LTC Rotation #2- Gouverneur Rotation Reflection Rubric and Guidance 

• Exposure to new techniques or treatment strategies – I was exposed to a variety of new treatments that I had not known about before. For example, we had a patient who used a “life-vest”, a wearable cardioverter defibrillator with an external vest dynamically detecting and correcting arrhythmias (1). It has a continuous ECG which automatically alerts the patient if he/she goes into ventricular tachycardia or ventricular fibrillation. It sounds an alarm allowing the patient to respond if he or she is conscious, if not, however, then a warning will sound and a shock will be given (2). I also got the opportunity to do CPR on a patient! She coded and I worked with the EMS team to resuscitate her! She was resuscitated and transferred an ED, but it was a unique experience for me to work with others as a team to save her life. I have never been in a successful CPR before. 
• Interpersonal challenges and how you addressed them– I did not have too many issues with any personality differences, but there were many times when I had a language barrier. I used a variety of methods to address them– primarily the language line.
• Skills or situations that are difficult for you (e.g. presentations, focused H&Ps, performing specific types of procedures or specialized interview/pt. education situations) and how you can get better at them. I did address this in rotation review, presentations have always been an issue for me, even when I do practice. After speaking with Dr. Davidson, I contacted other students for templates and now have them for future use. Another issue I had was that a patient was unaware of the severity of a breast cancer diagnosis (with mets), and the patient asked me why “doctors keep coming in and touching her breasts”. This was a difficult situation, as I was unaware of what to do as a student– I did not want to step onto anyone elses toes. I told the doctor and he re-entered the room, but now I know to follow some of the SPIKES protocol to see how much she understood/knew about her diagnosis.
• Types of patients you found challenging in this rotation and what you learned about dealing with them. The hardest patient aspect of this rotation was that many of the patients had various co-morbidities complicating their current diagnosis, but were unable to express themselves due to a language barrier. I often had to wait for the language line in order to give them the best possible care, but I learned that they really appreciated the extra effort. Another challenging part of this rotation were the many sad stories of elderly abuse/exploitation heard from our patients; this just gave me even more strength to push forward to ensure that each patient got the resources he or she needed.
• How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc).  I have a newfound appreciation for my ability to ambulate after seeing how difficult it is for some–limiting independence. I also now know that any advanced directive I sign will be DNR.
• What was a memorable patient or experience that I’ll carry with me? I met a woman who had a b/l below the knee amputation for uncontrolled diabetic neuropathy/osteomyelitis. At first, she was in denial and agitated to be in the hospital; however, after speaking with her, I found out that she was actually scared and was probably acting out in fear. 
• How could the knowledge I’ve gained here be applicable in other rotations/disciplines? I have learned to comb through patient history so carefully, because you cannot miss any clues which may be pertinent to the patient’s health later on. For example, we had a patient that had been recently incarcerated for possession, but I forgot to ask for which drug. Though he denied drug use for the last 2 years, some drugs put him at an increased risk of other issues, so I must not forget to ask these questions. 

• How was the way I did my work different from how other people did theirs? I spent a lot more time with my patients than others did, which is okay as a student but I must make sure to keep time while in practice so that I do not fall behind.
• What one thing would you want the preceptor or other colleagues to notice about your work in this rotation? I know that the preceptor knows that I was eager to learn and would go the extra mile to help my team and patients. 
• What do you want to improve on for the following rotations? What is your action plan to accomplish that? I am going to surgery next, so my plan is to read up on the surgery for the next day the night before. I also want to be more confident in myself, and I think more preparation will help to do that. I may also practice speaking in front of a mirror. 
• What did you learn about yourself during this 5-week rotation? I was surprised at how much I did knew, even though I felt unconfident at the time. I need to be more confident in myself!

Resources:

1. Wearable Defibrillator Cuts Overall Mortality, But Not Sudden Deaths After Heart Attack. (2018, March 13). Retrieved from https://www.dicardiology.com/content/wearable-defibrillator-cuts-overall-mortality-not-sudden-deaths-after-heart-attack
2. LifeVest. (n.d.). Retrieved from https://my.clevelandclinic.org/health/treatments/17173-lifevest