Student Profile

Amy Kwong, Class of 2019

Share a little about you and your background.

I am from Boston, Massachusetts and attended the University of Massachusetts Amherst, where I completed a Bachelor’s of Science in Biochemistry and Molecular Biology. Prior to PA school, I worked as an Emergency Department technician for 2 years at Newton-Wellesley Hospital.

I was most excited about coming to Duke knowing that Duke is the birthplace of the PA profession. Working alongside and learning from great preceptors at one of the world’s top academic medical centers, I knew that I would be given great learning opportunities that would allow me to learn and be a better provider in the future.

What has been one of the most memorable learning experiences you had in a patient care setting during your clinical education?

One of my most memorable experiences was working in a critical care setting. It was my first day with a new attending and midway through the day, we received a call from the OR stating that they were sending an intubated patient up to us. While trying to sedate the patient for surgery, the patient went into respiratory and then cardiac arrest. The patient arrived to the room with unstable vital signs and in the midst of the organized chaos of transferring the patient and receiving report, the attending handed me a central venous line kit, telling me that I will be taking lead in placing the femoral line. I picked up the kit and with my adrenaline running, began to gown up and drape the patient. With great guidance and support from the care team around me, I was able to place the line.

It is okay to be nervous when performing a procedure for the first time because everything was new to us at one point in our lives. From this experience, I not only learned a new procedure, but I also learned that as a provider in a care team, I am never alone. Thinking back to this day, I am humbled and grateful for the trust and support I received from the attending, the APP, and the other members of the care team.

What have been the most effective strategies preceptors have utilized to optimize your participation and learning?

I know I learn best hands-on and many of my preceptors gave me opportunities to direct an H&P and perform procedures like arterial lines, central lines, and laceration repairs. At the end of the procedures, they would give me feedback on what I did well and what I could improve on for next time.

What would you like your preceptors to do more of to promote the development of your clinical reasoning skills?

In order to promote the development of my clinical reasoning skills, I would like preceptors to discuss assessment/planning with me after seeing patients. Thus far, I have been very lucky in that many of my preceptors have taken time to go through teaching points with me in between patients, whether it is sitting down after an oral case presentation or walking from room to room during a busy ED shift.

What have been the 2-3 most valuable lessons preceptors have taught you?

Lesson number one, as a PA, you work as part of a team, however big or small. Be a team-player and be respectful. Work closely with your attendings, nurses, medical/nursing assistants, social workers, etc.

Another lesson I learned from my preceptors is that it is okay to not know the answers to everything. Instead, take time to look up that medical condition and/or discuss it with a colleague. As medical professionals, we are life-long learners – medicine is constantly changing around us.

This last lesson is a lesson that has been repeated to me since I started PA school, but it has grown to have greater meaning since I started clinical year. Several preceptors have reiterated to me the importance of self-care while working in a high-stress and fast-pace environment. In order to take care of patients, you have to take care of yourself. If you need a moment to gather yourself and your thoughts, take that moment.

Student Profile

Anthony Sciulli, Class of 2018

Share with us a little about you and your background.

I am originally from Pittsburgh, PA and earned my Bachelor of Science in Rehabilitation Science from the University of Pittsburgh.  Prior to PA school, I worked as a clinical research assistant in the emergency department of the Children’s Hospital of Pittsburgh of UPMC. As a research assistant, I enrolled pediatric patients in studies with aims that ranged from improving the diagnostics of ventriculoperitoneal shunt malfunction to suicide risk stratification. In the same ED, I also worked as a patient care technician and was able to assist throughout the busy department.

I was most excited about Duke’s historic ties the PA profession and its ongoing development for the future. I knew that in coming to Duke, the birthplace of the profession, I would have the chance to learn from a number of the profession’s pioneers alongside a diverse group of students from across the country.

What has been one of the most memorable learning experiences you had in a patient care setting during your clinical education?

One of my most vivid memories occurred in the early morning on the first day of my emergency medicine rotation. We had just received a call that a routine nursing home transfer was being diverted to our department after the patient began to develop acute-onset shortness of breath while in route to the new facility.  Within minutes of presentation, the patient became apneic and the attending turned to me and calmly asked, what medication would you like to give before you intubate this patient?

Shocked that the attending asked for my opinion on the intubation procedure, I quickly thought back to the RSI notes I had glanced over the night before, meekly said etomidate and succinylcholine, and picked up the MAC blade. With some beginner’s luck, I successfully intubated the patient and the patient’s respiratory status was stabilized.

I can imagine that most students’ first intubation is a memorable one, but what stands out most was the trust that attending had in my abilities as a student and his willingness to allow me the chance to complete such a significant procedure. That same level of guided freedom afforded incredible learning opportunities throughout the remaining month.

What have been the most effective strategies preceptors have utilized to optimize your participation and learning?

I have really enjoyed when preceptors utilize what if scenarios to expand upon our patient’s presentation. For example, our actual patient may be presenting with community acquired pneumonia for which antibiotic therapy is indicated. If the preceptor/student then asks something like, what antibiotic would we use if the patient had a prolonged QT interval?, the presentation of one, common presentation can be expanded into other, potentially less common presentations. I greatly enjoy this type of dialogue with my preceptors and find that it often allows for expanded learning opportunities throughout the rotation.

What would you like your preceptors to do more of to promote the development of your clinical reasoning skills?

 I’ve found that in every rotation that I have been afforded access to the electronic health record system, I was able to pend orders, notes, etc. under the student designation. The preceptor is then able to accept these pended orders to complete the order.  While this certainly creates an additional step for the preceptor, I have greatly enjoyed the opportunity to create an assessment/plan for my patient, write the note, enter in admission orders, and regularly update my patient’s medication regimen to simulate the same environment in which we will soon be working.

 What have been the 2-3 most valuable lessons preceptors have taught you? 

 I think the most important lesson I have learned this year, is to minimize bias wherever possible when evaluating a new patient. Regardless of how common certain patient presentations may seem, it’s important to remain critical throughout the exam to ensure that nothing is missed and that the patient is being properly diagnosed.

Working with PAs has also taught me the importance of remaining flexible as a lifelong learner. While we have all rotated through a number of clinical experiences, the bridge to clinical proficiency requires further work and study throughout a career. As students, it’s important to remember that for the remainder of our clinical careers that we will still be learning and honing our skills as providers.

Student Profile

Kendra Rumback, Class of 2018

Share with us a little about you and your background.

I am from Salt Lake City, Utah and I completed my Bachelor’s in Health Promotion and Education at the University of Utah. I worked as a Medical Assistant for almost 5 years prior to PA school. I spent 1.5 years working in a variety of outpatient specialties as a float and over 3 years working in an outpatient Internal Medicine clinic. I was most excited about coming to Duke because of the opportunities that being a part of a world-renowned academic medical center could provide.

What has been one of the most memorable learning experiences you had in a patient care setting during your clinical education?

One of the most memorable experiences that I have had during my clinical education was a patient who came to the clinic with uncontrolled diabetes. I walked into the room, introduced myself, and began to take her history.  She was responding to my questions with single-word answers and hardly making eye contact. I felt like there was something wrong that she was not telling me, so I stopped with my history taking and asked her again how she was doing. She began crying and told me that she was on the verge of stopping all of her medications and throwing in the towel because she felt that she had lost all control over managing her disease. Her hemoglobin A1C was 15% and at home, her glucometer was often giving her error messages because her blood sugar was too high to read. She felt like nothing she was doing was making any difference. I listened as she told me about all of her frustrations and fears. My preceptor and I were then able to come up with a treatment plan for her that took into account the issues that she was having. At the end of the visit, she gave me a hug and thanked me profusely for just listening to her. At her follow up appointment, it was exciting to see that although much more improvement is still needed, that she at least feels like she is in control of her disease and her disease no longer controls her. This experience helped to remind me of the importance of just taking the time to listen to patients. It also reinforced how crucial it is for patients to have the control over their disease management.

What have been the most effective strategies that preceptors have utilized to optimize your participation and learning?

One of the most effective strategies that preceptors use to optimize my learning is to give me the opportunity to do hands-on learning. It is difficult to learn how to do something effectively through only observation. It is helpful when preceptors offer to let me take the lead in doing a procedure without me having to ask.

What would you like your preceptors to do more of to promote the development of your clinical reasoning skills?

The more time that a preceptor can spend with me discussing the patients that we have seen or doing teaching, the better. It can be difficult in a busy schedule to get enough time to talk with preceptors and ask them questions. Also, it is greatly appreciated when a preceptor takes the time during my presentation to listen to my history, physical exam findings, differential, assessment, and plan so that they can provide good feedback.

What have been the 2-3 most valuable lessons preceptors have taught you? 

I have learned to treat your medical assistants with respect and constantly thank them for the work that they do because they are often underappreciated. The clinic would not function without the Medical Assistants.  Also, they have taught me to understand the roles of everyone in your clinic. Spend time with the front desk, spend time with the billing department, and spend time with the nurses. Being an involved member of the profession is every PA’s responsibility.