During the site visit, I had the opportunity to meet with a professor who is a practicing PA in emergency medicine. He provided valuable feedback and shared many real-world experiences from his practice. It was helpful hearing how he approaches different clinical scenarios and how he structures his thought process when evaluating patients in the ED. One of the H&Ps I presented involved a patient who presented with coffee-ground emesis. As a student, it was the first time I had actually seen this presentation in person, which was important because it significantly alters the differential diagnosis and the way the encounter is documented. Seeing this case firsthand helped reinforce how important it is to quickly recognize concerning findings and appropriately document them.
For another patient, I was able to assist with a limited video-assisted laryngoscopic airway evaluation in the intubation position for a patient presenting with repetitive throat-tightening episodes and hoarse voice without any identifiable allergen exposure. Because the symptoms were atypical and had occurred multiple times over several months, writing the assessment was more challenging for me. I sometimes find it difficult to narrow down my assessment when patients present with multiple concerns or atypical symptoms. During the site visit, the professor helped guide me through this by explaining how to focus on the most clinically relevant factors rather than including every possible detail. I tend to include many positives and negatives because I want to make sure nothing is missed. However, he showed us how to streamline our assessments while still demonstrating appropriate clinical reasoning. For example, summarizing key findings such as the absence of red flag symptoms or confirming that the patient is protecting their airway can sometimes communicate the situation more effectively than listing every negative finding.
For my journal article presentation, I reviewed a study comparing low-dose ketamine versus morphine for acute pain management in the emergency department. The article suggested that low-dose ketamine may provide effective analgesia with certain advantages in specific situations. We discussed the benefits, limitations, and appropriate indications for each medication. He also spoke about the increasing clinical relevance and growing use of low-dose ketamine in emergency medicine, noting that he has personally seen its use expand in his own clinical practice. This helped connect the research findings to real-world application. Hearing how experienced clinicians incorporate evidence into their practice reassured me that the research we review has meaningful clinical relevance.
In conclusion, the feedback helped me improve how I approach clinical reasoning and assessment writing. At the same time, I recognize that I still need to continue working on organizing my assessments in a way that clearly communicates my thought process and clinical direction so that anyone reading it can easily understand my reasoning. This is something I plan to continue improving as I gain more experience and clinical exposure.
