Getting ready to precept!

Florida, here I come!

Florida, here I come!

Today I write to you from an airplane! I am on my way back from Florida! I spent the last two days in the sunshine and on the beach away from the cold and snow!

No, really I came purely on a business trip. I actually met with three different field doctors to talk to them about potential precepting opportunities (!!).

Palmer’s precepting program allows its students to go out and work in an office with an approved field doctor. There are doctors all over the United States that are eligible to host student interns, and this program allows us to learn from someone who has been out in the field for a long time. It also allows the field doctors to learn from us! The profession has grown so much that everyone can benefit. They also get the extra help around the office and get an opportunity to help out a student.

So most of Thursday I spent meeting with the doctors and talking to them about their practices and trying to decide which place would be best for me. All three offices were very different and had really different things to offer. It was a really hard decision to make, but I think I have decided on which office would be the best fit for me!

I am very excited for this opportunity and being able to have met so many wonderful doctors out in the field. It’s really great how accepting and welcoming the field doctors are. It’s always great to get out and see different offices. I recommend doing that as much as possible!

On Friday we spent most of the day looking at houses. Everything is happening so quickly! I can’t believe it’s already time to do all of this. We looked at some really interesting properties, but we found one we really like. Everything seems to be falling into place. I am ready to get out there and take in everything I can. The precepting program is a really great opportunity, and I am so thankful to be able to get this experience.

‘I know this is going to go terribly’

Nerve-wracking

Nerve-wracking

So I mentioned that I took the clinical OSCE, and after you’re graded on it you have to go through and review your tapes and watch yourself perform the exams. This happens a few weeks after you take the exam, and so I had my OSCE review a couple weeks ago and it just seems so weird watching myself. Those awkward silences were just as awkward in the video as they were in the room that day.

Overall, though, I was pleased with how I did and I think I did quite well. I noticed a couple of things that I forgot to do. I was sort of dreading having to watch myself because I was thinking, “I know this is just going to go terribly.” I didn’t want to see myself being all frazzled trying to get through this test. At the time, you’re not sure if you’re acting awkward or not because you’re nervous about taking the test, and I just really felt like I would get in there, watch myself on the tape and see that I was just doing terribly.

Luckily, that was not the case. It turns out I actually know what I am doing! And I have learned quite a bit while I’ve been here.

-Allisha

What I did on my winter vacation

This is the trimester with our holiday break, which always makes the trimester feel super long. This break was nice because we got about two weeks off, and, being in a higher trimester, we didn’t have anything to study for over break and didn’t have a lot of homework. So I just got to relax and enjoy my break.

I remember in lower trimesters hating this break because there was always so much to study for over break and not wanting to study–because I wanted to spend time with family and do holiday things.

This break I did a bit of traveling around spending time with family. The first part of the break, I went to visit a friend in Minneapolis for a few days, just to get away and relax. On my way back from there, I stopped in Ames to visit my cousin then headed back home to spend a few days with the family. Then I went back to Ames so I could get a bridesmaid dress for my cousin’s wedding. Then I went back to Minneapolis for the New Year.

I ended the break by going to see Trans-Siberian Orchestra in concert at the iWireless center in Moline (right across the river in Illinois) the Sunday before classes started up again. It was a great show this year. This was the 11th time I’ve seen them in concert, but this year was the first year I had floor seats. We were in the 8th row, and it was an amazing way to end my break!

I spent a couple days in Davenport somewhere in there to get my homework done. I seem to work better in my own element, so I knew I would have to spend a couple days at my apartment or I would never get my work done. It was really nice to have a relaxing break with a bit of traveling and getting away before things pick up. Then when I got back to school in the New Year, I was able to start seeing outpatients, which was a great way to start the new year!

It’s clinic time!

Student adjusting in the clinic

In the clinic, students adjust patients under the supervision of a staff doctor.

Right before break, we officially cleared for the outpatient clinic in the AHC (Academic Health Center). We had two days to be in the clinic before we left for break. I spent the first couple days and the week after break just observing other interns taking care of patients, so I had a better idea of what to do when it came time for me to start taking care of patients.

There are quite a few differences between the two clinics. In the AHC, we have Medicare, Medicaid and insurance patients, which means there are certain ways the paperwork needs to be done and filed that is slightly different then how we did things over in the student clinic. I wanted to make sure I had most of that figured out first.

Since we’ve cleared, I really just spend most of my time in the clinic seeing patients. Since I’m still a new intern, I don’t get to see very many, but I have been able to take over a couple patients and it has been an awesome experience.

In the CHC (Campus Health Center, the student clinic), our patients are primarily Palmer students, so most of them are wellness patients or have a general understanding of being healthy. So we don’t see a lot of patients with problems. In the AHC, you have patients from the community coming into receive care because they have problems. It’s really cool to get the different experience and start working with outpatients.

So that has been keeping me busy. We have fewer classes during this trimester so we can spend most of our time in the clinic. It has been a couple weeks, and I think I’m finally getting the hang of things!

As the trimester ends, I suspect things will pick up and we’ll start to get quite busy. With not having as many classes this trimester, I find myself with more free time than I’ve ever had before–so that’s been a pretty big adjustment. I feel like its been well-earned, though it’s nice to not have things to do constantly. So I assure you, it does happen!

Except Boards are right around the corner again, so it’s back to hitting the books again real soon!

OSCE time … Nerve-wracking!

This last month has been a little more busier than usual for this trimester. We just had midterms before break, and this trimester we don’t have very many exams aside from midterms and finals. Most of our points come from projects or homework assignments, which is a big change from previous trimesters.

This guy looks just as nervous as I felt before the OSCEs!

This guy looks just as nervous as I felt before the OSCE exam!

I also took the clinical portion of the OSCE exam. The OSCE exam is a test all students have to take to clear for Level One clinic, and it just assesses you’re skills in a clinical setting and with patient care. It’s a pretty big deal and with it comes a lot of stress. The whole exam is recorded and after you’re graded you have to watch yourself and evaluation how you think you did. I went into the exam very nervous because it’s compared to Part IV of the National Boards and, well, we need to pass to clear for the outpatient clinic.

I am here to tell you from experience the OSCE exam is not scary. After I finished taking the test I was a little angry at myself for how nervous and stressed out I was about it. We are very well-prepared in our education that essentially the clinical portion of our education comes very naturally.

That being said, you should still study for the exam. It covers a lot of material and really makes you think about how you would handle real patient situations. There are three patient cases, you have to take a detailed history, perform orthopedic exams then answer some questions on how you would provide management for your patient. The kicker is you’re timed, and if you finish up asking questions or performing the exams before the time is up, you have to demonstrate your interpersonal skills with small talk.

Small talk is not one of my greatest skills. There were a lot of awkward silences during my exam. It definitely got better by the third patient case, but you can only talk about the weather for so long! Awkward silences and all, I was able to get through the test with no real issues.

Holiday Party fun

Friday was the Palmer Holiday Party! Every December, Palmer puts on a holiday party for all the students to go out and have a good time. I like to think it’s to celebrate all our hard work.

I had just finished my rotation at the Outreach Clinic and still needed to pick up some jewelry for my outfit and start getting ready. My friend was having a get-together before hand that started at 6 p.m. Another friend and I ran to the store then back to my place to get ready. We had an hour and half, plenty of time to run to two stores and for two ladies to get ready. We couldn’t have been more wrong.

We showed up to the pre-party an hour late. But it was fine; we had brought lots of snacks with us. We had fun playing some board games and taking lots of pictures before we headed down town.

A couple friends and I stopped by another pre-party on our way to the Redstone Room for more snacks. The Holiday Party started at 8 p.m., and I think we got there around 9:30 p.m., but I had been behind the whole day so that was inevitable. I was surprised that when we got arrived, there was still a decent amount of appetizers still there. This was my third time attending the Holiday Party, and I had never made it in time for the appetizers. Unfortunately I had filled up on snacks at all the other parties, so I only ate a couple pieces of pineapple when I got there.

The party was a lot of fun. It’s a lot of dancing and hanging out with friends, and we get to dress up nice. We ladies love a good reason to wear a dress. The school brought in a band from Chicago that was really good; they played great music and sounded awesome. We danced until midnight, and it looked like everyone was having a really great time. Everyone loves the “Palmer Prom!”

– Allisha

Clinic rotations get us ready for outpatient care

Dr. Marriott and a student intern with a patient in the AHC

Dr. Marriott and a student intern with a patient in the AHC

We have several rotations we have to complete before we are able to clear for the AHC (Academic Health Center clinic) and start working with outpatients. Those are radiology, rehab, outreach and front desk. We also have to observe several adjustments under the staff doctor we to which we are assigned. We do the rotations so we can get a feel for all of the departments we will be going into. Last week I did my radiology, outreach, front desk and clinic II rotations. The only one I have left to do is my rehab rotation.

First I had my radiology rotation. We went down into the AHC radiology department, got a tour and got to see how the machines worked. They are a bit different from the CHC (the student clinic, the Campus Health Center) X-ray machines so we got to move them around a bit and just see how they work. I am glad we did too, because today I had to take impromptu X-rays down there, and I am glad I knew how to work the machines.

We then got to look over some films and go over some cool or unusual cases that had come up through the clinic system, which was good practice. We finished up the last part by sitting in on Dr. McLean’s X-ray reading for local field doctors. This part was really awesome. It was great practice and exposure to reading X-rays, and Dr. McLean was really helpful in answering our questions and helping us just read the images better.

After radiology rotation, I sat in on the front dest rotation. This is just getting some extra exposure to what the ladies at the front desk do all day. Let me tell you, it’s a lot more than scheduling. They are all in charge of bigger projects that need to be done each day and sorting through paperwork and billing, on top of the demands of the interns to get patients scheduled and to check out equipment. Don’t take these ladies for granted! And be patient with them. They are wonderful and do a lot for you.

The last rotation I went to was in the outreach clinic in Davenport. It’s located on 6th and Harrison and is available for patient care for people who can’t afford care. From what I understand there are guidelines to qualify for care at this facility, but it’s a great asset to the community and it allows the students to help out in another clinic setting. It was a little slow while I was there but picked up and got pretty busy at the end of my shift.

I really enjoyed all of the rotations and observations I did and thought they were a great learning tool. I was really glad we had to do them before we get over into the outpatient clinic. I felt like it better prepared us for what we have to do and gave us a better idea of what our options were for the coming year.

-Allisha

Mock clinic for Clinic Abroad

An example of one of Palmer's Clinic Abroad clinic in India

An example of one of Palmer’s Clinic Abroad clinic in India

We had our first mock clinic for Clinic Abroad. We met in the gym and went over a few rules and just discussed how a regular clinic day would go while we were in Bequia or India. Then we took our equipment up to the second level of the gym to set up our clinic the same way we would be setting up the clinics each day in the areas we were visiting.

We were given limited space, so we knew how it would feel while we were actually there. The clinic we are going to be working in, in Bequia, is actually going to be smaller than where we were in the Palmer gym. So we all will be working very closely.

This was our first exposure to the actual paperwork we will be using in the clinics. It is quite a bit different from what we use in our campus clinics, since there are different requirements that need to be met abroad, as we are not seeing patients that get regular care.

Bequia Clinic Abroad

A Palmer student intern adjusting a patient at an orphanage during a recent Clinic Abroad trip to Bequia (Photo by Taryn Foster)

We ran through the full exam exactly how we are supposed to with our patients to get some exposure, so we don’t get there and have no idea what we are doing. I think it just got everyone really excited.

We got to work through some actual patient cases so we knew what kind of patient care we would be providing and what some of the past cases had been. It was something fun and enjoyable to come back to after the Thanksgiving break. I am really looking forward to going.

-Allisha

I survived OSCE exams

Hang in there cat

Hang in there cat poster

I had the first part of my OSCE exams this week. In our 8th trimester, we have to take two exams that allow us to go onto Level II clinics and eventually graduate. One portion is a clinical aspect where you go in and perform a full evaluation on a mock patient. The second portion is a radiology portion. I had to take my radiology portion this week. It’s done on a computer, and we’re given 10 different cases with films then asked questions over the cases. Then we have to identify what the most significant diagnosis is and how we would manage that patient’s care.

It wasn’t so bad. I wish I had studied more, but life calls sometimes and you just run out of time. I don’t have to take the clinical portion until Dec. 4, so I’m going to start studying for that soon so I am more prepared for that one than I was for the radiology portion. Really, though, these two exams have been all I’ve really had to study for this trimester so far, so I’d say that’s not bad at all.

It’s weird going from having to study every night for multiple exams to only having to study occasionally for a couple exams weeks apart. So it actually does happen! You won’t always be swarming with exams. Don’t get me wrong, we are still very busy but it’s a different kind of busy, a better busy. I would rather be taking care of patients in clinic than studying constantly and sitting in class all day.

So it does get better, I wouldn’t say easier, I would say better with a different kind of busy. It will all be worth it in the end, just keep at it!

-Allisha

My first set of X-rays

stock X-ray image

Random stock X-ray to avoid HIPPA issues :)

Last week, I had a week full of radiology. I got to shoot my first set of X-rays. We did a Palmer upper cervical series and a lumbar series.

It was fun to actually be able to get in and take the films. In class, we do the set-ups a lot, but we aren’t able to take films on an actual patient. It’s easy to shoot an X-ray on a phantom, they don’t move at all!

Our patient kept leaning to one side, so we kept having to reposition him so he would be centered in the film. After we took the films, we had to write a radiology report on them. We had to use the actual films for interpretation because the program we use on the computers wasn’t working that day. Then the next day we had to go to a radiology reading to make sure we didn’t miss anything on the film.

It went really well. Our diagnosis was right, and there wasn’t really anything we missed. We just didn’t word things well on our report. It wasn’t too bad, though. We were lucky our first experience wasn’t traumatic. Sometimes you hear horror stories about radiology review, but there was nothing like that for anyone that was analyzing films while we were there. I think some people must not be prepared when they go in there. Just be prepared, know your patient and do your best. You will come out all right.

-Allisha

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