Recommend a PA Elective

[Febrifuge]

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Hi, all. Long-time contributor here, looking for some opinions. Don't worry; you won't ruin my life by making a suggestion. Please don't be shy with opinions.

I have somehow found myself in the final 8 weeks of my didactic training(!). My clinical rotations start in May. As it stands now, I have my six required rotations lined up, and one of my electives is set (all rotations are 6 weeks, and the final one is an 8-week preceptorship; kind of like a Sub-I). Here's how it looks:

1) Internal Medicine
2) Peds
3) OB/ GYN
4) General Surgery (at a gun-and-knife-club hospital)
5) Family Med
6) EM (Level One Trauma, county hospital, urban)

7) Trauma (Level One, urban, this is my first elective)

8) TBD​

So, clearly this is the list of a former ER Tech who feels fairly sure he's going into EM. (Furthermore, I have nothing against Urgent Care, and don't really mind the quasi-primary care nature of EM at times... I just don't want to spend my life in Fast Track.) So far, so good.

The question is what to do with that last 8-week spot. I have a few choices:

• Something fun, maybe involving warm weather (this will be taking place one year from right now)
  
• Radiology or Interventional Rads, with the theory that I'll become scary-good with anatomy, procedures, and imaging... especially US, since in my home ED we are all about that
  
• Hanging out with a wise old IM doc friend of the family, who is very much an Osler disciple; I'd learn a ton, and it would be a nice way to concentrate on old-school history and exam stuff
  
• Heading back to my hometown, where my job search will take place (of note, #6 will already be at home).

Anything jump out as the best choice? Or is there a "none of the above" I should be including? As a PA S-2, I'll have a lot less exposure to some areas than an MS3/ MS4 would (no specific, dedicated Neuro, Cards, or Psych time, for example). Are there huge gaps you can see that I'd need to work back home?

If it helps to focus, let's assume there are two goals: carry my share at the county tertiary care hospital (within 4-6 mos of starting), and solo cover a suburban 20-bed ED, with MD supervision a phone call away (within two or three years).

 

[Chronic Student]

The best advice I could give is concentrate on an area where you are weak or the least comfortable.

The other thing to do would be to look at a list of the top diagnoses in the ER and pick a rotation based on what you are most likely to see (i.e. cardiology, ortho, etc.).

 

[plasticcigar]

Hi, all. Long-time contributor here, looking for some opinions. Don't worry; you won't ruin my life by making a suggestion. Please don't be shy with opinions.

I have somehow found myself in the final 8 weeks of my didactic training(!). My clinical rotations start in May. As it stands now, I have my six required rotations lined up, and one of my electives is set (all rotations are 6 weeks, and the final one is an 8-week preceptorship; kind of like a Sub-I). Here's how it looks:

1) Internal Medicine
2) Peds
3) OB/ GYN
4) General Surgery (at a gun-and-knife-club hospital)
5) Family Med
6) EM (Level One Trauma, county hospital, urban)

7) Trauma (Level One, urban, this is my first elective)

8) TBD​

So, clearly this is the list of a former ER Tech who feels fairly sure he's going into EM. (Furthermore, I have nothing against Urgent Care, and don't really mind the quasi-primary care nature of EM at times... I just don't want to spend my life in Fast Track.) So far, so good.

The question is what to do with that last 8-week spot. I have a few choices:

• Something fun, maybe involving warm weather (this will be taking place one year from right now)
  
• Radiology or Interventional Rads, with the theory that I'll become scary-good with anatomy, procedures, and imaging... especially US, since in my home ED we are all about that
  
• Hanging out with a wise old IM doc friend of the family, who is very much an Osler disciple; I'd learn a ton, and it would be a nice way to concentrate on old-school history and exam stuff
  
• Heading back to my hometown, where my job search will take place (of note, #6 will already be at home).

Anything jump out as the best choice? Or is there a "none of the above" I should be including? As a PA S-2, I'll have a lot less exposure to some areas than an MS3/ MS4 would (no specific, dedicated Neuro, Cards, or Psych time, for example). Are there huge gaps you can see that I'd need to work back home?

If it helps to focus, let's assume there are two goals: carry my share at the county tertiary care hospital (within 4-6 mos of starting), and solo cover a suburban 20-bed ED, with MD supervision a phone call away (within two or three years).

i would recommend neuro or an ultrasound elective (radiology might be very dissapointing if you're looking to brush up on anatomy. if you want to get good at ultrasound, do ultrasound).

as far as neuro, based on my limited experience PA's tend to be a little lacking in this. not to bash PA programs at all, i had PAs in many of my med school classes and they were at least as bright as the med students, often with more clinical experience, but it just seems like you don't get a lot of neuro in PA training and it really is one of those things that can bite you in the a** if you don't know how to do it well.

 

[Febrifuge]

Good advice; thank you both!

And yeah, we had a Neuro unit in the big systems-based class, but while we have a specific course for OB, Peds, Geri, and EM, we don't have anything really set aside for Neuro.

Keep it coming, everyone. Hopefully my brilliant thread title doesn't make it sound like I'm talking about Pennsylvania...

 

[deleted6669]

feb- neuro is a good idea...I would also add inpt psych....you see a lot of folks in practice with psych disorders and having a handle on the most serious ones is always a bonus, especially in em...sounds like your rotation schedule is similar to mine. I did:

trauma surgery
inpt IM
obgyn
peds em
community hospital em
trauma ctr em
inpt psych
fp

total 54 weeks and > 2500 hrs

 

[primadonna22274]

Feb, do inpatient critical care. I had the opportunity to do it but chose outpatient endocrine instead and always wished I had taken the critical care. Particularly if you are going to be in the ED it would be really helpful to be comfortable with really sick and all the machines & stuff.
Good luck.
L.

 

[Febrifuge]

So, the suggestions so far include:

Neuro
Cards
Ortho
Inpatient Psych
Critical Care/ ICU

I have an interest in Addiction Med/ Detox, so I wonder if that might be handy later on...

As far as Emergency US specifically, my clinical coordinator has been out of school for a little but, and isn't an ER person, and so doesn't really get why anyone would want to do 100 bedside ultrasounds in 4 weeks... "will you really be doing those?"... but the IR thing is still on the table, and it seems like it covers a lot of CT reading, US-guided biopsies and drainage, plus even some FASTs.

There's plenty of time to decide, but it's good to let the wheels turn a little. Keep it coming, folks, and I really appreciate it. Thanks.

 

[kungfufishing]

What about regular old radiology?

How good are you at eye complaints?

Cards?


Kids?