Of all of my rotations thus far, ambulatory care has afforded me the ability to integrate everything that I have learned from my previous 4 rotations and to continue to build my skillset. My fifth rotation was ambulatory care which I did at AG Urgent Care an urgent care and primary care practice in an underserved part of Brooklyn. Most of the patients that came to the clinic were on some form of government subsidized healthcare. One of the most difficult aspects of my rotation was grappling with the frustration I felt on behalf of my patients, many of whom were forced to wait months in order to see their ob/gyn for a pressing gynecological matter or weeks to get in to see a pediatrician for an acute fever or rash which is why many of them presented to the urgent care. On the one hand it was great exposure for me because I had the opportunity to treat many different types of patients, but on the other it was difficult to know that rather than seeing the appropriate provider given their complaint they were told to go to urgent care. I did my very best to apply my knowledge thus far to give each of them the best care I could given their presenting complaint.

I was given a lot of autonomy during this rotation. Most days I had my own exam room or was paired with another student. I would call patients back, elicit a history, perform the appropriate exam, write the note, consult with the provider on my assessment and plan and then put my plan into action. At first I was terrified of this format, but quickly found that it forced me to begin the transition from student to provider while still having the safety net of my on-site preceptor. By practicing this way I strengthened what I have been weakest at in the past – my assessment and plan while familiarizing myself not only with the appropriate medications to prescribe but their dosages as well.

As I mentioned above I was able to draw on the skills and knowledge that I have accumulated over my last 4 rotations. I did many pelvic exams and drew blood for STI screenings, I looked into many screaming babys’ throats and ears, I did splinting and suturing and sometimes saw patients who were new in town and needed a simple medication refill. Granted many of the cases that I saw at AG were less acute than those I have seen in my other rotations, but this provided a great opportunity for me to become comfortable seeing and formulating a plan for my patients. I was actually fortunate enough to be able to follow up with a handful of patients during my rotation which gave me a good understanding of the continuum of care. While I don’t see myself working in family practice or urgent care in the future (I prefer more complicated patient management and procedural work) I truly did enjoy this rotation which was a bit of a surprise for me. The patient interactions I enjoyed most were those related to women’s health. This is unsurprising given my general interest in gyn, but I found patient education whether family planning, contraceptive methods, or safe sex practices particularly gratifying in the patient population where I was working. I found that my patients were generally receptive and grateful for the counseling that I provided and the interactions were usually positive for both myself and the patient.

My greatest struggle during this rotation was typically centered around medication selection and dosage for my patients and is where I sought the most input from my preceptors. What I found is that each practitioner has their own medication/dosage that they prefer for each diagnosis. Some providers preferred a shorter regimen as they felt that ensured better patient compliance while other clinicians would give a longer course because they felt that gave better coverage. I realize that this is something that will come with practice, but in the meantime I have been focusing more on the dosages and indications for medications. Up to this point I hardly ever look at dosing information – it’s not on our boards right – but this rotation showed me that although I may not need to know this for my exams I will for practice so I might as well start now.

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