When I found out my first rotation was Internal Medicine, I felt both excited and apprehensive because of the wide range of conditions encountered in this field. Something I initially underestimated was the complexity of each individual patient. Most of the patients I encountered were elderly and critically ill, with multiple comorbidities requiring careful coordination of care. Their management could not always follow a standardized approach, as it required thoughtful and individualized planning. This experience challenged me to think broadly and integrate every aspect of a patient’s history, including past medical histories and medication regimens, into my clinical decision-making.

A challenge I faced during this rotation was conducting patient interviews during rounds, as the responsibility extended beyond gathering background information about the presenting complaint. It required a thorough understanding of each patient’s ongoing management plan and anticipated next steps, which meant I needed to review charts carefully every morning to stay current with their care. I communicated this difficulty with my preceptors, who were always supportive and readily stepped in when patients asked questions I was not yet prepared to answer. I made an effort to improve this skill each week, and over time I noticed a steady growth in both my confidence and competence when evaluating and discussing my patients.

Something I learned about myself during this rotation was my ambition and motivation to step outside my comfort zone and perform procedures I have never done before, especially so early into the clinical year. I recognized that competency in common procedures, such as venipunctures, IV placements, and (especially in IM) ABGs, is essential to becoming a confident clinician. Therefore I made a conscious effort to seek out these opportunities by asking my preceptors, nurses, and even phlebotomists if I could perform them to built both skill and confidence. These procedures were often more challenging than expected due to the patients’ critical conditions, including edema and fragile veins, but working through those difficulties strengthened both my skills and perseverance. NG tubes were especially challenging, as many of the patients were altered and unable to follow directions, such as swallowing during insertion. As a result, the process required patience and careful technique, often progressing slowly while closely observing for swallowing before advancing the tube further. Therefore placing my first successful NG tube felt very rewarding!

Caring for critically ill patients also comes with the emotional weight of medicine, something no textbook can prepare you for. Delivering difficult news and supporting patients and families through uncertainty required a different kind of strength than clinical reasoning alone. These experiences reminded me that medicine is as much about presence and compassion than it is about diagnosis and treatment. I was able to recognize this early on during my rotation when my team had to inform a young patient with advanced cancer and her husband that she was experiencing strokes as a complication of her malignancy, and the chances of her survival were getting lower. The doctor maintained her composure and balanced honesty with compassion, clearly explaining the medical situation while also acknowledging their emotions. She gave them time to ask questions, validated their fears, and ensured they felt supported. With continued exposure and self reflection, I hope to grow more confident and composed in moments like these, while still maintaining empathy.

Looking back, although my initial nervousness about this rotation was understandable, I am very grateful and proud of the experience I gained. While many of my learning experiences were through observation, such as stroke codes, a thrombectomy procedure, and RRT (Rapid Response Team) activations, each experience contributed significantly to my growth. I left this rotation not only with a deeper understanding of medicine, but with a stronger awareness of my own resilience, ambition, and eagerness to continue learning and improving as a physician assistant.