My last rotation was long term care at the VA hospital in St. Albans. In many ways it was the perfect end to my clinical year – the schedule was reasonable, my patient evaluations were unhurried and I was able to take my time working on my physical exam, there were a number of clinics I could join during the week to get some specialty experience. That being said, for me the rotation did not add anything to increase my understanding of medicine. It was not particularly challenging and for someone like myself who enjoys the frenetic energy of the ED and ICU it could be a little boring at times.

Nevertheless, I took every opportunity that came my way in this rotation as I have with those before it and did my best to get everything I could out of my time at the VA. What I enjoyed most about my time in long term care was speaking with my patients. So many of them had such interesting stories and were always happy to have a long chat with me about their many interests and life accomplishments. As I mentioned above, I tend to enjoy more intense environments when it comes to medicine where my patient interview is rushed and I have to focus on the salient aspects of my patient’s medical history without having an actual conversation. It was refreshing to be able to get to know my patients on a more personal level.

The specialty clinics offered were helpful to break up my day. The urologist was extremely knowledgeable and a very good teacher especially when it came to various prostate cancer treatment regimens. There was also a vascular clinic where the physician was great at explaining and demonstrating the importance of a good physical exam, but because of the time I spent working for a vascular surgeon before PA school I found much of my experience there to be redundant. The only drawback to these clinics is that I found myself in more of an observation role rather than actually performing the history and physical.

I definitely still have areas of weakness that I continued to do my best to improve upon during this rotation. My muscluskeletal and neuro exams are still works in progress. Fortunately, I was able to take my time in examining my patients and so got good practice in incorporating the important parts of those exams more fluidly into my own exam. As expected my assessment and plan need work but I do feel like I continue to make progress in this area and I expect that I will continue to do so for many years to come.

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