Final Reflection

Sierra Teegarden

Clinical Correlations Reflection Paper 3

Over the course of the semester, my differential diagnosis has become more focused and is listed in accordance with most life threatening and most likely. At the beginning of the semester, the differential had more “zebras” listed without much organization to it. My presentations have become more concise. In the beginning, I would try to include as much information as possible about the subject, but my presentations were too long and included a lot of “fluff” that distracted from the main take away of the topic. My methodology by the end of the semester was to present disease processes in the following order with the highest yield information only: pathology  patient presentation  diagnosis  treatment  and any additional “follow up” details. For other topics, I complete a variation of this format to keep the flow consistent. My research for most topics has stayed consistent, as I primarily use UpToDate because it is an evidence-based resource that usually helps me understand the information better than other resources. I have used the “PICO” format to look for a few topics that did not have direct answers towards the end of the semester because now I feel more comfortable identifying a good study vs one that is not reliable based on what I have learned in our evidence-based medicine course. My collaborative skills have improved substantially but there is still room for growth. I have become better about allowing for silence so that my colleagues can share their input and listening more to their opinions to help guide my clinical thinking. Overall, I think I have identified my primary weaknesses and made improvements in all the areas that clinical correlations calls upon, and I will continue to work on these areas for future growth.

Content & Focus: 90% (Between Proficient and Developing)

At this point, I can recite OLDCARTS quickly and move through each stage of the patient interview quickly and accurately. However, I initially struggled with the trauma cases where a patient interview was not possible and immediate intervention was needed. By the end of the round, I feel more comfortable with the steps for those scenarios: stabilize with ABCs then manage which starts with ruling in or out life-threatening conditions. I also have room for improvement with learning how to write orders, but overall, I believe the orders were thorough with only a few corrections needed. My sources of evidence always come from UpToDate, Lexicomp, ACLS guidelines, or other credible sources that maintain current practice guidelines.

Logic & Flow: 100% (Proficient)

I presented 2nd generation antipsychotics and post-ROSC management with the use of handwritten flow charts and other visual aids on the discussion board that depicted the most pertinent info in an organized fashion. For example, the atypical antipsychotics started with pathology, then discussed 1st gens that treated the symptoms related to that pathology and tied their most common/severe side effects back to that same pathology. That order set the platform to discuss why atypical antipsychotics were developed and how they work on in relation to symptoms and side effects. At the end of the handout, I included clinical reasoning for choosing one drug over another. The logic I presented ties each drug and their respective indication and side effects back to the pathology of psychosis.

Analysis: 95% (Almost Proficient)

For most scenarios, I was able to analyze the information given and decide on the next appropriate step in management. However, I often struggle with the details of the decisions. For instance, I was able to quickly analyze the ABG for the ventilated patient and identify that he needed potassium replacement and that it would have to be IV because he was intubated. However, I did not know how to calculate the rate of replacement for that patient. The same held true for not knowing how to calculate the maintenance fluids regarding his body weight. After the session for that day, I was able to look it up and include it as part of my presenting orders for the following session. This is a skill I now feel comfortable with.

Communication/Collaboration: 95% (Between Developing and Proficient)

I felt comfortable communicating with our patients (in the scenarios where they were conscious). I captured all the information presented, reflected upon it, and then contributed to the management of each patient appropriately. Regarding communication and collaboration with my colleagues, I am still developing but have made improvements over the course of the semester. At the beginning, I noticed that my eagerness would either interrupt another student or dominate the interview. This still happens from time to time, but to a lesser extent. Overall, I have learned to be more thoughtful with spacing out the time between giving input and becoming comfortable with a few moments of silence to allow other classmates a chance to answer. What I have gained from doing this is the value of my classmate’s input which often gives me additional knowledge or insight that I would have otherwise not had the opportunity to listen to.