PA-C!

I thought I would update everyone that I am now officially a PA-C! I just found out this morning that I passed the PANCE. I will post an update on my final rotation of PA school and preparation for the PANCE in the upcoming weeks. 

Thanks everyone for following along with me during this long journey! 

Accepting a job and my thoughts on post graduate fellowships

When I first started PA school, I had the mindset that post graudate fellowships, or residencies for PAs was a waste of time. I mean, why work for less money as a resident when you can get hired on making a great salary and do training on the job... It makes sense right? or does it? 

I started thinking more about this topic during my job search over the past few months. I had applied to about 3 or 4 job postings for emergency medicine. Every single organization replied back with an explination that they were looking for a PA with experience and not a new grad... this got me thinking of the old conundrum "how can I get experience without a job, and how can I get a job without experience?!"

So I took a serious look at what a residency program would entail, and if it would be a good fit for me. During my research I learned that a PA residency is a lot more than just getting some extra experience in order to get hired with that ideal, great paying job... its an opportunity to make you an amazing PA!

Ok, so now you're thinking to yourself... if this is such a great opportunity why doesn't every PA do a residency?! Well, it is a matter of personal prefrence, and It really depends on your career goals as a PA. A residency is not for everyone, but if you pushed it out of your mind, like I did, because you would make less money for a year... take a second, read my experience, and give it a chance to bounce around in your brain to see if it fits your PA career goals.

When starting as a brand new PA most places give you a few months to get settled in and learn the ins and outs of the hospital or clinic. After this period of time typically productivity is increased in order to see a bigger case load. This can really make it difficult to continue to learn and to make matters worse many collaborating physicians don't have the necessary time to teach when a unique case presents itself.

As a PA doing a residency you get an opportunity to take on a smaller caseload to really understand each medical decision, be part of unique cases, and get many opportunities to practice proceedures and perfect them.

Also, any hospitals require that you do a certain amount of proceedures before you can get credentialed to perform them at their facility. (chest tubes, intubations, ect.) Doing a residency gives you the opportunity to do many proceedures and get good at them, so you can not only get credentialed in them when you get your job, but perform them more often after you are hired.

So when I looked up PA residencies in Arizona, I found only a few. I saw that the Mayo clinic offered one in abdominal organ transplant, hospitalist medicine, and ear nose throat-head/Neck surgery. I always enjoyed surgery and wanted to go into a field that would provide me the opportunity to work in clinic and in the OR, as well as do many different proceedures. I had a history of going to an ENT doc when I was younger for vocal chord nodules, and I always found the field interesting.

The deadline had already passed for applications... but I figured I would send out an email and ask anyway, I figured the worse they could say was no. Lucky enough they asked me for an interview! I flew back home to Arizona and had an awesome time at the interview. I loved the environment there and found that all the PAs had a really great friendship and relationship with eachother. It felt like they were all just a bunch of friends hanging out. It was a really cool environment.

Mayo clinic selects only 2 PAs each year to be a part of this one year ENT fellowship (residency). I was hopeful, but at the same time I understood that my chances of getting accepted were low out of pure statistics alone. I must have done something right during the interview because... 

 I was selected to be part of the fellowship!

I was SO excited upon hearing the news... and of course i'm still very excited.  

I learned that this is a very surgical heavy fellowship (which I like very much) and I also felt like the program would allow me to work in many different areas after completion. The education is so broad and provides some great rotations in peds, oralmaxillofacial surgery, reconstructive and plastic surgery, along with all the ENT specialties. I feel that I will be able to find an area I really enjoy and make my PA career out of it.

As PA residencies are not very common, I will continue to document my experiences for those who are contemplating if they want do complete one as well. And as always, feel free to ask any questions.  

AAPA conference and being the AOR rep for my school

I just recently returned from the AAPA conference in Boston. I honestly didn't think I would have such a good time, especially as a student. I was wrong! I really had a great time making new friends, getting to speak with PA students from other programs and hearing their stories. 

The main reason I went was to represent my school in the Assembly Of Representatives (AOR). This is a basically the governing body for the Student Academy of the AAPA. We voted on resolutions that were brought forward from ordinary PA students like you and me in order to create a focus and schedule for the student academy in the upcoming year.

Anything that students have an opinion about can be brought up to make changes, even to be brought up with the House Of Delegates in order to make changes for students with the AAPA. 

I never really understood this before attending the AAPA conference. 

For example... A student from a PA program resolved to speak with the ARC-PA about developing a "standard set of PA school pre-requisites" in order to remove the frustration of different pre-reqs with each program. This way students could complete the "standard pre reqs" and focus on how they fit with whatever program instead of focusing if they can even apply or not.

I never realized how much of an impact we can make for current and future PA students. My suggestion is, if you have a complaint or want to make changes for PA students, figure out who your class AOR rep is (for us it was the class vice president) and submit a resolution to make it better. Then they can bring it with them to the AOR meeting at the AAPA conference and make a difference.

Boston was really beautiful and was fun to explore for the short time I visited. 

This is the AOR  meeting where we voted on resolutions

One of the Keynote speakers

This is where the knowledge bowl took place

I highly encourage everyone to attend the AAPA conference as a student, the knowledge bowl was a really cool experience to watch and I bet it would have been fun to be a part of. Its only a short amount of time that you are a PA student... enjoy every minute of it!

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.