If you’re reading this then you know as well as I do that the way of life prior to COVID no longer exists. Similarly, the medical landscape is no different and has changed in just about every aspect. Unfortunately these changes have delayed or impacted you/students either by shortening the length of duration at rotation sites or even worse + a canceled rotation + forced to learn patient encounters virtually.
Now it’s become such a time of complete uncertainty for you and nerve-wracking to say the least for those of you really hoping to get some sort of experience in before seeing patients in real life. All completely valid feelings.
Here’s one thing that I’m sure of: you have the opportunity to be an even better provider because of it.
….Read that again.
Yes, it might sound ridiculous & yes, I really do believe this…
Why? Because despite the lack of bedside experience, you have one thing that everyone wished they had in PA school… TIME!

At the end of the day, a great provider is not great because he/she had incredible rotation sites or went to a better program. They are great because they fully commit and do more than what’s expected of them.

 Each day brings new challenges and as a provider you have to be ready to not only face them, but anticipate when they may arise too. COVID is one of those challenges & overcoming the daily curveballs thrown your way will only make you better.

Improvise, Adapt, and Overcome.

You’ll need to apply these steps to succeed in Clinicals (esp. during COVID and for the rest of life’s hurdles too)
Just know, your feelings of uncertainty during this time are just a part of your growth in becoming a provider. Stay fully committed to your future patients & utilize this time of preparation for the day you will be expected to perform.

Before we jump in – let’s face it, whether its learning medicine or not; there’s nothing in life that will teach you anything quite like experiencing it for yourself. Clinical rotation experiences are no different when adjusting to patient interactions and gaining bedside experience.

In the pre-COVID era, PA programs typically have about nine different 6 week rotations which include your core rotations plus an elective (or two) of your choice! But now in 2020, thousands of students currently are experiencing either a canceled rotation site, a shortened rotation, or limited hands-on opportunities due to new contact precautions in effort to minimize exposures.

Wherever you find yourself headed for rotations, it’s important to approach each rotation with a fresh set of eyes & an open mind to potentially working in each of the specialties you’ll be placed for the next year

– So, soak up the experiences and have fun in the process! This will be the ONLY opportunity you’ll be given that serves a specific purpose to lead you through each specialty without committing contractually, with a preceptor to guide you. After this, it’ll be up to you to find these opportunities to ‘test the waters’ of a new specialty (but instead, you’ll be a licensed provider with more expectations)

Whether the fact that you will be seeing your own patients has sunk in yet or not – it’s right around the corner and rotations are the last time you’ll be guaranteed this fostered learning environment where your preceptor is expecting  you to ask questions – so utilize each day appropriately!

1. Learn what you can change, what you can’t change, & how to navigate the two:

When prepping for your rotation it’s important to not only have the right materials, but the right mindset as well.
You will adapt and learn more during this time if you go into it with an approach that welcomes change and leaves all prior expectations behind. I mean it is 2020 after all – anything is possible, Haha. So, my advice to you is to try and shift your perspective into focusing on the aspects of things you CAN change and come to peace with those you can’t.
Realize that there will be countless factors you will encounter within the hospitals/clinics that you simply cannot & will not be able to change – including the outcome of someone’s health. In fact, this year of clinicals may be your first exposure to death and dying, to unjust circumstances or hardships your patient’s have encountered, or giving a terminal prognosis to someone.
You will experience so much in such a little time- let it mold you into a better provider because of it.
You must remember that your perspective on life & your patient’s perspective will often be quite different. The definition of life often means something different to each of us and it’s not our job to change their mind/opinion.
The key take away from the situations we cannot change is how we allow it to motivate us to be the provider who advocates for their patients to the best of our ability.

2.  The stress that makes you grow: 

Be aware of your stress levels and how you respond. Clinical year is amazing because you get to apply alllll that you covered in didactic- but it can also illicit a new kind of stress! Here’s my personal take on stress as a student or even as a new grad: it makes you grow.
Whether you want to or not, you’ll be learning something.
The stress and anxiety that occurs when caring for patients is neither ‘good’ or ‘bad’— IF you are aware of it & manage this in a healthy way. I once heard a phrase that says “stress makes you grow and anything else doesn’t”…. if you aren’t stressed enough, the mind will become bored, resulting in little to no growth. Whereas too much stress typically induces panic. Leaving you in a survival mode only with no growth.
Learn to push yourself to your limitsLearn to push the borders of your abilities for the sake of growth and how to spot (and then change) the types of environments where you are not growing, because this season you’re in is made to be a time of growth. At no other time will you have the supervision and ability to try, to fail, and to grow as in your rotations. Don’t squander it!

3. Know what’s expected of you before you begin:

Contact your preceptor roughly 1-2 weeks before your rotation begins (or if you’re notified last minute because of COVID- do what you can) via email or phone and introduce yourself. There’s a chance they’ll be expecting you & reaching out beforehand demonstrates eagerness & responsibility to learn from them!
Things to ask at this time include: what the overall schedule of their week looks like, what attire is expected for clinic/hospital/where to get your OR approved scrubs at, where to meet the first day, the expectations for students before/after your shifts (this including rounding on their patients)
– This is important during this time since patients belonging to your services/specialty may be on floors dedicated to COVID (+) patients, PPE could be limited at your facility, the hospital could have new protocols for students, etc.
– Sometime on your first day, put feelers out to see how your preceptor prefers you ask questions / how comfortable they are with you having hands-on patient interactions

4. Have a study plan for EORs:

This isn’t like didactic year & you’re going to be exhausted by the amount of thinking you’ll be doing after your days on clinical rotation sites! If you still have the typical 6 week rotation, I would be sure to have a study plan by the end of the first week (if yours is shorter I would consider making this once you find out your schedule). Going from multiple exams each week to only one final exam at the end of the rotation will make procrastinating studying something you’ll need to actively avoid.
To help you keep the pace without cramming for your EOR, make a study guide on a calendar to help coordinate which topics you’ll cover each day.

Gather resources such as:

–       The EOR Blueprint & Topic List by PAEA: Linked Here I highly recommend going through these and incorporating which topics you’ll cover on a given day. I will discuss in much more detail on how to study for EORs in Part 2 / 3 of this series, but for now you can also check out my blog here where I elaborated a bit more when I was on my General Surgery rotation.
–       Physical Books/Resources that would be helpful for keeping on hand so you aren’t always on your phone if given the opportunity to study if you find free time at your site.
–       Mobile Apps that are Easily Accessible: I use UpToDate every single day, it’s my go-to Bible for all things medical. Other apps I have found useful include: DrawMD, Medscape, Epocrates, and MedCalX

[ More helpful resources will be linked at the bottom of this post ] 

Approaching the PAEA Blueprint from scratch at the beginning can be overwhelming and intimidating.
I always suggest beginning with either printing the EOR blueprint out or copying it over to a frequently accessed document so you can organize the larger topics + prioritize diseases you haven’t covered yet that you might feel uncomfortable with FIRST to maximize exposure to the information.
THEN applying this foundation of diagnoses you want to be sure to touch with supplementation using the EOR blueprint to guide you through topics based on the percentage PAEA uses to assess.
During the specified rotation period, I planned to read up as much as possible on the heavy hitting topics that I know I’d be seeing on the EOR (based on these PAEA percentiles) and combined this with diagnoses that patients were often coming in with.
When doing this, I’d create a ‘disease sheet’ (formatted as: presentation, signs/symptoms, diagnostic labs/rads, and treatment options with special caveats to aid in memory when I would come back to review) for each given disease process.
For example, if we were seeing a patient with an aortic aneurysm, I would make sure I studied this topic prior to seeing the patient (when applicable) and then I would be sure to make notes on my ‘disease sheets’ on the topic to help solidify the disease process (& have written to review thereafter).
Associating a specific disorder with a patient encounter & treatment process will amaze you at how long it will stick to your memory!

5. Prepare your Attire:

But also, don’t break the bank and definitely make sure you’re comfortable & presentable! When new to the site, I would just expect to dress as business casual under your student white coat + badge unless given permission to wear scrubs by your preceptor (ya know…in that email I suggested you send before beginning 😉 I personally stuck to neutral colors until I determined the type of atmosphere I’d be working in.
For example, most of my business casual wear was a nice pair of chinos (linked in my likeittoknowit below) with a conservative/ low-key business casual top (also linked) until I could get a better idea of the environment I’d be in.

What to wear in clinic setting / inpatient medicine: Most of medicine is a messy place and though you may not be on your surgical rotation or expecting to encounter blood every day – don’t wear your most loved light linens or white shoes because these are definitely going to get stained. I went ahead and provided you (click photo above) with some examples of outfits I have either bought myself or thought looked appropriate for clinic setting! I made sure to include examples that would be cost effective for the sake of student loans! If you’re looking for menswear, less feminine looks, or want a larger variety- just request another post below & I’d be happy to provide! This is simply to give you an idea of what I personally wore on my rotations to get your started 🙂
Looking for scrubs? You already know I’m a huge fan of FIGS- if you want to save some $$ on your next set, use my code “FIGSXAshleyKay” and share with your colleagues!
[Disclaimer: I don’t make any sort of commission based off your purchase using my code, I just simply love the brand & want you to experience that, too!]

6. Planning food/meals

Until you get a solid start on your rotations, it’s a good idea to pack a lunch and snacks to hold you over until you know when it’s okay to leave campus or leave to grab food elsewhere. I packed my lunch for just about every rotation (unless it had a docs lounge) because the last thing I want to expend energy on is figuring out where to find food when I’m mentally exhausted (& likely pretty hangry, Lol).
When prepping for the week, my go-to for breakfast was a protein bar or oatmeal in a to-go cup. For lunch and/or dinner, I’d prepare a big one-pan dish on Sunday night to get me through most of the week- including: chicken, veggies, and sweet potatoes.
If we’re being honest, I low key stuffed food from the docs lounge in my white-coat pockets & basically lived off this 2nd year when I didn’t get time to make my meals on Sunday. Lol
Also Note: This is frowned upon and I definitely will not take credit for advising this, but don’t sleep on it fam!

7.  Get Involved & Take Advantage of ALL Opportunities:

Here’s the thing, any student who demonstrates eagerness to be an active role in the patient’s care (even with the mundane / simple tasks that may seem like scut work), will be 100xs more likely to be invited to do procedures that are more complex and will get more experience.
Students need practice – end of story.
So regardless if you think you’re proficient at suturing or splinting an injury, do it again & willingly!
Pro Tip: show up early & stay until everything is done (even if they say it’s okay to go), always ask your preceptor if there is anything left that you could assist with or be of help for before leaving each day, and never leave without an approval or responsibilities left to be completed.

Honestly, most of the amazing experiences that I had on rotations were all because I stepped up and asked “Hey I’d love to do this for you!” or “Would it be okay if I do XYZ with the next patient? I’ve never done it before and think it would be great experience!” Yes, all new procedures can be scary…but fake it till you make it!
You will never be proficient at anything until you do it several times. So, proceed with confidence even if your hands shake (between you & me: mine still shake at times when my surgeons watch me close up)
Pro Tip: You will have moments when your preceptor asks you a question that you will not know or did not ask during your patient encounter (it’s inevitable) ** Instead of making up an answer, just be honest and say “I did not ask the patient that” Just be sure learn from that mistake and try not to make the same mistake twice. Similarly, if you don’t know the answer to question (& can’t even guess a close answer) follow your “I don’t know” with “but I will look it up and tell you tomorrow!” **Engrave this tip into your memory because this is what your preceptor expects from you if you don’t know !

8. Always ask for help, but be cognizant of the timing & delivery that you ask: 

First things first: Always ask for help if you aren’t sure how to proceed with a task …medical errors happen very often & your pride is not worth the damage you are capable of doing without proper guidance.
And remember: you’re a student It’s literally your job to have a curious mind that’s always learning new things! IMO, it’s always better to make mistakes and ask those “silly” questions as a student versus when you’re practicing and expected to know how to do it.
There are ways to ask for help while not feeling like you’re annoying or bothering your preceptor/attending and it’s all about presentation: they want to know you’re critically thinking and not just being lazy.
So a good way to ask for help or advice with a patient is to present it with the correct approach!
I recommend prefacing your question with “Sorry to bother, but I wanted to run a quick question by you that I had about ABC” *insert question* then immediately (or in the same text) follow your question with stating how you think the situation should be handled based on your research or past experience,
ie: “I’m not sure about ABC given factors X, Y, & Z ”  Using this format of presentation shows your effort in actively trying to be a part of the solution and willingness to participate in the task you’ve been given… but that you need help or haven’t yet experienced a similar situation, too. The attending will be 100% more likely to not only answer your question, but help you in using that situation as teaching point as well.
The most important thing about learning the basics of medicine from a clinical perspective (aside from patient safety) is learning how to recognize recurrent patterns & use past examples of similar patient cases or preferences to help you with future decisions / expectations!
Take note of the explanations you’re given by your preceptor so you can apply it down the road and avoid asking the same question twice.
Expect to not know a lot of things – a lot of the time! + get over it
I mean, that’s why you’re here, right?! Give yourself grace and remember that you cannot possibly know everything about every specialty. The sooner you accept this, the less you’ll doubt yourself when you DO know something!

Phew. That was long! But I purposely tried to make this blog post very comprehensive so that you aren’t left in the dark in any areas of your experience. I really want you to embrace all that rotations serve to teach you & get the most from this year! If you are a student who has been affected by COVID-19 and still don’t have rotation sites- I’m here for you! Though I can’t take any students for rotations right now, I’d love to help in any way possible to make your experience the best it can be given the unfortunate circumstances.
Rotations were my favorite part of school & it gives you a great glimpse into life after PA school! Use this time to observe how each provider is different with his/her own way of conducting their practices, take away qualities you would like to implement for your own practices, and note the qualities that were not so appealing to the yourself and/or patients. Try to figure out what setting you prefer being in (hospital vs. outpatient), and which specialty you enjoy given these experiences. With each rotation, you will begin to feel yourself growing into your soon-to-be role as a physician assistant.
As always I’m happy to answer any questions down below & hope this ease your nerves to begin rotations!

ROTATION RESOURCES I USED:

Pance Prep Pearls: Basically, IYKYK- This book has been a staple for PA students everywhere with it’s bold and italicized essentials of each frequently asked topics. Places emphasis on high-yield information with charts that compare and contrast commonly paired diseases. Simple yet effective layouts to maximize learning and increase retention of difficult topics! If you’ve already bought it & interested to see how I chose to label my PPP in PA school +  how I got it ring bound, click here.

OnlineMedEd: My #1 go-to online source & would HIGHLY recommend if your lecturer just isn’t making sense on a topic. I owe it to Dr.Williams for making it through my PA program- his decision trees and approach to complex topics that I still utilize today. These guys have over 70 + hours of video covering 250+ topics and 19 specialties.

HippoEd: Another site that I would use to review topics that I just didn’t feel too confident in. I’m pretty sure if it weren’t for their quizzes, didactic would’ve been even more gnarly. HippoEd offersentertaining video lectures and written summaries. 2,250+ practice questions covering the complete NCCPA blueprint, filterable by PANCE and PANRE-specific topics. Plus has a built in adaptive Qbank that delivers true-to-test questions to drill your weaknesses. You can try it for free here.

Smarty PANCE and Rotation Exam Review: This site covers information in the same categorical fashion as the PANCE, all based on the PANCE blueprint. They focus on need-to-know information specifically for PA students to prepare you for each level of the PANCE blueprint. Highly recommend (I used to have a discount code, I’ll reach out to them in the meantime to see what I can get for you guys!)

Rosh Review: The most challenging, yet comprehensive question bank. Rosh review gives amazing explanations to their questions banks & have great EOR practice exams you can purchase! I used this site religiously at the end of each rotation to see which topics I needed to spend more time focusing on before my EORs.

Osmosis & Picmonic: I’ve never used these sites, but have heard amazing reviews! They break down topics for visual learners using mnemonics, quizzes, and high-yield notes.

ExamMaster: I also used this site occasionally since we had a subscription through our program & would also use this for test taking in didactic. Another helpful question bank site & if you have a subscription through your program- worth it to use for saving $$. If you don’t have an already existing account, I probably wouldn’t recommend buying this.

+ For those effected by COVID19 who’s rotations are either canceled / have limited bedside experience: Practical Clinical Skills provides free training and reference guides. Their Simulation-based lessons cover heart sounds, murmurs, lung sounds, carotid bruit, blood pressure measurement and EKG training. The quick reference guides are a timely information source at the point of car

Smarty PANCE + ReelDx: This is an amazing feature that I would definitely recommend to those who aren’t getting enough bedside experience. SmartyPANCE also offers four different 60 Questions Interactive Exams

Helpful templates available for download: COMING SOON! For now, click here to link to a few templates I’ve posted in the past!