As part of the Physician Assistant program at McMaster University, students are expected to complete three Longitudinal Placements (LP). Students are responsible for setting these placements on their own. LPs are clinical observerships organized by the student int he domain of his/her choice to gain relevant clinical knowledge in that are of medicine.
- Area of Longitudinal Placement: Emergency Medicine
- Supervising Preceptor: Maureen Taylor, CCPA and M.C., CCPA
1. What LP did you do?
I did my LP at Sunnybrook Hospital in the Emergency Department
2. How did you go about contacting and arranging the LP?
Maureen Taylor is a preceptor for the PA Program. A few of my classmates did an LP with her and so I decided to contact her to set one up as well.
I did a day shift from 10AM-7PM with Maureen and a night shift from 5PM-12AM with MC the next day.
3. What were the two main things you learned from the LP?
1 – I observed how a Physician Assistant works in the ER. Maureen sees 2-3 patients at a time on her own. She takes patient history and performs physical exams to access the patient. Then she orders the necessary tests and imaging if needed. Before discharging/referring the patient to another department, she would run the cases with the attending physician.
You may ask, well, does the physician help/see the patient at all? Yes! It is the physician’s duty to make sure every patient in his/her section is attended to.During the time that the PA is attending to his/her patients, the attending physician is looking into more complex cases and also teaching the medical residents/clerks. The physician will be visually checking each patient behind the desk and she also gets a verbal report from the PA. We had a patient who had bad migraines and felt nauseous. MC did a neuro exam with her, ordered some IV fluids that may help her migraine, and tests that would help with the diagnosis. Upon reporting to the attending physician, MC asked her to check on the patient as well in case she was missing something.
All medication orders are written on a form and the nurses will get to it. They are the only ones who have access to medication. From my point of view, PAs and nurses are working VERY well together…at Sunnybrook anyway.
2 – I practiced writing SOAP notes. In the ER, each patient has a chart that needs to be filled out regarding what their presenting problems are, what the physical exam results are, what were the differential diagnosis and what is the plan/management. MC had me write SOAP notes for each patient we saw and then we compared mine with hers. It was really helpful because now I know what I need to include. SOAP notes are also a good way to practice how I will present the case to the attending physician in the future.
4. What did you wish you knew beforehand to help you in your LP?
In retrospect, I wish I reviewed how to write SOAP notes. Other than that, knowing common medications would help a lot. For example, what are some pain medications that can be given to patients (other than morphine).
5. How has this experience helped you clinically, in class and/or in career decision-making?
I learn very well in the clinical setting so I feel that this exposure will greatly help me in the program and in my future career. I also really like the working pace in the ER. Patients get registered when they come in by the triage nurse, which gives them an acuity number (1-5, 1 being the highest acuity). PAs are to see patients when low acuity levels (4 and 5) first and if there are none, they are to help out areas in the ER where patients have not been seen yet. It was literally like, oh, section orange has 4 patients that are not seen yet, I am going to put my name on one and attend to them.
In terms of career decision-making, I do enjoy the ER environment! MC said she likes the ER because it is fast paced and she also gets to exercise different skills set. She finds the challenge rewarding. I agree with her!
6. Share your most memorable experience from the LP!
One of the patients I saw with MC was a 24 year old male with abdominal pain. He felt nauseous and had a loss of appetite. I watched MC take a history and do an abdominal exam, which was positive for McBurney’s point. Outside the room, she asked me what the most likely diagnosis for abdo pain in this age group was. I guessed acute appendicitis because of the positive McBurney’s point finding, and I only knew this from another abdo pain patient I saw with Maureen the day before (that patient turned out to have bowel cancer, which was likely for someone in their 80’s). MC then walked me through the tests we should do to diagnose appendicitis. In young patients, we want to avoid doing radiation imagining so we sent him off for an ultrasound. The radiologist sent the report back and he did indeed have acute appendicitis. Treatment for this is surgical removal of the appendix, which he was scheduled for.
HOW COOL WAS THAT?! I thought it was so cool how MC walked me through the Hx, physical exam, investigations, and management!
Prior to becoming a Physician Assistant, Maureen worked as a medical journalist and television reporter for the CBC for two decades. She is currently working as a PA at Sunnybrook Hospital in the Emergency Department. She is also a preceptor for the McMaster PA Program Professional Competencies class.
Follow her on Twitter @maureentaylor31.
Read more about Maureen on The Toronto Star.