For this rotation, my site evaluations were completed via Google Meet with one-to-one meetings with my site evaluator.

During the mid site evaluation, I presented one case/H&P on a patient who had a breakthrough seizure. As I read through my H&P, my site evaluator recommended to make my HPI more concise including only the most pertinent positives and negatives and moving the additional details later on in the H&P under the past medical history and/or social history. She stressed the importance of obtaining the PQRST for each complaint or symptom. Though, this was a challenge as the patient was not awake during the episode. Still, it was valuable information to keep in mind for my later H&Ps. She also provided useful feedback on the pharm cards I had submitted regarding renal dosing, differences in antibiotic infusion rates, and caution with certain medications in the elderly population.

For my final site evaluation, my site evaluator went through my final two H&Ps after which I presented a journal article related to one of the cases. She noted the improvements I applied in keeping my HPIs more concise following the first site visit. I then presented a narrative review that discussed the safety and efficacy of blood pressure modulation in patients with acute ischemic stroke whereby permissive HTN was utilized to optimize cerebral blood flow. As the literature supported, the patient in my case had been managed to allow for permissive HTN whereby his anti-hypertensive medications were withheld unless SBP reached >220 mmHg or DBP reached >120 mmHg, as he was not a candidate for tPA or thrombectomy and increased perfusion of stenosed vessels was the goal.