Applying for the PANCE and Starting my Internal Med Rotation

A very scary reality came to me a few weeks ago when I paid the money and scheduled my date to take the PANCE. I cannot believe that I am so close to becoming a PA-C! (assuming I don't completely fail the test and have to retake it) However, I am thinking good thoughts and assume that I will pass the first time I take it... 

So let me explain the process:

•  When I was officially 90 days away from graduation my program submitted my name and info to the NCCPA. 
• I was then able to create an account with the NCCPA. (It took a few days after creating the account for the PANCE test to show up in my "Dashboard" before I could apply for it)
• When the test finally showed up in my account, I signed up and paid the fee for the PANCE.
• I waited a few days for my application to be processed and receive my "official test acceptance email". 
• I was then able to schedule my exam with Pearson VUE. (They have testing locations all over) I picked a date and time and its now officially scheduled!

So there is my process so you can know what to expect when the time comes for you to do the same. I scheduled my PANCE as soon as possible after I graduate (the earliest that someone can take the exam is 1 week after graduation). So the end of August is when it is scheduled. I'm excited, nervous, and scared to death!... but its the next step and I can't wait.

I just started at the Prison in Texas and so far have just been exposed for only a few days of prison life. Lets just say its not as exciting as I kind of imagined it would be. Its not the crazy inmate fights and altercations you think you would see on TV. This location is basically a big infirmary. Prisoners come here for recovery from surgery, management of chronic conditions, or hospice care. I basically am doing the history and physicals for the incoming prisoners and following up and doing progress notes on the patients I have worked with. This is my first time really writing out inpatient notes and working in an inpatient setting. It is a little intimidating, however it is a great learning environment and my preceptors are all willing to be patient and teach me.

This rotation is typically done with 2 PA students from our program completing the rotation together. However, for some reason, I am the only one here for this rotation. My preceptor said it is the only time he has had only 1 PA student. But I see it as a good opportunity to learn, because I am not splitting up the patients, I get to see all of them the easy and the difficult patients.  

Like always this rotation will fly by and I will be onto my final rotation in a level 1 trauma center! I may be way too busy to blog during those final 5 weeks, but i'll try my best to keep everyone up to date.

Making the transition from didactic year to clinical year -- What I wish I knew when starting rotations.

In honor of the first year students in our program I have decided to share some of the things I wish I knew when I started clinical rotations. They start their first rotation in June 2014, and it honestly feels like I was just in their shoes. So here is my attempt at producing useful information while sharing my thoughts.

1. Clinical rotations are still part of your learning

         I cannot begin to tell you how nervous I was starting my first rotation. "Will they think i'm an idiot", "do I know what I am supposed to know for having just completing the first year", "what if I totally forget everything I learned". These were just a few of the thoughts that entered into my mind. My suggestion is that you put all that aside, know that you can look anything up if you need to, and realize this is still part of your learning. I found that I didn't remember or memorize any dosing of medications for certain diseases in the first year. When I first started, I didn't know the typical dose of Amoxicillin to give for a strep throat infection... but I can look it up! That became a phrase I would use a lot with my preceptors. And honestly... for the most part, they were ok with that. 

           These things are the type of things you should learn in your second year- what dose, how much, for how long, calculating and adjusting the dose for a child... ect. The other thing I felt I learned and am learning is the typical course of a disease and advice to give. I didn't know with a certain disease when patients would typically get better, or how long patients needed to avoid certain activities, or medications ect... this knowledge comes mainly from experience, of which I had, well... none! So soak all that stuff in when you hear your preceptors talk about it.

2. You don't have to know everything

              Like I mentioned above, remember you are still learning and you are not expected to know everything. You will at times have a preceptor that will push you until you don't know the answer. They do this so they know where you are at in your training and what they need to focus on with you. They want to make sure you will do well with their patients and they can trust you to do certain things. They want to make sure that when you don't know something, you'll come to them for help. Remember you can always look it up, and when you have seen a disease a bunch of times, you will know start to know it very well.

3. Keep a record of the little tips you find along the way

       I found that during my rotations I received so many little tips from preceptors. These ranging from dosing with certain medications, treatment duration, approach with certain patients, ect. I started to keep a little notepad, but found that it was a bad way to keep it all easily accessible. Sometimes I would forget it, and keeping them organized was not easy. I always had my phone with me, so I started taking and keeping notes on my phone. This turned out to be the best way for me. They are easily accessible and I can always whip out my phone and type in a note. It is already my go to source for anything I need to look up... So now its my go to for writing down these little tips of the trade. 

4. Always learn from your rotations-for good or bad

          Some rotations, no matter how many people have given it awesome reviews before you, can be a bad fit for you and your learning style. Don't give up and just check out till it's over... as tempting as it may be. Really strive to learn something that you can take with you. You can always learn what you don't want to do, however it is important that you take advantage of what is available to you. If the nurse or MA who does blood draws will give you the chance, ask if you can do all the blood draws so you can get practice, and start to get good at it.

          If you feel you are not getting the chance to visit with patients on your own, go in with the the nurse or MA to help with vitals and do a brief history with the patient, and maybe even a physical exam. You can get practice and you'll have the details to present to your preceptor. All I can say is try and make it a good learning experience. However, as an aside- sometimes its not you and you should bring your concerns to the clinical team to make changes for the next class if it really is a dysfunctional site.

5. Take advantage of the opportunity

        Picking up a little from my last point, always put yourself in situations to learn something. Your skills become much better with repetition, and you learn more from struggling through it yourself than just simply observing. So always find a way to practice being the provider, interviewing patients, and doing physical exams on your own. I recall being intimidated to go in and interview patients when I first started. This is totally normal. You're afraid of messing up, that they will ask you a question you don't know the answer too, that you'll forget something, ect... however this became MUCH easier as the clinical year progressed. Try to jump in with both feet and don't be afraid to make mistakes, just blame it on being a student! 

6. Don't neglect the opportunity to make connections with patients

          

            About halfway through rotations, when I got more comfortable with the "medicine" part of seeing patients, I tried to practice listening to what the patient was saying and wondering what their actual concerns were. This takes practice. Instead of racing through my mind "what disease could they have" or "what special physical exam tests am I going to do" I started thinking along the lines of "what are they hoping I can do for them" and "what was it that brought them in now".  It helped me taylor their treatment plan and they were more satisfied with their care because their expectations were met and addressed. It also allowed me to make a connection with patients.

          As a student I am not always rushed to see so many patients as my preceptors, and because i'm learning I can take more time to sit and listen to patients. Patients feel valued and cared for, plus when I saw them again we had an instant connection. It helped relieve the patients anxiety and fear when they knew I was involved with taking care of them. 

These are just a few of the thoughts that came to me while pondering on my time as a PA student thus far. I hope you will find this helpful, especially to my fellow classmates who are about ready to start their second year. Feel free to ask questions and leave comments too.

Community Medicine - Rotation 7

So I am now into my Community Medicine rotation. For this rotation I am in the most rural location I have been yet... Christmas Valley Oregon. Lets just say its out in the middle of nowhere! It has a total population of about 800 people (this is an old stat, so it could be more or less now). 
Anyway, I am enjoying my time trying to adapt to such a rural community. I must say it is beautiful at night, you can see every single star in the sky. However I do have to travel about 90 miles to the nearest grocery store... 

Being back in family practice after working in the ER is really a challenge. I have to think in a totally different way and document things differently. Not only that... It is also a challenge to think about what I do while being in such a rural environment. Some patients cannot afford to drive 2 hours to the nearest big town to get certain tests or diagnostic procedures. Or they can't do it within a certain time schedule.

I have been able, however, to work on some of my hands-on skills a few times already. Since we are the only clinic in town (in fact for like 90 miles or so) we are also the Urgent care. So we get the opportunity to sew up some lacerations and work up some acute care or trauma care. 

I also have to do a community medicine project, which involves me speaking with my preceptor about needs of the community. We decide something that I can do to bring awareness to the community or serve them in some way. We decided that I could introduce people and help to make them comfortable with some complementary medicine. I wrote my clinical project paper on Yoga as a means for treating cardiac arrhythmias (especially atrial fibrillation). So I wrote an article that went in the towns newspaper reporting my findings. We also have a Yoga instructor in town who holds classes and can help individuals get started or come regularly.

It has been an enjoyable experience, the staff here are very friendly (as with everyone at all of my clinical sites). This rotation is flying by, I only have 2 more weeks left. Then I am down to my final 2 rotations before graduation! (it still doesn't feel real). Also on a second note, my wife just accepted a job as a speech therapist in Arizona, and her graduation is in 2 weeks! So a lot of things are changing, finally we will start to get some income and begin to make a dent in our student loans!