INTERNSHIP REPORT-SUMMER 2013
This report consists of task descriptions, activity descriptions, and an overview report. A student evaluation and internship provider evaluation were provided to the internship coordinator at the University of Colorado, Colorado Springs
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Over the course of my summer internship with Vanguard Skin Specialists, I assisted in a number of procedures treating skin cancer, as well as performed patient intake for general dermatology patients. This section describes the surgical procedures as well as requirements for general dermatology patient intakes to let the reader better understand the activity reports following.
Skin Cancer Treatments and Procedures
Mohs Micrographic Surgery is a highly specialized surgical technique for removing basal cell and squamous cell carcinomas as an outpatient procedure with local anesthetic. The surgery is performed in stages, removing the tumor one layer of tissue at a time, in order to spare as much healthy skin surrounding as possible. Mohs surgery provides a 99% success rate and is the best choice for the smallest scar and best cosmetic outcomes as possible.
Surgical excisions are another valid option for less invasive and aggressive skin cancers or atypical moles. Excisions are also performed in office with local anesthesia similar to the Mohs surgery; however excisions are not done in stages. The tumor will be removed in one step with surrounding margins to ensure complete removal. The tumor is then sent to a pathologist who will determine if the skin cancer or atypical cells have been completely removed, or if there are residual cells needing to be treated. Excisions offer a 95% success rate.
Electrodessication and curettage (ED&C) is another option for minimally invasive and superficial basal cell and squamous cell carcinomas. These types of skin cancers are often called “in-situ” meaning in place. The tumor is numbed with local anesthetic then scraped and burnt with a cautery for 3 stages until the skin cancer has been destroyed. This procedure often leaves a circular burn scar and skin cancers can recur more often than they would with a surgical procedure.
Treatment options that are used less frequently are topical chemotherapies where patients apply the medication to the skin cancer daily for 4 to 6 weeks. The medication causes a burning, stinging sensation and extreme redness since the cancer cells and healthy tissue surrounding are being destroyed. Another less common treatment is cryosurgery, where the lesion is frozen with liquid nitrogen for two 30 second cycles. Both of these treatments require follow-ups to ensure that the skin cancer does not recur.
Patient Intake Requirements
As a medical assistant, I was required to document history of present illness (HPI) which is a description of the skin, hair, or nail concern, location of the condition, duration and onset, symptoms, context, and prior treatments. Relevant personal and family history relating to amount of sun exposure, frequency of sunscreen use, and history of skin cancers and atypical moles are included in this section. Medications and allergies are verified, and vitals including heart rate, respiratory rate, and blood pressure are collected. After completing a patient intake it is my responsibility to present the patient’s case to the medical provider as well as any labs, blood work, or pathology results associated with the patient.
Activity Report #1
As of June 23rd, I have completed 35.85 hours of paid internship at Vanguard Skin Specialists. My daily responsibilities are to clean and set up exam rooms in the morning before patient’s arrive, perform patient intakes, present the patient to medical providers, and work as a scribe during the actual examination. In examination, I type exactly what the providers describe and if there is a concerning lesion needing to be biopsied, I document the size and description of the lesion, as well as the differential diagnosis. I then would prepare a bottle for the skin sample, draw up syringes of local anesthetic, and assist during the biopsy. I discuss wound care with these patients and ensure that the biopsy is processed properly and sent to the pathologist at CU Denver (CU Dermpath). I clean exam rooms after each patient and complete their progress report, adding assessments and treatment sections. The treatment section includes prescriptions and counseling on proper skin care, sun protection, and various other importance pieces of information depending on the condition. In between patients, myself and other medical assistants are coding patient charts for insurance, and answering phone calls from patients and pharmacies. Whenever there is a break in the action, I washand sterilize patient gowns and make sure we have enough medical supplies and surgical packs for the next few days.
I really enjoy my job at Vanguard, and appreciate the fact that I can also use this opportunity for my internship hours. I feel like I can apply knowledge I learned in classes like health communication and anatomy and physiology. Each day at Vanguard is different and I love how we have designated surgical days and general dermatology days. I am looking forward to working more often and more frequently this summer and hope to learn more about this practice.
Activity Report #2
As of 7/3/13, I have completed 84 hours of internship at Vanguard Skin Specialists working as a medical assistant and surgical assistant. My daily tasks include performing patient intake, acting as a scribe for the medical providers during examination, and making sure the patient is given their prescriptions and a visit summary as they check out. Patient progress notes must be completed before the day is over, so I am also responsible for coding my notes for insurance reasons and reading through each note to ensure over 95% accuracy. As a surgical assistant, I perform patient intake, check patient vitals, assist during surgery blotting and bandaging the patient after stages in Mohs surgery or after the procedure is completed. On days where Mohs surgery is being performed, I prep slides for tissue samples and help clean and set up surgical rooms for my coworkers to speed up the waiting process for patients. On a weekly basis, I do laundry with patient gowns, pillow cases, and towels. I also help other medical assistants in sterilizing instruments and organizing supply cabinets.
During my time working for Vanguard, I have come to realize that the medical and surgical assistants are expected to perform their jobs as perfectly as possible, as the clinic would like to be recognized for proving outstanding patient care. While I respect this goal, I do think there needs to be understanding that the medical assistants cannot be perfect, due to being human, however we can do the very best that we can and strive to provide excellent patient care. I also believe that there are times where the medical assistants are understaffed and clinic cannot run smoothly when there are not enough assistants to ensure patients are brought back to the rooms quickly. Other days, too many medical assistants are scheduled with not enough patients or daily tasks to complete, and the assistants are waiting around for patients to show up. This is not the most efficient way to run clinic. I believe the person in charge of creating the schedule should look at how many patients are scheduled for the day and schedule accordingly.
Activity Report #3
As of July 18th, 2013 I have completed 126.31 hours of paid internship and 5 hours of unpaid internship for projects I am completing for Vanguard at home. This totals to be 131.31 hours of internship so far. My daily tasks continue to be performing patient intakes, acting as a scribe for the medical providers during examination, and making sure the patient is given their prescriptions and a visit summary as they check out. I continue to review patient progress notes at the end of each workday, code for insurance, and make sure the notes are all together 95% accurate. As a surgical assistant, I continue to perform patient intake, check patient vitals, assist during surgery blotting and bandaging the patient after stages in Mohs surgery or after the procedure is completed. For Mohs surgery days, I prep slides for tissue samples and help clean and set up surgical rooms. Anytime I am scheduled at our South office, I do laundry to make sure there are enough gowns, sterilized towels, and pillowcases. I take clean laundry to the North office as well and stock exam rooms with these supplies and additional supplies needed for general dermatology days.
Recently the Vanguard staff attended the annual business meeting and worked together to come up with plans to make clinic run more smoothly and to ensure we are providing the best patient care that we can. The practice is continually growing, and from the day I started at Vanguard, 18 months ago, to now we have hired another medical provider and eleven staff members. As more employees are being hired, the practice continues to run more smoothly and clinic days feel less stressful because we are no longer short staffed. Since my last internship report, the staff schedule has become much better, since one of our senior medical assistants has been creating the schedule for other medical assistants and schedules according to the number of patients scheduled and types of patient visits. This has been extremely helpful, and clinic days are now rarely overstaffed or understaffed.
My internship is progressing well, and I have begun to learn new procedures due to our nurse practitioner, Tonya Sook, who works for Vanguard with medical patients and procedures as well as with our more cosmetic practice, Clara MediSpa. Since Clara MediSpa opened in April of this year, I have learned how to assist in laser treatment procedures for warts, rosacea, and more cosmetic reasons. I really appreciate how the medical providers at Vanguard Skin Specialists and Clara MediSpaprovide education for the staff so that we can be knowledgeable about procedures and medications so that we can effectually help our patients.
Activity Report #4
As of today, July 31st, I have completed 5 hours of unpaid internship and 195.89 hours of paid internship for a total of 200.89 hours. My daily tasks at Vanguard Skin Specialists continue to be performing patient intakes, acting as a scribe in exams, assisting in Mohs surgery and excisions, as well as performing suture removals and wound check appointments without provider supervision. I wash patient gowns twice per week at the South office and make sure both the North and South office exam rooms are fully stocked with fresh laundry and supplies. The past two weeks, I have been working more fulltime than I ever have due to many other medical assistants being on vacation or ill. I helped wrap and sterilize surgical packs and other instruments used on a regular basis. I made sure our Autoclave was properly sterilizing and helped make an ordering list for supplies we were running short on.
This past week, I have felt a sense of pride being a member of the Vanguard staff. It constantly amazes me how hard working all of our medical assistants, front office staff, and billing staff are and how we all work together to provide a good patient experience. I am honored to work with these people, and am proud that the Vanguard team can treat so many skin cancers per week and manage other skin conditions for patients. As we were short staffed this week and constantly busy, I saw many of my coworkers step up to fulfill a role they do not normally work as. Everyone helped one another and would not let another team member fail. I am proud to work beside many of these hardworking and caring individuals.
As I wrap up my internship hours for this semester, I believe that by working more hours per week than I normally did, I have learned a vast amount of new tasks, and perform better due to the extra practice I have had. I look forward to completing another 200 hours with Vanguard and hope to learn more procedures and more information about various skin conditions.
Overview Report
Over the course of the past 200 hours I spent working at Vanguard Skin Specialists, I have learned so many important concepts to apply to patient care regardless of what specialty, and have perfected tasks I have been performing since I was hired in March 2012. Interacting with patients on a day to day basis has allowed me to work on my communication in a health setting and to be empathetic for those afflicted with something I would consider minor like eczema or a rash as well as empathizing for those diagnosed with melanoma, or other less invasive skin cancers. I enjoy working in the clinic inhands on setting, assisting in not only paperwork and administration duties, but also being an important member to the skin cancer surgical team and assisting in other procedures like acne surgery, cyst removal or drainage, and allergic contact dermatitis testing.
I am proud to be a member of the Vanguard medical and surgical assistant team, and now better appreciate the staff at doctors’ offices I am a patient at, because I understand how much effort and time go into ensuring the patient has an amazing experience from start to finish. I now understand how health insurances work with authorizations and billing, as well as the important communication between pharmacies, military base pharmacies, and the medical office. Communication is a huge factor in creating the ideal patient experience, because communication is important when appointments are being created from referring doctors and the general public, communication must be clear and concise when the medical assistant relays information about the patient to the medical provider, and communication is yet again crucial during examination, describing necessary procedures and treatments, as well as discussing potential pathology results or lab results to the patient.
The main struggle I noticed this summer when working at Vanguard, was the scheduling of the medical staff. Due to recent decrease in medical staff due to maternity leaves and staff moving, we were short on medical assistants. There was also changes being made for administration responsibilities such as switching who creates the staff schedule. The schedule was very confusing, with many staff members being scheduled overtime for weeks in a row, or having some says where we were drastically understaffed causing a chaotic clinic day and stress on the medical staff. Recently, we have been in the process of interviewing potential medical assistants, and have hired one new full time medical and surgical assistant. This creates a few weeks of difficulty with schedules, as training for the medical assistants takes a while for them to acclimate to the terminology used in examinations and the many procedures we do in office.
Overall, I really enjoyed the opportunity to perform my internship at my current place of employment. I was able to learn more in a short amount of time, and work in a real world situation applying the knowledge I have received at BethEl in the health and wellness promotion program. I am looking forward to finishing another 200 hours at Vanguard Skin Specialists and hope to learn more about the practice and our partnering cosmetic practice, Clara MediSpa. I hope to gain more responsibilities soon, and look forward to the training process of new medical assistants.