One more notch in my belt

Just completed ACLS training this afternoon, and now I am ACLS certified! And I feel like I know absolutely NOTHING.

Perfectly normal feeling, right? Many of you who are well into PA school can attest to this, I'm sure. The more you know and learn, the more you realize just how little you do know. Today as we ran mock codes, I found myself stopping and thinking about the algorhythms (which have recently changed a bit), second guessing my choice of drug and doubting that the intervention I suggested was correct, all while the "patient" lay there dying. Talk about pressure. It didn't help that the instructor at my station was sharp as a tack and tough as nails. I always manage to get the BEST instructors who give just a little bit more education that what is called for.

Again, it's all about integration. How can I take this piece of information that I learned months ago and apply it to this new information today. It's like building blocks, really. This is when medicine becomes fun! I have some fun moments. Moments when answers to questions just fly out of my mouth without a thought. And then I have not so fun moments when the only words that come to mind are, "I don't know."

I have many reasons for being so excited about clinical year. First, I'm tired of the classroom. There's no real fun in learning lots of medicine if one can't practically apply it. I'm a hands on type of person, and I learn by doing. Second, I miss the patients. I love the interaction with patients and I miss talking with them and hearing the stories they tell. Third, I love to travel. I love moving around. I look forward to being in a new environment with new people every 5 weeks! We will see if I eat those words 2 months from now.

Good night, folks!

3 months in, 1 month out

Warning...this will be a long blog. Why? It's the least I can do for being away so long.

Hey gang! Wow...where do I begin? I can't believe I've let this much time pass since my last entry. I see I've gained a few more readers. Thanks to all of you who read the blog. I hope it is serving a purpose and answering questions. At the very least I hope it's allowing you to live vicariously through me while I journey through this thing called PA school. So, without further ado....

I'm three months in, and so far this semester has been another rollercoaster ride, albeit much easier than last semester in that I know what is expected of me, and I know what type of work ethic it will take to successfully complete it. The material is very interesting, and this semester we are really learning how to integrate. Early on the instructors stressed the importance of NOT integrating to avoid confusion. At this stage of the game, integration is key. Now I'm expected to take the anatomy I learned this time last year and apply it to the Neurology and Nephrology that I'm learning now. Not an easy task, but when it's done it makes learning a lot easier. Medicine becomes fun because you now are able to answer the most important question: why?

I'm enjoying the material for the most part. I would guess my weakest subjects this semester are endocrinology and neurology. My strongest subjects are nephrology, ortho, and EM. I've discovered that I'm really good with my hands and calm under pressure. I've also discovered that I need to work on developing a better differential list, and on my physical exam techniques. We all have strengths and weaknesses. It's important to acknowledge them, pat yourself on the back for the strengths, and work on the weaknesses.

Today we began our ACLS training. How exciting!! Recent changes have been made in BLS and ACLS, so we began learning the BLS changes (its CAB's now, and not ABC's), then we went on to learn how to intubate and place IO lines. Out of all the skills we learned today, I think intubation was my favorite. I got it in the very first time with no help, and the instructor praised me when I finished. Talk about an ego boost. Keep in mind, we practiced on dummies. Let's see how good I am when I intubate my first real patient...old school style, without a Glide-o-scope!

In the midst of studying for 3-5 exams per week, being in class from 4-8 hours a day, and having a social life, we've had to prepare for the clinical year, which officially begins one month from now. I'll be heading off to Juneau, Alaska to complete my primary care rotation. I can't express how excited I am about this opportunity. This is a wonderful site that will allow you to do what you want as long as you are competent and confident. I will be working both in the clinic and the hospital, and I'll even be working with the radiologist on occasion. I'll be sure to take lots of pictures, and if I remember to bring the appropriate equipment, I will post them here for those who are interested.

This blog will no doubt morph into something quite different as I embark on my clinical year. I plan on sharing as much information as I can with the readers here, being careful to maintain the anonymity of my patients. I'll let you know what I see regularly, and what I'm allowed to do. Something I would love to do is post student cases here. If time allows I will surely do that.

Ok...not much else to say other than have a good weekend, and if you're in the NW part of the country, try to stay dry!!

Let's get back to work

I've three more days before I board the plane that will take me back to PA school. These six weeks have come and gone so quickly. By far this has been the best school break ever. I think my mind and body were so exhausted; I definitely needed every hour, every minute of this break. Now it's back to work!

I've already outlined what lies ahead of us this semester. Looking at the spring calendar is like looking at the calendar for last semester. We'll be as busy as ever, but this time we know what to expect. I say bring it on!

Happy New Year!

Hey gang. I hope all is well, and I trust you all had a Merry Christmas and a wonderful New Year's Eve/Day. Time is just flying by.

I am officially a second-year PA student. In retrospect, I'm amazed that I have three semesters behind me. I've learned a lot, but there's so much more to learn, and now that clinical year is 5 months away I've got to kick it into high gear. What I love about my program is we have some say in where we want to go, and we are allowed to pursue preceptorship in any area of the country. The bad news is each and every one of my prospective rotation sites here at home have fallen through. But who cares! The great news is...

I'm going to Alaska!!

Our program is affiliated with a private Primary Care office in Juneau that has state of the art facilities: labs, micro, xray are all on site! They also have hospital privileges so I will have a chance to participate in that as well. Needless to say I am excited and appreciative. What a great opportunity this is for me. I will be the second student from my program to attend this site. The first student to go gave this site rave reviews, so I'm expecting to learn a lot. No word yet on any other rotation sites, but I feel like I will end up exactly where I need to be.

Now, the following is for any pre-PA students out there. Repeat after me: there are no shortcuts. There are no shortcuts. One more time...There are no shortcuts. Good!

I recall mentioning this before, but it bears repeating. PA school is a well demarcated path etched in the road. There are many side paths that feed into it, but there is no one way that will get you to your destination (a seat in PA school) the fastest. There are no shortcuts. Yes, PAs make a comfortable living and they are an integral part of the healthcare system, and they get to wear the cool white coat. Before you can begin to enjoy these perks, you've got to get your "C," and before you get your "C" you've got to graduate and pass the PANCE, and before that you must do well in your respective program. And in order to do well in your program you must lay the ground work.

There are many common threads floating around on the forum as of late, the most common being "What are my chances," and "Am I competitive." The most recent one to irritate the heck out of me is "Which schools don't require HCE." My response is if you don't have the time to acquire direct HCE you may want to reassess your goals. I have personally journaled my experiences in the unit where I racked up my hours, and you can refer to the 2009 entries to learn more about it. It sealed the deal for me in more ways than one. Not only was I touching patients, sticking them, drawing blood, run EKG's and do preliminary interpretation, doing wound dressings, talking one on one with patients' families, doing post mortem care, and drawing flushes for codes, I got a chance to stand bedside as I watched lines being put in and ventriculostomies being performed, and in my down time I read SOAP notes, learned how to read a basic chest xray, read lab values, etc. You can't begin to understand how this has helped me during didactic year. And I bet I won't truly appreciate my time on the unit until I reach clinical year.

The question is do you want to hit the ground running or do you want to play catch up? When questions like this come up, it screams that many of us coming into this profession don't know its history. No one expects you to know it all. No one expects you to be a PA on the first day of PA school. Knowing the basics, however, goes a long way in prepping you for success during didactic year and clinical year, and it just might help you land the job you want once you graduate. It's a snowball effect. Ok, I'm done.

I have two weeks left until we start up again. I am renewed and refreshed, in part because I know this is my last semester in the classroom. I couldn't be any happier about that! I miss the patients.

There's No Place Like Home

I've been home for exactly 5 days now and I'm already getting antsy. It doesn't take long for me. Don't get me wrong...I love being home with my family, not having to study for 10 exams at once, not dealing with the nasty winter weather up north, but I do miss the hustle and bustle of school. I miss learning. I am the ultimate nerd! I better enjoy this break while it lasts. Rest now, work later! I did bring a few books with me to read: my lab medicine text, Cecil's (not the easiest read, but a fascinating read nonetheless), and my radiology text. I'll start cracking those sometime next week.

Here's a line up for the classes that await me next semester:

General Surgery

General Surgery lab

Clinical Medicine

Pharmacology

Primary Care Modules

Geriatrics

Research class

Clinical Decision Making

Just a continuation of what we've been doing, minus the Pathophysiology. Man, I'm going to miss Patho!

A word to the wise: PA school is much more than going to class and getting good grades. I'ts much more than showing up and performing well. It's much more than memorization and regurgitation. There is a lot expected of you outside the classroom. Criminal background checks, liability insurance payments, AAPA/local chapter professional organization fees, additional training (BLS, ACLS, etc.), traveling off-site for lectures and seminars, fingerprinting, the list goes on and on and on. Be prepared! BE PREPARED! Paying for PA school can be challenging all by itself. Be sure that you have residual funds for these kinds of expenses because they will come up, often at the most inconvenient of times.

I think I've rested up enough to go out tonight! It's time to show these Southern salsa folks what I've been up to while I've been away. I had to cut down a bit on the salsa dancing as of late due to the heavy workload. It's been two weeks since I've danced. Insane! That's unacceptable. Yep...tonight's the night! I plan on writing again soon, hopefully after I've visited my old coworkers in the unit! I can't wait to see them.

First year of PA school...DONE

Wow, I've been so busy I almost forgot I had a blog.

Sorry for the wait, dear readers. I can't put into words how busy the last three weeks have been for me. But this is a blog, and words are all I have, so I will do my best!

It's quite simple really...14 exams total over the last two weeks, seven per week including practical exams. I was warned long ago about the rigors of PA school. I began school 12 months ago with my eyes wide open. I knew what I was getting into. I knew about the hard work and the late nights of study, and the unforgiving amount of information that was expected to be learned. There is NOTHING that could have prepared me for what I've been through this semester. When they tell you PA school is tough they are not lying. I didn't expect it to be this tough, though. I feel like I've been run over by an 18-wheeler.

The topics covered this semester were vast: hematology/oncology, EKG interpretation, lab medicine, Cardiology, Pulmonology, Psychiatry, GI, more history taking and soap note writing, etc. We learned a lot, and I enjoyed it. I'm starting to feel myself transforming into a clinician.

When I return to PA school next month, I begin my second year. My second year! Where has the time gone? I remember the days when I was still taking prerequisite courses. I remember deciding what school I would apply to. I remember going shopping for my interview outfit (man, I looked good that day!). And here I am, one year into my professional training as a PA. Absolutely amazing. This semester has been a whirlwind for me and many of my classmates. I've never performed so poorly academically in my entire life. I've never been a "C" student. I've never been accustomed to failing test after test...until now. It hurts the ego for sure, but you get up, dust yourself off, and get back on the horse. I must say, though, I ended strong, my final exam scores look amazing, and I am really proud of myself and my accomplishments.

One more didactic semester left before I am let loose to begin treating real live patients. Scary, yes! But I'm ready to get out of the classroom. I learn with my brain and with my hands. I am a doer, and I know I will thrive during clinical year.

Well, not much else to say for now. I have the next 6 weeks to do absolutely nothing, and nothing is precisely what I'm going to do. Currently I sit in the Charlotte, NC airport heading for home. I haven't seen the detective in almost four months. I can't wait to talk to him and spend time with him.

Updates

Hello November...so nice to see you!

I'm counting down the days to the end of the semester. I'm amazed at how quickly time has passed. We have been extremely busy lately, as usual. And grades are on the rise! Woo-hoo!

So, what's been going on? Well, lots! We began our POME module two weeks ago. This is our version of problem-based learning, where we are given a chief complaint and must come up with a differential diagnosis and primary diagnosis with only the use of a history and physical exam findings. I love learning this way! It forces you to commit to a disease process, even when you don't have all the answers. It forces you to think. It forces you to ask yourself some serious questions. The bottom line is you must know your diseases. If you don't know a disease exists, you won't consider it. You must know how to perform a thorough physical exam. If you don't you will miss important findings that may steer you in the wrong direction. And finally, you must know how to take a good history. It's true when they say that most diagnoses can be figured out based on the history alone!

This weeks' CC was abdominal pain. As a class we rattled our brains to come up with diseases that would manifest in abdominal pain: neoplasm, GI bleed, acute pancreatitis, Ulcerative Colitis, Crohn's, AAA, pyelonephritis, peritonitis, appendicitis, ishcemic bowel, biliary ostruction, cholecystitis. We ended up with 99 potential diagnoses! We were split up into three groups and were given a history based on the questions we asked. If we didn't ask the question, we didn't get that part of the history. The next day in lab, we asked for physical exam findings. I'm happy to say that our group got the diagnosis correct. I'm even happier to say that the correct diagnosis, acute pancreatitis, was my primary diagnosis even before getting physical exam findings. The history was textbook acute pancreatitis! I love this stuff!

I think what I love most about PBL is the feeling of really becoming a clinician! PAs are sleuths, detectives, investigators. They ask questions, and use their senses (ears, eyes, nose, etc.) to detect disease. It's amazing what we are able to do without the help of sophisticated diagnostic equipment. Thank goodness we have it to confirm our suspicions, but we do quite well without it most times.

We had no class last Friday, so salsa was definitely on the list of things to do last weekend. And Salsa y Control, Boston's top salsa crew, came through to give workshops and to perform. I had a ball, and I shared a dance with both brothers! AMAZING! A few dancers from neighboring states came by also, and I got a chance to dance with brand new dancers...and they were fabulous!!! It's always fun meeting and dancing with new people.

Two exams down this week, and one more left to go tomorrow. The next few weeks should be smooth sailing, but the weeks leading towards finals week will be hellish for sure. I look at it as my rite of passage. If/when I emerge victoriously, I will have 6 whole weeks of bliss to look forward to. I can't wait!