For my first evaluation, I had the pleasure to present to PA Combs. This was the first time anyone had asked me to present without looking at my history and physical. I was caught off guard. However, because it was a case that I was interested in, I remembered what I had documented and, in my opinion, I did fairly well. Mr. Combs informed me that in real life we would not have documents in front of us telling us what is going on with the patient, and that I should be comfortable presenting a patient that I encountered and chose to present. He was right. One criticism I would have for myself would be that I forgot to mention some key point about a neurological exam, which was very relevant to the patient, considering that she was having a stroke. Besides that, the advice that I received was that, it should have not taken me as long as it did to present the patient. I guess I said a lot of irrelevant information that did not pertain to the patient’s condition at the moment. Another suggestion that was made was that I should wider differential when it came to the patient. My particular patient, that I chose to present, was having an obvious stroke, and because of this, I did not find any reason to think of other differentials. My evaluator explained that internal medicine is more than just the obvious, it’s about understanding the consequence of details and how it could affect the patient. I presented my pharm cards as required, and overall I felt like I did a fair job.

For my final site evaluation, I again was assigned to Mr. Combs. I had decided to present a case which had broadened my differential diagnosis, so I chose a patient that had many co-morbidities, was on many medications, and came in for acute renal injury due to consistent diarrhea and vomiting. I think I did fairly well in presenting this patient because this time I knew that I had to memorize what I had to present. There were still some slip-ups on my end, for example, the patient was on an anti-epileptic medication, and I could not remember the name of it at all. Mr. Combs was generous enough to help me out when I had these moment’s where I either forgot something or I did not know what to say. One of the more constructive criticisms I received pertained to my history and physical, in which how I described the patient did not match up with what was written. I described the patient as paralyzed however, able to move extremities on demand, which does not make any sense. I should have said that the patient was extremely weak on all extremities. As for my article that I had to present, which had to be relevant to the case, I chose to present an article that spoke about the dangers of using bisphosphonates in patients with multiple myeloma, leading to chronic kidney disease. I did not have much of an interest in this topic and did not fully do my research on this topic, so when questioned on this article, I did not have the answer. My evaluator as nice enough to let me look up the answer and come back and present it the next day, when I had the chance, as I did. For future case presentations, I will make sure I do my homework before presenting, making sure I know the basics of the medicine behind the case.

Overall, I believe this site rotation has changed my method of presenting. I liked the idea of presenting without a paper to look at, which really made me focus on presenting the most pertinent information. My evaluator was also extremely helpful, as we discussed the pathophysiology about certain diseases, and he helped explain some basic concepts that I had forgotten. I hope from this rotation on, I will be more comfortable in presenting cases and patients, bettering my performance.

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