Mixing Business with Pleasure: Traveling Across America for my Clinical Rotations

As many of you know, I completed my physician assistant education at Drexel University in Philadelphia, Pennsylvania. Drexel is the oldest PA School in the state of PA, and one of the oldest PA programs in the country. At my interview, Drexel highlights their clinical rotation sites all around the country, and that every student usually completes at least 1 clinical rotation outside of the state of Pennsylvania, or at minimum the Philly area.

This opportunity to travel for rotations intrigued me and is one of the many reasons why I wanted to attend Drexel for graduate school. For some, travel can be stressful. However, for me, I find it fun. I knew as soon as I was accepted into Drexel that I wanted to travel for my clinicals.

When it came to ranking sites within our core specialties (internal medicine, emergency medicine, behavioral medicine, pediatrics, surgery, and women’s health), almost all of my top choices were out of state. Of course, in addition to ranking the sites with good reputations high, my other focus was to rank the coolest destinations high hoping I would be placed there.

Luckily for me, my efforts succeeded. I was able to have core rotations in New York, Pennsylvania, Colorado, and California. I was pursuing clinical rotations when COVID was still running rampant, and some of my original sites were cancelled. Although stressful at the time (as I was afraid at how these cancellations would affect my education) everything ended up working out perfectly in the end. I am a true believer that everything happens for a reason, and that things will work out the way they are meant to.

Drexel focuses on closing gaps in underserved communities, and by doing this, there is an emphasis or training clinicians who will work in primary care after graduation. For this reason, all of my rotations are in primary care. Drexel does not have the opportunity to rotate in specialty rotations such as dermatology, orthopedics, neurology, etc. Drexel’s PA program is 2.5 years. One year of didactic training, and 1.5 years of clinical training. Clinical training is broken up into six, 5-week core rotations, and two primary care practicum (PCP) rotations that are 10-weeks long. The 6 core rotations are completed first, then the 2 PCP rotations. Of the two PCP rotations, one must be completed in Family Medicine. The other PCP rotation can take place in any primary care setting of your choice (Pediatrics, outpatient internal medicine, family medicine, EM, women’s health).

I was lucky enough to be able to travel for half of my rotations and be home in the state of PA for the other half. This allowed me to travel like I wanted, but yet, still have the ability to stay with my family for rotations, which allowed me to spend time with them, but also save some money. Traveling around the country away from home in Central PA allowed me to satisfy my desires of wanderlust and exploring. It truly was the best of both worlds!

Let's take a little trip around the country while I reminisce about PA school rotations!!

Rotation #1- OBGYN: Lebanon/Palmyra, PA

My Women's Health (WH) rotation was one I set up myself through an ED contact I met while I was scribing. I met this contact back in 2016! This is a prime example of always keeping those relationships in your back pocket, and to never end relationships, jobs or experiences on a bad note! My Women's Health rotation was honestly one of my favorite rotations. My site allowed me in the office setting, but also the OR, and on L&D. My VERY first day of PA school (EVER) I was scrubbing into a C-section within the first hour! It was intimidating but SO fun! I was so slow at scrubbing in that the baby was practically out by the time I was gown & gloved in the OR. 😂 That was okay, the bladder blade and I became good friends that day, and I got to help close, which to my surprise takes longer than actually getting the baby out.

My rotation for WH was truly amazing. I worked with staff who was willing to teach, and I was ready to absorb whatever they would let me. I remember I was so scared to do a pelvic exam for the first time, and my preceptor walked me through, teaching me great technique. My VERY first attempt I found the cervix, and honestly, I have never missed since! I am convinced it is because my preceptor took the time to teach me the proper technique the first time and made me feel comfortable to learn.

My schedule on this rotation consisted of OR time approximately 3 mornings a week, with afternoon clinic. Other days, I would spend full days in the clinic, and when my doctor was on L&D call, so was I. I volunteered to do night call once so I could truly get the full experience. When we had downtime on the L&D floor, my preceptor would take the time to explain to me concepts I was getting wrong on Rosh Review and other practice tests. We would also practice surgical knot tying, looking at specimens under microscopes, and suturing.

I loved WH so much that I would 1000% consider working in this profession when I (eventually) decide to transition from EM. As a woman myself, I am convinced that OBGYN providers establish a more meaningful, trustworthy rapport than any other specialty. And truly, what's better than empowering other women?

Some cool things I saw on my rotation were: drainage of Bartholin cyst, Pap smears, colposcopies, numerous fetal US, C-sections, myomectomy, L&D triage, post-partum care, IUD/Nexplanon replacements and removals, & so much more. I even got to deliver a few babies!

During this time, I moved home from Philadelphia and out of my apartment I lived in didactic year. It didn't make sense for me to continue leasing an apartment in Philly since I only had one rotation there. It was a busy move home, but after that I got to spend some much-needed time with my family. I was exercising daily, going to Farmer's Markets, and grabbing coffee at cafes with my sister. Having the opportunity of living with my family and having them support me during such a big transition meant everything, but also made my life easier and the stress manageable.

Rotation #2- Emergency Medicine: Camp Hill, PA

Ahhh, Emergency Medicine. Back to a place where I felt comfortable and familiar because of my scribing experience. This rotation was an approximate 30-minute commute from where I stayed with my family. The cool thing about this rotation is they provided FREE housing to students if needed (first come, first serve basis). Since Emergency Medicine is shift work and requires working a lot of different hours, having a short commute was essential. I couldn't imagine having a long commute, especially since most EDs work 10–12-hour shifts.

My very first day of Emergency Medicine I had the opportunity to suture. I'll never forget telling my preceptor that was my first-time suturing after the fact, and seeing an element of surprise on her face, because of how well I did. I LOVE doing procedures, which is a big reason why I do EM today. In PA school when learning suturing, I would sit at the dining room table, put on an episode of Grey's, grab a glass of wine, and practice. I would go to a local butcher by my house to buy pork belly, because I read online that was the best thing to practice on that felt the most similar to human skin. I would suture chicken, fake skin, banana peels, and essentially anything else I could find for practice. It felt so good to have all of that practice pay off, especially on my first day, and then to have it be recognized.

From that point forward you could definitely say I thrived in the ED. I went up to everyone (specialists, trauma surgeons, nurses, phlebotomy, you name it) to introduce myself. I would always say, "Hi my name is Amanda. I'm a PA student from Drexel here on a rotation. If you see me around and you're doing something that you have time to teach me, I would love to learn."

That simple phrase opened more doors than I could count. I was suturing all the lacs and doing all the procedures while there. I would give IM injections, place Foley catheters, place NG tubes, establish IVs, perform chest compressions during CPR, assist with level 1&2 traumas, splint, and more! It was a blast. Some of my most memorable patient cases came from this rotation. I truly believe encompassing this many skills early on in my clinicals set me up for success.

From a personal standpoint, I was able to spend the Holidays with my family. I got to hand out candy at my sister's house on Halloween, eat Thanksgiving dinner with my family, go Black Friday shopping with my mom and cousins, and celebrate family traditions on Christmas Eve and Christmas. It was exactly what I needed before starting my travel.

Rotation #3- Internal Medicine: Anaheim, CA

After staying in central PA for my first two rotations, I was ready to get out on the road and travel. I made the most of my rotation which started the beginning of January. I decided to fly out 1 week early before my rotation started. Not only did this allow me to familiarize myself with an unfamiliar area, but I got to EXPLORE! I went hiking in Joshua tree, ate fish tacos in Malibu, experienced Ventura Beach, drove up the Pacific Coast Highway, and roamed the streets of Hollywood. We also can't forget a few trips to In-N-Out! I made the best of this time while away. Although I worked diligently in clinic, I made sure to fully utilize my free time. I really wanted to go to Disneyland, but unfortunately, it was closed due to the pandemic.

My Internal Medicine Rotation was my first time really interacting with other PA students, or, other students in general. My first two rotations I was the only student rotating at the time. My first day was nerve-racking, as all first days are. I was in a fast-paced, very busy clinic. I was in LA County during COVID. This is when COVID shots were first coming out. I remember my preceptor wrote me a letter stating it was medically necessary for me to receive the shot as I was working first-line with patients in her clinic. Only with this note was I allowed to be vaccinated.

Because we were still in the unfamiliar COVID territory at this time, a lot of my patient visits in clinic were telemedicine. A lot of my patients were also Vietnamese. I learned a LOT about Vietnamese culture in my 5-weeks here. I would independently start a patient visit. I would obtain a history and perform a physical. Then I would step out to get my physician. I would present the patient, present my management plan, and then we would go in together to finish the visit. This was the first rotation that I really did a lot of charting. I remember that it was overwhelming. The management plans for IM are very detailed. You literally can have 15 things to address from a visit, and you need to list them all with your plan to address them. It is definitely very time consuming.

On this rotation, my preceptor was very into teaching. She had PowerPoints, lectures, and would schedule meetings for all of the students in the clinic so we could learn together. A lot of the things she taught me on that rotation were on my EOR. She did her hardest to help students understand the pathophysiology and details of why we were doing certain things. Understanding the concept of something you are learning instead of just memorizing it makes learning so much easier. I also learned a lot of clinical skill on this rotation, like drawing blood, doing TB tests, and IM injections.

This rotation felt like it flew by so fast. When every day is a perfect day, how can it not? I did my best to hike as many trails, visit as many beaches, and soak up as much sun as I possibly could before heading back to PA.

Rotation #4- Behavioral Health: Philadelphia, PA

After California, my next rotation was in the Philadelphia area. I was originally scheduled to go to NYC, but due to influences from COVID, this was cancelled, and I was thankfully able to be placed at a location close to my school. I stayed at an amazingly cute and ideally located airBnB on the Main Street of Chestnut Hill. On my days off I loved to walk up and down the main street, stopping in at local stores, eating at local restaurants, and becoming a temporary regular at the Starbucks across the street. Also, while in the Philadelphia area I was able to reconnect with some of my friends from PA school for the first time in many months.

My behavioral health rotation was at a Methadone clinic. Honestly, I knew very little about methadone and had a lot of research to do before this rotation started. My very first day I sat with a nurse and watched as she dispensed the medicine. I watched as the machine automatically dispensed everything so precisely. I remember thinking the methadone looked like cherry-flavored cough syrup.

Over my time here, I was with a PA who was very respected by her patients, and really great at her job. At Drexel, we are required to receive MAT training to receive our certification to be able to prescribe buprenorphine. It is hours upon hours of training, and I never thought I was comfortable enough to actually utilize this training until I did this rotation. This rotation showed me how many people can succeed and do well with MAT. This experience was eye-opening and inspiring.

My days here started very early. Patient appointments started at 6AM, which meant I had to be there by 5:45 AM. The bright side of going in so early was that I was out early, too. My days were usually concluded by 1-2PM, latest. Most patient appointments were check-ins to see how they were doing with their dose. I would help titrate up and down Methadone doses. We would order and interpret EKGs as Methadone can prolong the QT interval and cause lethal arrhythmias if this interval becomes too long. I would do annual physicals in addition to in-office lab draws and MANY TB tests. The TB tests were always my favorite because I found the wheels that formed very satisfying.

At the end of this rotation was a week-long spring break. I went home, relaxed, and prepared myself for my next destination.

Rotation #5- General Surgery: Long Island, NY

For this rotation, I stayed with one of my closest friends, who is my best friend from college. Her family is like my second family, so being with them was a second home away from home. This rotation was very demanding. I put in over 350 hours in 5 weeks (for those of you that don't know how much that is, it's a lot).

This was my first rotation working with a lot of med students, in addition to residents and fellows. On this rotation, since I practically lived at the hospital, I saw a LOT. I perfected my two-handed AND one-handed surgical ties and even got to throw some surgical knots in surgery. I also did a lot of bedside procedures, too, like wound-vac changes, dressing changes, and removing JP drains.

Each week of my 5-week rotation I was on a different service. Week 1 was vascular surgery, Week 2 was General Surgery, Week 3 was ENT/Oncologic surgery, Week 4 was Trauma Surgery and Week 5 was the specialty of my choice. I chose bariatric surgery, because they also do general surgery cases, too. They also did a lot of robotic surgery and the robotic surgery PAs helped train me in how to change the arms of the robot, switch tools, and do other means of assisting in these robotic laparoscopic surgeries. The bariatric and trauma services allowed me to be the most hands on.

In this time, I was officially trained in how to scrub. I assisted in MANY surgeries, as many as they would let me. I would also ask to scrub in even if I wasn't assisting, just to practice. Some surgeries I saw during my time at this site was: bronchoscopy, appendectomies, cholecystectomies, intraabdominal tumor removals, Whipple, colonoscopy, colon resection with ostomy placement, and below the knee amputation.

Some cool procedures I was able to perform were: Chest tube placements, ABGs, pain pump catheter placements, and foley catheter placements. I loved the hands-on aspect of surgery, but did not love the lack of sleep, quick turn-around time between shifts, standing all day, never-ending beeper pages, and essentially working such long hours/days I had no time to do anything else.

Although I was so close to NYC, I was only able to go into the city once. I went to undergraduate school on LI at Hofstra University, so I was able to catch up with some friends. Although I did not have much free time, my time spent here was still great.

Rotation #6- Pediatrics: Frisco, CO

I will go ahead and say that this rotation location was BY FAR the best of all my core rotations. Frisco is approximately 2 hours from Denver in the mountains. Not only did I love working in a rural clinic, I loved the exploring that was nearby.

The clinic was M-F. It was both a pediatric and Family Medicine practice. It was a small practice with 1 physician and 1 NP. There were many students at this clinic at once, and all of us worked together to see the patients and divide the tasks. We primarily would go in when the physician was there, as she was the pediatrician. She would work part-time, so we had a lot of free time to ourselves. To satisfy the hour requirement for our program, we would go in some mornings or some afternoons with the NP to see her FM patients.

This rotation was a lot of fun. I loved working with the little kids, and the pediatrician was very knowledgeable. I definitely learned a lot. Clinic days were definitely busy, but it would make them go by quickly. We also always had a lunch break, which was great. We would take call after hours to go into the clinic for sick visits to keep kids out of the local ED.

My preceptor would be at all deliveries at the local hospital and was the pediatrician performing APGAR scores once babies were born. She would bring us along for deliveries, C-sections, and newborn examinations. She was also very active, so she would invite us along to go hiking with her and her dog, too.

Luckily for me, I was at this rotation with another Drexel student, and we ended up becoming close friends. We explored as much of Colorado as we could. On our days of we would spend hours driving around to see anything and everything. We tried many delicious restaurants, drank amazing beer, went hiking, and drove to all the nearby towns. We adventured to Rocky Mountain National Park, Fairplay (the town South Park is based on), A-Basin, Breckenridge, Red Rocks Ampitheater, Vail, and so much more. If you are ever in Breckenridge Colorado, The Blue Moose has the BEST, homemade cinnamon rolls I've ever eaten, HANDS DOWN!!

PCP Rotation #1- Family Medicine: Juneau, AK

Honestly, no number of words can describe how amazing this experience was. My preceptor was hands down, the best. This clinic was amazing. She was a DNP and owned her own practice. The practice consisted of two Nurse Practitioners, which I think is super cool because it's not a standard model that most see.

I set up this rotation myself. I googled FM practices in Juneau Alaska and picked the practice with the best reviews. After reading their website, I decided to reach out to the clinic. I called the practice and sent an email. When I started PA school, I told myself I would keep an open mind about rotations. I went into PA school wanting to go into EM. However, I didn't want this desire to taint my experience with my other rotations. I didn't want to be narrow minded, so, I went into each rotation like that was the specialty I was most looking toward the most. I ended up liking all of my rotations, which in my mind reinforced EM even more, because you see a little bit of everything there.

Emergency medicine is a very difficult area to work in as a new graduate PA, and even harder to land a job. I was preparing myself with a back-up plan. I decided if I didn't land a job in EM, that I want to work in rural Family Medicine. I wanted a family medicine rotation in a rural area so I could experience what it would be like firsthand. This is why I set up this rotation. I ended up loving practicing rural FM. Just like my rural rotation in CO, this family practice would do a lot of things in clinic to avoid patient's needing to go into the ER for minor things. Lac repairs, IV fluids, I&D, joint injections were all done here.

As a student, it was the most hands on I've been. Here, there really was no choice but to see the student. I would get patients from the waiting room and get their vitals. Then, I would draw their blood and room them. I would process their blood on the machines in the office. While they were processing, I would go back into the room and take the history and do the physical. Then, I would collect the processed specimens, and print the report. I would take this information and present to my preceptor. I would discuss with her my management plan, and we would finish the visit together. I LOVED this rotation. Honestly, probably my favorite.

Here I learned how to manage a lot of things that primary practices might not usually manage. Because Juneau is more rural, they don't have access to a lot of things most people do. Locals needing to see almost any specialist have to travel to Anchorage or Seattle. For example, there is no cardiologist in Juneau except for certain weeks they make a trip. Most people here have flight insurance, because if you're too sick for their small hospital or need a specialist that is not there, you need to, again, go to the nearest big city.

Not only was the clinic experience great, but my personal experience was amazing too. Juneau is land-locked by mountains. So, much like an island, the only way on or off is by boat or plane. There is approximately 40 miles of road in all of Juneau, with 1 highway and 1 exit, labeled "exit". I explored all 40 miles, and more.

My rotation was in Mendenhall Valley, which is where a lot of the locals live. Downtown Juneau is where the cruise ships dock, and is very touristy. The other part of Juneau is Douglas-Island where more locals live, in addition to the location of Eagle Crest Ski Area.

My first week there I bought an unlimited bus pass and bike off FB marketplace for 100 bucks as I didn't have a car. This was my method of getting around until my preceptor bought herself a new car and allowed me to use her old one for the rest of the summer (like I said, she was pretty awesome).

While in Juneau I ate countless King Crab, went salmon fishing, hiked, saw many glaciers, went whale watching, saw bears, went to my FAVORITE BREWERY (Devils Club Brewery) and was fortunate enough to have friends and family come out to see me. Juneau will always have a piece of my heart. If you have never been there, it's a 10/10, I highly recommend going. Returning home from this rotation was bitter-sweet. I was happy to see my friends and family after 10 weeks, but was so sad to say goodbye.

PCP Rotation #2- Emergency Medicine: Camp Hill, PA

This was my last rotation of PA school. Before this rotation started, I completed my final summative exams, OSCEs and essentially all other requirements of PA school except for actually finishing this rotation. During this time, I was was essentially just focused on studying for the PANCE.

After traveling all around, I was back in Camp Hill at the same site I did my EM rotation. I loved this rotation so much; I reached out to my preceptor and asked her if I could come back for my last 11 weeks. This rotation, I would pick up patients and see them with the physicians. I would help manage their care from start to finish, more like they were my own. This rotation solidified even more EM was where I wanted to be after graduation. I was very blessed to receive a job offer from this rotation, which is where I'm currently working today. It's kind of surreal to think I started as a fetus PA-S here on my SECOND PA rotation ever, and now I'm a fully grown PA-C, with over a year and a half of practice under my belt.

One thing I will say is a lot of job offers do come to students who do well on a rotation. If you're interested in a job at your rotation, let them know. It's ok to show them you're interested, as it likely will get you far.

As I finished up my last weeks of PA school, I was able to enjoy home cooked meals from my family. I was fortunate enough again, to have off for the holidays and to be able to spend them with my family. I'm blessed to say I finish PA school with a lot of love and support.

In all, I can honestly say I am a stronger provider because I traveled across the country to learn medicine. I was exposed to patients, populations, and diseases I never would have had the opportunity to treat and learn from otherwise. For example, learning about High-altitude pulmonary edema (HAPE) which patients are only exposed to at high altitudes, like Colorado. It was also a blessing that I was able to use the traveling to my personal advantage too. Some of my very best memories come from PA school, from this traveling. I know not many other PAs are fortunate enough to say that.

If I had to go back and do clinicals over, I 100% would, just so I could have the opportunity to cherish and re-live these opportunities and memories. (Just don't send me back to didactic year... lol 😅)

I hope you enjoyed this trip down memory lane as much as I enjoyed writing about it. If you have the opportunity to travel for your clinical rotation, do it! I promise you; you won't regret it.

XO,

Manny

❤️