Hi guys! Long time no blog. I have a habit of neglecting my blog when things get stressful but now that I am on a lighter schedule, I've decided to write a series that was inspired by one follower's request. My school provides a guide on each required rotation but I still feel that I don't know what to expect when it comes to a rotation. How should I approach my preceptor? How is the style of asking history and physicals different on this rotation? What should I expect to do on this rotation?

Although everyone's experience will be different depending on location of rotation, preceptor, schedule, etc. I wanted to write a blog on my experiences in each of my rotations so that you guys can have a way to compare your experiences. If you have any tips, I'd love to add them to the blog. I found it really helpful to ask my peers what they did during their rotations so I could have an idea what to expect.

Today's blog will feature my experience in rural Family Medicine.

Length of Rotation: 8 weeks
Location: Rural West Virginia, 6 room clinic
Environment: 1-2 doctors, 2-4 nurses; 2-4 patients an hour
Attire: business casual/professional. I wore blouses with dress capri/pants and loved my comfy Payless Shoes everyday.
Types of Patients: Medicare/Medicare patients, adult wellness exams, minimal acute care, chronic issues
Schedule Type: Routine Monday-Friday from 8am-5pm with free weekends

Things that were expected:
  • Taking full history and physicals of adults (rarely children)
  • Completing wellness exams (asking about vaccinations, colonoscopies, mammograms, surgical history, medical history, medications, etc.)
  • Write SOAP notes (subjective, objective, assessment, and plan) 

What it was like daily: 
  • Show up to clinic 15 minutes before my preceptor to log into the EHR and look at the types of patients that day.
  • On the first initial day of every rotation, I like to shadow the doc to get an idea of how they do their history and physicals. Every rotation differs in what you ask and what you perform.
  • I would go into every patient room and depending on the chief complaint, I would do a history and physical. Many of my patients were wellness exams so many of my questions involved asking about vaccinations, colonoscopies, mammograms, etc. I ended up doing modified physicals according to my preceptor's preferences.
  • I was fortunate enough to be able to write entire SOAP notes while in the room with the patient. This would continue until noon and then I would have lunch.
  • Patients would resume until 5pm.
  • I would be home by 6pm, eat dinner, and read/study for 1-2 hours a night.

Things I learned: I learned a lot about chronic issues like hypertension, diabetes, chronic pain, etc. This rotation was really good in the sense that it eases you from didactic years to clinical years. I used a lot of my mnemonics for history and physicals and I was able to have full conversations with patients. For me, everyday was very much the same, dealing with patients and their chronic issues and medications. Being in rural WV, I did not get much variability. I was able to draw some blood and give shots but it was not very procedure-heavy.

Things I wish I could have done more of:
  • I wish I asked more questions to my preceptor and wish I asked the nurses to do more blood draws and vaccinations. Family medicine can be slower pace than other rotations so it is to your advantage to do any procedures that occur. 
  • Read more and maybe take my shelf exam more seriously (it was hard to jump back into studying after boards)

Resources used for shelf exam:
  • Med U cases (great for wellness exams)
  • COMBANK COMAT questions 
  • Case Files Family Medicine

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