First rotation as a PA Fellow

As a PA fellow, much like a second year PA student, I have different rotations in all areas of ENT. My first rotation was in general outpatient ENT. I saw many ENT pathologies including: benign paroxysmal vertigo, dysphonia, epistaxis, cerumen impaction, acute hearing loss, nasal polyps, sinusitis, laryngitis, vocal nodules, and so much more. I learned a ton during this rotation, but I will continue to be part of the ENT clinic throughout my year, so I kind of got an introduction here. 

My second rotation was Head and Neck surgery. This included me seeing patients in clinic for pre and post op follow ups, assisting in the OR, and rounding on patients admitted to our service every morning. I learned SO much during this first rotation. We had some very long surgeries.... like 14 hours. But they are some of the most amazing surgeries I have every seen. 

An example of a flap reconstruction of the right cheek

We work with a lot of head and neck cancer, and utilize flaps for head & neck reconstruction. These flaps typically are harvested from the anterior lateral thigh, radial forearm, or fibula and lateral leg. As part of the process the flap, along with an artery and vein, is harvested and reanastomosed with an artery and vein in the neck. This new flap is what repairs the defect made by resection of cancer.
 This is truly life changing, as it can affect how the patient eats, swallow, smells, and especially how they look. I am always humbled when I get the opportunity to be part of these surgeries. 


My third rotation was rhinology. I got to be part of some amazing surgeries during this rotation. I learned so much about nasal anatomy, and nasal obstruction. I got to see patients in clinic, and assist in the OR. We performed lots of different types of surgeries including: Septoplasty, turbinectomy, frontal sinus entrostomy, ethmoidectomy, resection of polyps, nasal valve surgery, rhinoplasty. I had no clue how much an individual's nose effects the look of their entire face. I learned to respect the ENT surgeons who are part of this sub-specialty as it is truly an art form. Most of our patients left home from the hospital as outpatient surgeries. However, we would have a patient every once in a while that would have to stay a night or two. In which case me and the resident would round on them, and make sure they had all their progress notes and orders in daily.

One great thing about being part of a fellowship is it has allowed me to learn how to do the little things like putting in orders, or how to dictate a note, honing my interviewing skills, and getting better at what questions to ask patients. The fellowship is allowing me to gain confidence in myself and my recommendations to patients. Each rotation builds on the next, and I feel I understand the principles of ENT a little bit better and more thorough than before. I have also got the chance to practice common ENT procedures including flexible nasopharyngoscopys, ridged rhinoscopys, trach replacements, prosthetic speaking valves, and microscopic cerumen impaction removal. 

An example of flexible nasopharyngoscopy

An example of ridged rhinoscopy
(notice the straight long scope vs the flexible scope in the above picture)

As part of the fellowship I go to weekly "core curriculum conferences" along with the residents. These conferences cover topics in ENT and help to serve as a foundation for ENT anatomy, pathology, and treatment plans. Surgical modalities, difficulties, and common mistakes are discussed. I always learn so much during these conferences. I also attend Sim lab trainings with the other PA fellow in the ENT program and PA fellows in the internal med program. These are always helpful, as they give us the chance to learn in a safe environment and learn from each other.

I also share first call about 4-5 times per month. It can be really taxing at times as you get calls all night, and sometimes get very little sleep. However it always provides some great learning experiences.

My next rotation is Oral Maxillofacial Surgery, then general outpatient ENT, followed by pediatric ENT. I cant believe how fast everything is going. I feel like I just started, but with all i've learned it feels like i've been here for years! 

Graduation and First day at Mayo Clinic

I thought I would have more time during my "time off" after graduation and starting my job... lets just say I was wrong! 

I have been very busy getting settled that I haven't had a chance to update my experience with my final rotation and graduation... So lets summarize quickly to catch up.

My last rotation was at a VERY busy trauma center in Portland. I worked 6 days/wk 14hr shifts... I basically lived and breathed there. It was a great experience and I had the opportunity to do a lot, and get a lot of great exposure. The PAs there work very hard, and they have a lot of knowledge. Needless to say I was happy to be done with the crazy shifts, but I learned a lot and it did go by fast at the same time. 

Graduation snuck up on me very quickly... Before I knew it we were saying the PA Oath and getting our graduation certificates and Masters degrees! It all went by in such a blur... It was such a strange feeling to know that was it; Last week I was a student, and now i'm a PA... Sure I still had to study and pass my PANCE, but school was officially done! It was a love/hate relationship, I already miss my classmates. Its fun to see where they are working, and get excited for the awesome opportunities that they are getting.

I am thinking of dedicating an entire post to PANCE prep and taking the test... It wasn't as bad as I thought it would be, and although I didn't feel 100% prepared (not sure if anyone does) I passed and performed just fine. Waiting for the results was the hardest part I think... just a constant worry all the time! 

Today was my first day and orientation day for Mayo Clinic... what an AWESOME opportunity. It is crazy to think that I am now a PA-C and will no longer be the "student". I will still have a learner role as a fellow... but I am no longer simply a spectator from the sidelines, its time to get my hands dirty! Basically today was just orientation and computer training for the EMR. I have a feeling that things will pick up very quickly... We do have rotations in different specialties in ENT, i'll update the blog when I get my schedule. In the meantime... i'm just trying to get adjusted to the new hospital, schedule, staff... just everything! Great things are coming though... I can feel it. 

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!