Monthly Archives: March 2026

Awkwardness Made Comfortable

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Let’s get straight to the topic of this post: pelvic and genitourinary exams. It’s a critical skill for people in medicine to learn. And like most skills, you learn by doing. At some point, you’re going to have to do your first one. For me, that first one was today.

Would you believe me, if I said that I actually enjoyed today’s practical and left it smiling? Before you jump to assumptions, let me be clear, I enjoyed it and was left smiling because the people we practiced with made is easy and comfortable. I have permission from two of them to use their names. The other three people I met, I did not get a chance to ask for permission and while I’m fairly confident they’d have given their permission, because of the subject matter, I won’t use their names.

Mary Conway PA-C is the owner of a company called META – Medical Education Teaching Associates. She setup META close to 37 years ago. META’s goal is to train people, such as PA students on how to do a proper pelvic and genital exam and how to make it comfortable for both the provider and the patient. And I want to say she does a great job. Earlier this week, she did a Zoom session with the students from both campuses. During this one hour session, she walked us through what META did, how, and what we would do today.

We were broken into two groups before today. Half were scheduled for the morning, and my half for the afternoon. I think we were all nervous to different degrees. I’ll admit I wasn’t super nervous, but I’d be lying if I said I wasn’t nervous at all.

First, for the afternoon, the entire group was taken into one of the larger classrooms where one of the instructors, a nurse, showed us the proper technique of a genitourinary exam on a man. It was a bit surreal to stand there in a group of twenty-two as he showed us what to do. But it was also instructional and strangely, not very awkward. We then broke into two groups of eleven. My group went with Mary and Nicole into one of our exam rooms. There Mary walked us through the steps on how to do a pelvic and breast exam on Nicole. Again, you might think this would be extremely awkward, and while there was a bit of awkwardness to it, less than one might expect. It was a thorough demonstration and explanation and they both answered any questions we had.

All the instructors and models have their reasons for doing what they do here. Often it’s for personal reasons. Nicole said she had 5 daughters, so for her, women’s health was very important. She’s been doing this for years and it’s clear she wants students to learn not only the right way physically do perform such exams, but also language used to make things more comfortable for the patient and honestly for the provider.

Once Mary had demonstrated what we were expected to do, we further broke our group of eleven into a group of six and a group of five. The five went off to practice the male genitourinary exam. Once the door closed Nicole asked, “Ok who wants to go first?”

After a moment of awkward silence, it should surprise no one who knows me, that I volunteered. While I honestly felt comfortable with the required techniques, I was still very grateful as Nicole basically walked me through each step. I’d like to think I did a fairly decent job on my first pelvic exam on a real human being.

And here’s why the whole experience left me smiling and was enjoyable. In some places, your first pelvic exam might be as a student, while you’re on a rotation and your preceptor is walking you through it. This puts you on the spot. The patient is most likely nervous since such an exam is already awkward and that is compounded with your inexperience. I can’t imagine it’s good for anyone, or that you learn much from it.

Here though, Nicole (and the other models who I didn’t meet) are there explicitly to help you learn. They’ve been through this, literally 1000s of times. They know their bodies. They can tell you what to expect. They know their own bodies so well, they can even help explain what it is you’re feeling and not feeling, especially during the bimanual portion of the exam. They turn what might otherwise be an awkward experience into what’s honestly a very comfortable and routine feeling learning experience.

After my group finished the pelvic exam with Nicole, we went to another classroom to practice the genitourinary exam that we had seen earlier. Again, the process was made to be as comfortable and easy as possible.

And really in many ways, I think that’s what these sorts of exams should be: comfortable and routine feeling. We as a society often don’t like to talk about our genitals. We tend to have hang-ups when talking about our pelvic regions and possible medical issues. But really, at the end of the day, it’s part of our bodies and medically we need to be aware of and comfortable with examining that area.

At some point, I’ll end up doing my first such exams on actual patients, but after today, I’m already feeling more comfortable than I thought I could be.

Disclaimer: my views here do not represent those of my employer (AMC) or my PA program (Arcadia University) and are my own views. The people named gave permission for their names to be used.

My Journey So Far

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While showering this morning (right after listening to a lecture on women’s health for pharm) I got thinking about my journey to becoming a PA and reflected on how far I had come. I thought I’d share some of those thoughts.

The official “start” date was I believe December 28th, 2021. I think that’s the day when I sprung upon my wife the idea of a dramatic career change. I’m grateful that she was supportive from the moment I suggested it, even if neither of us fully understood what was involved.

I didn’t really announce it until January 1st, 2022. Looking upon that post, I’ll have to admit I was a bit optimistic. I thought I might be able to finish it by 2025, 2026 at the latest. Well it’s going to be 2027. But, short of something traumatic happening, that date is pretty much set in stone. I know the date of graduation, but I will still have to pass the PANCE after that. So the exact date is still up in the air a bit.

Unofficially, I can’t say when I started. Was it in 2015 when my dad was sick and folks kept asking me if I was in healthcare, or when I met with a friend and now colleague to talk about medical school, which at the time we agreed wasn’t practical?

Was it earlier when I got involved in the NCRC or a bit later when I became an instructor, often helping teach the medical curriculum?

Perhaps it was when I first took SOLO at RPI. Or perhaps earlier? For example, I think my first aid class and CPR class was in elementary school at Lee H. Kellogg.

I think I’ll stick with the December 8th, 2021 goal. I do know that after graduating RPI, the thought of grad school wasn’t in my mind. My GPA was so low that I had ruled it out. But by 2021 I was ready for change.

So what have I done since then?

In January 2022, after jumping through some hoops, including getting vaccine titers, I started taking my prereqs. It quickly became clear that I wouldn’t be able to get all the prereqs in and get in the necessary patient contact hours in time to apply in 2022. So the goal of getting accepted in 2022, starting in 2023 and finishing by 2025 was quickly dropped.

It wasn’t even until October of 2022 that I could start acquiring my patient contact hours.

In the meantime I kept taking more classes. By December of 2023 I had ended up taking 41 credits for prereqs. In May of of 2023 I started submitting my first applications for PA school. And shortly after I started to receive my rejections. I had known my GPA would hurt me, but I was hoping the rest of my application and story would be get me a spot. The closest I came was being put on the waiting list for the school I currently attend, Arcadia. But there was no movement there.

So I went into 2024 already planning a second round of applications. By now, I had taken pretty much all the requirements I could, let alone needed. This did let me focus on working more in the ED, so that was nice. I slowly wound down my consulting. I was at this point very much committed to getting into PA school. Honestly, if I hadn’t, after dealing with a second round of defeat, I might have gone back and retaken some of the more basic classes from undergrad that I hadn’t done well in, but I was hoping to not have to do that.

I had a number of submissions in in May of 2024, basically as early as possible. And then I waited. And waited.

I finally heard back from one of my top choices. It was a no. I exchanged a few emails with the program director, but there was no change. The day after the last email from him, which honestly, I found a bit dismissive, I received an email about another decision. This is the one that changed my life. July 9th, 2024: It is our pleasure to offer you acceptance for admission to the Physician Assistant Program (the “Program”) at the Delaware campus for the class matriculating in May of 2025. It was from Arcadia. I don’t think my feet touched the floor for a week. The only hard part about this decision was whether to put down the required deposit and secure the spot, or wait and to hear from other schools which might tempt me. I didn’t want to risk the spot, so I put my money down. And it’s a good thing too, since it was my only acceptance. From then on, I could relax. At least until May of 2025.

As May 2025 approached, I started to make plans. One of them was forming my Council of Moore. Another big one was a road-trip. I’m so glad I did that. It really helped me clear my head. And then in May of 2025 I showed up and met my classmates.

May 2025 is less than a year ago. But honestly, it seems like it was both a decade ago and yesterday. I’ve often described PA school as like drinking from a firehose. And it has been. I’ve had my ups and downs. Since January though, things have generally be on the upswing.

We’re just over 10 weeks from starting our clinical rotations. I have a number of exams and quizzes between now and then (roughly 2 dozen quizzes, tests, other grades between now and my com). But I think I’ve got a handle on them. With the growing light of spring and the end of the didactic year so quickly approaching, things feel good. Yes, I’m realistic I still have a lot of exams and I could do poorly on any of them, but I’m at the point where clinical year is all in sight. And I can’t wait.

And now, back to studying for Pharm and my other 3 exams/quizzes this week.

Rolaids Spells Relief

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Or more accurately, scoring high on my most recent pharm exam spells relief. I mentioned in a previous post how I walked out of the first pharm exam of the semester worried whether I had passed or not. I was right to worry. I did pass, but barely. And that honestly made me very nervous. With the way PA programs are setup, you can’t afford to fail a class. There’s no “make it up next semester”. Generally if you fail a class, you’re out. Some might allow a make-up exam or some form of remediation if you’re just on the cusp, but most don’t.

And I honestly find pharm the hardest of my classes. This is not because of how it’s taught or anything, but because it’s mostly rote memorization. Often in other classes, you can reason out the answer from first principals. But less so with pharm. It was my lowest grade last semester. So I was nervous if the trend continued I’d be in real trouble.

Now, back in my days at RPI I let my ego get in the way. I mean why not? I was one of the highest ranked students in my high school. Obviously I was smart. So if I had trouble in my classes at RPI, I didn’t need help. I could figure it out on my own. But the truth was, I couldn’t and didn’t. It wasn’t until I started asking for help more that I did better. When I started my journey to PA school, I vowed I’d ask for help when I needed it. And I have been. So, with hat in hand, I emailed the course director on my campus. As I mentioned in a post late last year, any time we fail a grade this is required. But if we pass, even if barely, it’s not required. So I could have let my ego get in the way and simply tried to tough it out. I’m glad I didn’t.

Now I’d like to say there was some breakthrough here and she gave me the key piece of advice. But it’s not quite that simple. We did talk about what I got wrong and why and how to approach the upcoming exam. She gave me a lot of reassurance. And yes, she did give me an idea or two to help with my study habits. We then met again last Friday which helped reinforce some of this. The one real study habit I changed was how I built my flashcards and studied. Instead of focusing so much on drug names and then things like indications, side effects, etc. I focused on certain keywords such as specific contraindications and side effects and then worked back to the drug name. I also for some drugs built up little mnemonics or memory palaces.

For example, one mnemonic I built was to remember that Benznidazole is for Chagas aka “kissing disease” and that Ben would kiss someone and get weak in the knees/bone (bone marrow depression is an adverse effect) and makes him all tingly in the fingers (peripheral neuropathy is another adverse effect) and that if Ben kisses too much he could get someone pregnant (one of the tests you want to give before prescribing it.)

And it worked. While taking the test there were a number of times while reading the stem, I felt confident of the answer even before looking at the possible choices. This is always a good sign. There were a few I definitely had to think about a lot. And honestly, one or two I simply guessed at. But, in the end, I ended up with my second highest exam grade so far this semester. It salvaged my Pharm grade enough to the point where even if I barely pass the final two exams in the class, I’d pass it. Technically I could just barely fail both and still pass. Not that I plan on that.

But the relief I feel, is very hard to describe. I’ve sort of been on a high from it for a few days.

I’ll take that.