt it was a great exprience for learners overall.
How a PA student interacts with a preceptor (PA/MD) on clinical rotations
Preceptors during clinical rotations teach and guide PA students to be better clinicians.
“I think what a PA should be expecting from a preceptor is that no matter how busy they are, they will take the time to teach you. It may not be directly after the case, but at least a couple points throughout the week. The preceptor may ask: “what do you wanna get out of this placement? And how can I facilitate that?”
For instance, Brooke expressed being nervous when she first started in her elective rotation. Especially considering that she would be in a setting where she would be evaluated and others would be paying attention to what she was doing in the clinic and how she was interacting with patients. Over time, she became a lot more confident in her skills, especially with guidance from her PA and MD preceptors on clinical reasoning and case presentations.
Targeted feedback helped her become a better clinician and she had made tremenous improvement over the month she was there. She attributes this to the excellent learning environment within UHN and her interactions with preceptors.
“I think the thing that I liked most about being in my rotation at UHN was the people and the learning experience, which I know I've mentioned a couple times, but I just really appreciated the fact that any time I went in and saw a patient the physician would let me ask any questions I had after the case was over, they'd sit down and explain to me the reason they've decided to go with a certain treatment or the reason they're deciding to just wait watchful waiting and follow up.”
In fact, her preceptors had explained to her:
“As a PA student you are there to learn, and your clerkship year/second year of PA school is the time to ask as many questions as you want. “
Having a PA as a preceptor during rotations
Having a PA preceptor was really important to Brooke. Many PA school clinical rotation are done with physician preceptors, but with increase in practicing PAs over time, students have an opportunity to be precepted by PA students.
Brooke completed her placement with Maitry, a seasoned PA working in Radiation Oncology. She had the opportunity to see how PAs directly work with patients, and staff on a day-to-day basis.
Enhancing Learning through a Personal Learning Project (PLP)
“A couple of weeks before starting my placement, I reached out to my PA preceptor to ask if there was anything I could do on the side just to enhance my learning experience. Since oncology is something I'm really interested in doing and something I've thought of doing outside of clinical practice in research I thought if there was anything I could do that could give me exposure to the nonclinical side.”
Brooke decided to utilize and modify history and physical examination templates to help residents or different medical learners to see and assess oncology patients during clinic. This challenged Brooke to consider important aspects of the patient history and exam to incorporate into the templates. She would modify the templates based on questions physician and PA preceptors wanted to know until the template was comprehensive. This would fit onto one page, and allow for easier case presentation to a preceptor, and quick dictation following the patient encounter. This helped improve patient flow.
This endeavour also enhanced Brooke’s own learning:
“This project helped me with time management on top of a full-time placement. This project also helped me learn about oncology. Going through those templates and looking up what are the pertinent details for different types of cancer was a way to solidify what I was learning in placement.”
Tips for excelling on Clinical Rotations
Tip #1: “When choosing an elective rotation, select a specialty that you think will help you for the rest of clerkship”
Brooke was provided advice that when choosing an elective for your first placement, that is helpful for the next placement. She gained base skills that she ended up using for her next placements - including taking good histories, physical examinations, clinical reasoning, patient management and dictating. These skills are transferable.
Tip #2: “Being successful in a challenging clinical rotation requires 100% effort.”
What motivated Brooke was the idea that when she walks into a room, she wanted the patient to be confident that the person the patient speaks to is the right person to help guide them through treatment.
She spent time prior to the start of the clinic reviewing patient charts. She wanted patients to know that she learned as much as she could prior to their interaction, including tests that were done and the whole story of their previous diagnosis.
“I'd start every interaction saying, ‘I just want to hear from your perspective what your story's been and what brought you here today.”
This helps Brooke assess the patient’s understanding of why they are at the Radiation Oncology clinic as well as provides patients with the opportunity to talk about their experience instead of just her telling them.
She wanted patients to feel comfortable when their interaction was done, and that the patient felt like they were in good hands .
Tip #3: Building rapport with staff on rotations starts with being kind
Brooke’s approach was to be kind to everyone she met at clinic, from the nurses, to residents and other health care professionals.
“ I just wanted everyone to feel like they could approach me if they wanted to ask me questions or anything and hopefully build a good relationship so that they'd be open to me approaching them with questions.”
Interview with Maitry, Brooke’s PA preceptor
Brooke’s preceptor was Maitry Patel, Physician Assistant working in Radiation Oncology. Maitry shares her expectations as a preceptor and what students can expect when working with a preceptor.
