The first clinical course most people will take is 592A. This is focused on didactic material covering adult to geriatric conditions and the clinical experience to apply this knowledge in practice. In my opinion, this is the easiest clinical rotation so far because most of us have experiencing working with adults. However, this is also the most nerving wracking because it is likely your first clinical experience as an NP. This is usually the easiest clinical to place so I wouldn’t worry too much about placement.
Per usual, my recommendations are study the slides. You will do well on the quizzes and exams if you focus on the slides. If you are someone who needs to read textbooks to retain info or are not understanding information on the slides, buy the books. I did not buy any of the required books for this course. I stuck with “The Common Symptoms Guide” we used for advanced health assessment, and utilized the slides or UpToDate for other information gathering. I made study guides for each section. I will post these in the resources section once I clean them up a little and make them more presentable. You absolutely MUST pay attention in this class. She will say this related to the slides, but not necessarily on the slides that will be on your quizzes/exams.
This was the part I was most nervous about. So much more is expected of you as a NP student versus RN student. I prepared a couple different ways listed below:
- SHOW UP EARLY! I was always 15-30 minutes early and would look up the patients schedule to see my provider ahead of time. My provider was so experienced and absolutely brilliant that he was comfortable just walking in the room and going from there. I felt I did a better job when I at least new the chief complaint (cc) ahead of time. This allowed me time to develop a plan, look up specific physical examinations I wanted to do, and think of labs I might want to order.
- TAKE NOTES! Many of this things you will encounter in clinic, you will encounter several times. I kept a tiny notebook that fit into my white coat pocket with me at all times. I not only kept record of my patients to put into medatrax this way, but also recorded any notes. This might be a physical exam maneuver I had never seen before, a treatment for a diagnosis we were frequently coming across, medications I had never heard of, etc. I try to gauge the flow of the day and ask questions when convenient. You should always be asking questions everyday, but asking them when your provider is trying to listen for a murmur is not an appropriate time. Hopefully, we all know that 😉 I ask in between patients or if it is super busy… the end of the day.
- DOWNLOAD HELPFUL APPS! I 10/10 recommend downloading UpToDate, Epocrates, GoodRx, MDCalc, and ASCVD Plus. I use UpToDate ALL THE TIME FOR EVERYTHING, and APU provides this app to students for free! Epocrates is good if you just need to look up dosing and already know what med you want. If I don’t know which med, I go to Epocrates. GoodRx is good to help you find any local deals on prescriptions for your patients. Sometimes, you will have to change to drug if you’re patient cannot afford it. MDCalc has all the medical calculator/tools we use to support certain treatment plans or diagnoses. For example, does you pt have afib? Are you deciding whether to put them on anticoags? Do their CHADSVASc and include this score in your charting to support why you made your decision. ASCVD Plus helps you determine a patient’s cardiac risk (risk of cardiac disease or a cardiac event). I like using this because it is interactive. You can plus in the numbers with your patient and how them how something like reducing cholesterol will reduce their risk!
- JUMP IN! Aside from the first day, you should try to lead the appointments as much as your preceptor will allow. This may only doing a general physical exam at first (you should all know how to do a head to toe by now) while your preceptor does the Cozen and Mills test. Eventually, you want to try to run must of the appointment on your own and try to even give recommendations for the plan. When it comes to clinical, I try to follow the simple, traditional surgical residency method of learning, “See one. Do one. Teach one.” If there aren’t other students with you that you can teach, teach your patient while you are doing whatever it is you are learning. They may not necessarily need the information to repeat it, but it is nice because they will know what is going on. You are also testing yourself on how much you can truly recall by teaching.