For my ninth (and final!) rotation, I worked in the Queens Hospital Center Psychiatric Emergency Room.  As I shared with many people in advance of the rotation, I was nervous and frankly not looking forward to it for fear of the sad situations I would inevitably encounter.  I was more than pleasantly surprised with this rotation and I wound up really enjoying myself over the course of the five week period.  Amil Alie, our psychiatry professor, was also my preceptor for this rotation and he and the other PAs and physicians I worked with made the experience very enjoyable.

I was not sure what to expect during the rotation and shared these concerns with PA Alie during my first week.  I knew there would be many patients we’d see in the ED setting that were malingering and looking to stay overnight in the shelter and I thought I wouldn’t be able to decipher between those patients and those that really needed support.  This unknown made me very anxious but I found the providers I worked with in CPEP extremely welcoming and willing to discuss their patients with me to help me build / improve upon this skill set.

As this was my ninth rotation, it was expected that I was able to interview patients and complete an HPI without much guidance.  That said, psychiatric HPIs are slightly different and require additional contextual information to help provide the necessary context in making a diagnosis and obtaining relevant information to the patients.  After a few days of working with PA Alie and PA Mondal, I understood this style and what was needed in order to provide the level of detail for CPEP patients and I was trusted to write HPIs on the patient’s I’d interview either in CPEP triage or as consults in the medical ED.

Queens Hospital has a pediatric psychiatric emergency room, which surprised me as it was something I’d not thought about prior to coming to this rotation.  Given my interest in pediatrics is well-known, I informed the providers that I would be happy to see pediatric patients when they presented to the hospital.  Not surprisingly, some of these patients had horrifying stories, that you wouldn’t wish on your worst enemy, but I was proud to be a part of their care in aiding them to feel better.

The schedule I had over the five weeks was different than most of the other rotations I’d experienced and I really enjoyed the versatility of this fact.  I worked from 4PM – 12AM Monday through Wednesday and 8AM – 4PM on Thursday and Friday.  The schedule allowed us (as students) to see how both the day shifts and evening shifts work and the different roles the PA have within the team.  During the day shifts, we (as students) didn’t always have access to the computer, which made it more challenging to do an adequate chart review and include these findings in the HPI.  The day shift has more physicians working and we were often paired up with these doctors to help them see patients and formulate dispositions and plans after morning rounds.  In the evening, there is one attending in house and the other providers are PAs caring for the patients.  In the evening, providers are responsible for managing the patients present from the day shift and seeing any new consults that come in overnight.  That said, given less providers work overnight, we were able to access the computers and review the patients chart prior to seeing them in triage or the medical ED.

I truly enjoyed this rotation more than I ever thought I would.  I learned a lot of psychiatry here and was fortunate enough to see some concepts we learned about in the abstract in person.  A lot of the psychiatric medications and their subsequent side effects were confusing to me prior to starting this rotation and I found seeing how the medications were used in practice extremely helpful for associating side effects and monitoring techniques / strategies.  We were fully integrated into the team at QHC and expected to provide feedback and insight into our patients alongside the providers.  Ultimately, this rotation was a great one and I would recommend it to other students even if they are not interested in psychiatry.  It was a great opportunity to see patients and hone my skills as I begin my career as a PA.

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