I had the opportunity to work as an outpatient extern at Epic Heart and Vascular and an inpatient observer at HCA Houston Northwest for four weeks. Despite the limited time here, this experience has given me the confidence to engage with patients and the ability to see the day-to-day routine of a clinic. Assisting providers including Dr. Khan , Melissa Wilkin, NP, and medical assistants in patient care was an excellent learning experience.
During this time, I was tasked to take the history of patients and scribe relative complaints using an electronic medical record system. I was exposed to a combination of rural and urban populations of all ages. Their care focused on hypertension, hyperlipidemia, varicose veins, arrhythmias. heart failure, and myocardial infarction. Following a patient encounter, I was evaluated for my clinical knowledge and encouraged to ask questions. Additionally, I had the opportunity to observe outpatient procedures to treat complicated varicose veins such as non-thermal ablation using microfoam called Varithena and Venaseal. I also participated in patient counseling on smoking cessation, dietary modification, and other lifestyle modifications for improved outcomes in cardiac diseases.
Apart from patient care, I was involved in scholarly activities such as discussions about current cardiovascular guidelines by American Heart Association. I presented a the clinical trial published in Journal of American College of Cardiology named “4-step Protocol for Disparities in STEMI Care and Outcomes in Women” and Dr. Khan appreciated the details, style of presentation, and concise information delivery.
Working with the back office team and medical assistants, I performed patient intakes, medication reviews and obtained vital signs such as temperature and blood pressure. Additionally, under the guidance of ultrasound techs, I was able to determine reverse flow within various veins of lower extremities and recognize plaques on ultrasound imaging of carotid arteries. I also learned the cut-off values of ICA/CCA ratios for stent placement with carotid arteries. The highlight of this cardiology rotation was the opportunity to observe cardiac catheterization and stent placement at HCA Houston Northwest. I was taught about the pharmacological stress test, the significance of fractional flow reserve in the decision of stent placement, various types of guidewires, and their importance during the procedure. I was also taught about the prepping methods for complicated arterial plaques such as non-compliant balloons, and sonic wave plaque remodeling using Shockwave cardiac lithotripsy. I was evaluated for the knowledge of cardiac anatomy and calculations of flow resistance within the pulmonary artery using pressure values from Swan-Ganz right heart catheterization.
In conclusion, this four-week observer ship and externship under the mentorship of Dr. Khan was an experience full of learning about devotion to patient care. It help me develop my communication skills and provided a platform to exhibit the skills of scribing and team-based learning. This observer ship is recommended for self-motivated medical students and graduates, where they’ll receive mentorship from a compassionate and diligent physician, Dr. Khan.