Clerkship 2: Underserved

In my program, we all have to do an underserved rotation. Mine was at a School Based Health Clinic, a Teen Health Clinic primarily.  I spent some time at a clinic at an elementary school as well.

School based health care practitioners manage medical conditions such as asthma and diabetes, and behavioral health experts address issues such as depression, anxiety, attention disorders, and social conflict. SBHCs provide immunizations, sports physicals and well-child visits, and health screenings. Many sites are offering services to support students in health education, social services, oral health, vision care, and nutrition counseling.

Eight out of ten SBHCs serve students in sixth through twelfth grades. The goal is to empower this age group to make healthy and positive decisions regarding their health. SBHCs have long focused on the health of adolescents and this effort has been proven to prevent school dropout by addressing barriers to learning. Some of those barriers include: drug use, teen pregnancy, violence, hunger, and poverty. These issues ultimately affect health, and the rate of high school drop out affects the nation economically and morally. SBHCs take advantage of their captive audience to make a major investment in their health, enabling kids to thrive.

Access to birth control has been a controversial issue for the SBHCs. However, only 37% of SBHCs provide birth control, and only 11% offer long acting reversible contraception (LARCs). Teen pregnancy rates are at historic lows, in part because teens are using contraception more, not because they are having less sex. In 2014 the American Academy of Pediatrics recommended LARCs for prevention of teen pregnancy, however, these methods are more invasive and longer lasting when compared with taking the pill. Therefore, it is difficult for many parents and guardians to get on board with their teen having access to LARCs.

I have truly enjoyed my experience at the Teen Health Clinic. I’ve never heard of such a thing until this clinical rotation, and I have to say it’s amazing. I saw patients who were technically homeless, living in shelters, transitional homes, and even in cars. In fact, during the 2015-2016 school year 3800 homeless students were identified in the district. The team I have worked with most extensively is the most caring group of individuals, from the office coordinator, to the health educator and mental health counselor, to the school nurse and the PA/NP medical providers. Everyone is invested in making a difference in the lives of the kids that come across their paths.

Fun thing about working at a school on Halloween: You get to dress up!

Everyone is welcome here.

Clerkship 1: Behavioral Medicine (Psychiatry)

At my program we have several one month clerkships and also a 4 month preceptorship in primary care. The preceptorship is either at the beginning or end of the clinical phase. Mine is at the end, so I'm doing the clerkships first.

My first clerkship was in psychiatry, and the setting was a public hospital. I was on one of the inpatient teams. Our team was led by an attending. We also had a PA, and half of the time we had a resident. There were two students on my team, a 3rd year Med student and myself!
We saw psychosis, mood disorders, eating disorders, along with complications from TBI and/or substance use.  I learned about medications and also about CBT, DBT, and other therapies.

I really enjoyed this rotation. I was able to start interviewing patients on the 2nd day of my rotation. I wrote progress notes, interim summaries, and discharge summaries on my patients. The Med student and I chose a couple of patients each for those tasks, and we split up tasks for other patients, like obtaining collateral or getting referrals, etc.

I had an opportunity to visit one of the state mental hospitals. The most eye-opening part for me was visiting the area that housed only children. The forensic area was also interesting. I also witnessed patients receiving ECT treatment. It's very benign these days, nothing like One Flew Over the Cuckoo's Nest, if you even know what that is. It's not barbaric at all. It's a very good treatment for certain conditions, including major depression, and very safe for pregnant women!

I went to lunch conferences twice weekly and to didactics also once or twice a week, which were always informative and helpful. I learned so much in this rotation.
I would like working in psychiatry, but I know for sure that in most every discipline, a knowledge of psychiatry will be essential to treating our patients to the best of our abilities! And also knowing when to refer!

A helpful book for your psych rotation: First Aid Psychiatry clerkship. https://www.amazon.com/First-Aid-Psychiatry-Clerkship-Fourth/dp/0071841741/ref=sr_1_1?ie=UTF8&qid=1476657629&sr=8-1&keywords=first+aid+psychiatry+4th+edition

During my psych rotation

For a reason, and for a season...

Summer session is quickly coming to a close and we are getting ready for new beginnings, life in the clinic!
While this portion of our training is often the most anticipated, I am feeling less than prepared. 

 
It is in times like these that I must remember that I really know more than I think I do. We crammed a lot into our brains over the last 15 months or so, not to mention all of the experience we acquired in the years leading up to this journey.

As I reflect on my time in PA school thus far, I feel stretched, supported, and a kinship with my classmates because they are the only ones who can truly understand what this ride has been like.

I am also a part of a prayer group which has been a Godsend, truly an answered prayer. This spiritual support has truly made all of the difference for me. 




I wish I had more time to blog about my experiences in didactic year, but I hope to at least make one entry per clinical rotation.

First up in a just over a week... Psychiatry!

Some of us during an optional POC ultrasound course this summer.