During my mid-site evaluation, I presented a case about a 36 year-old-male with a psychiatric history of depression, anxiety, bipolar type II, and borderline personality disorder who presented with suicidal ideations in the setting of multiple psychosocial stressors. Overall, the case was complex, involving extensive medical history, social stressors, collateral information, and at times disorganized information from the patient. Therefore, I found it challenging to organize the HPI in a clear and cohesive manner without making it seem fragmented. However, I ultimately feel that I was able to present the information in an organized and effective way. I appreciated that my evaluator asked many questions throughout my presentation because it encouraged me to think more like a psychiatrist rather than simply a student recalling information. For example, I initially presented the treatment plan based on what the provider had told me would happen next and what was documented. However, when I was asked what I personally thought should be done for the patient, it pushed me to critically analyze his presentation, symptoms, and overall picture. This helped me move beyond simply reporting information and instead focus on developing my own clinical reasoning and decision-making skills.

For my final-site evaluation, I presented a case involving a 41 year-old-male with a psychiatric history of schizoaffective disorder who came in with increased agitation and talking to self (per mother), in setting of medication noncompliance. My discussion with my evaluator (as well as my journal article) regarding Invega Sustenna was very informative and helped deepen my understanding of 2nd-generation antipsychotics, including the role of long-acting injectable medications in improving adherence and preventing relapse. I felt well prepared to present this patient because I had been following his care throughout his entire stay in CPEP. Prior to presenting, and based on the feedback I received during my mid-site evaluation, I made a conscious effort to consider what my own next steps would have been if I were the PA managing his care, which helped me present the case more confidently.