Category Archives: Physician Assistant

My thoughts about my journey getting into (and soon attending) PA School.

The End is Nigh!

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I really should be studying. And after this and a bite of lunch, I’ll be back at it. But I need to get out of my own head for a bit. My second semester of PA school is nearly done. I have one paper to submit to two classes (it gets judged separately in both classes) and then two exams. One is a comprehensive final. Oh and some dang fool volunteered to help develop the slide deck for the comprehensive final and lead the study session for that final. Perhaps not my smartest move from a time management point of view, but it does go with my goal of trying to help others. At least I hope my classmates get something out of the study sessions.

What’s on my mind right now, besides cramming some last bits of information into my brain, or at least working to remember what I already learned earlier this semester is my overall GPA. I shouldn’t, but I do. Here’s the deal. I’ve probably mentioned we need a 2.7 or better to progress on in the program. Barring some sort of catastrophe, that’s not an issue. I’ll clear that bar. My first semester GPA was 3.3. I had hoped for a 3.7 (or even a 4.0) but it was quickly clear that that wasn’t going to happen. That said, a 3.3 isn’t to bad. It’s a whole point higher than my overall undergrad GPA. And assuming I continue my trends in the remaining tests and paper, I’ll solidly hit that. (note my program only measures ranges in GPA, <2.7, 2.7, 3.0, 3.3, 3.7, 4.0, hence my fixation on those particular numbers.) A 3.0 still isn’t impossible, but I don’t think I’ll do that poorly. But honestly, even if I do, I’m not going to lose too much sleep over it. Our professors continually tell us as long as we’re getting 80s and above, we’ll pass the PANCE and that’s all that matters. So, I’m good in theory.

Ok, I haven’t gotten out of my head obviously, but let me get away from numbers a bit and talk about the actual classes.

Medicine 1 – This is the meat of the semester. 8 out of 25 credits. I’ve generally enjoyed this. This is obviously a huge part of what we’ll do as PAs. I was doing great until my last exam. Basically I fell about two days behind in terms of studying. But that’s on me. I wouldn’t say the class is difficult per se, but there’s a LOT to learn in a small amount of time. The fact that I’m learning something struck home over Thanksgiving break when I was able to correctly diagnosis one of the ER patients as having COPD and in another case, correctly read a blood gas. (note this was practice, I wasn’t actually involved in any patient care).

Physical Diagnosis I – This honestly was the most fun class I think. Here’s where we actually put hands on bodies (in a consensual way of course). 5 credits, so also important. Whereas Medicine I is a lot of theory, this is more practice. Unfortunately in both practicals my brain skipped a beat and I forgot to perform some of the required exams. But I did well enough. I enjoyed this class and am looking to the follow-up next semester.

Pharmacology and Therapeutics II – this is my Achilles Heel. For me, this is my hardest class. I walked out of the first exam convinced I had failed it. Ironically it was my second best grade in the class. This class is hard for me because it’s basically a LOT of rote memorization. Something that honestly at my age I find harder. It is reassuring that one of my mentors, a triple-board certified ED attending (with one certification in toxicology) admits she has to look up pharm stuff all the time. This is one class I’m NOT looking forward to for the Spring. But I’ve already given some thought about how to tackle it a bit differently and hopefully do better. Only 3 credits, but it’s the biggest drag on my GPA.

Behavioral Health – Honestly, one of the easier classes for me. Some of it was simply “common sense” or stuff I had learned over five decades of living. Some of it was stuff that I honestly had learned working in the ER. I don’t plan on going into this field, but the skills I learned will be helpful in the ER settings I hope to find myself in. 3 credits here.

Diagnostics and Clinical Procedures I – Another class I really enjoyed and found fairly easy, in part because of my ED experience. There’s a few times I’d have to remind myself that what I learned in the ED was not always the same as what the class expected. But it’s a good class. I look forward to the next part in the spring. One area that I did particularly well in was EKGs. Again, experience in the ED, plus some of my own self-education, as well as RPI math and physics helped. Only 3 credits, but sort of countered my Pharm grade. I have one last test to go. This should be the hardest of the tests in this class.

Evidence Based Practice – This class a mixed bag. I referred to it as our version of the “Defense against the Dark Arts”. It is in my mind, actually one of the more important classes we’re taking. A lot of it is focused on why and how we do certain things, i.e. what’s the evidence for certain practices. It’s not something that can be taught “in the field.” (which honestly, a lot of the above classes can be to an extent.) There’s important stuff in this class. For example, we examined the original “Wakefield” paper that sort of started the “Autism is caused by vaccines” movement (hint the paper is terrible on several standards and actually doesn’t come out and say that.) I knew I was old when none of my classmates recognized the name of former Dr. Wakefield. But the structure of the class left many of us a bit frustrated. This was apparently true last year and they had restructured it for this year. My understanding was even two years ago had issues (hence my DaDA comment above). I’m doing great in the class, so it’s not a matter of sour grapes. But I do hope they find an even better way to teach this class to future cohorts. Only 2 credits because of the amount of work, but an important 2 credits I think.

Professional Practice II – another important class. This is about how to be a PA. This is the other class the same paper is due in. I’m doing great in it, but being only 1 credit, doesn’t influence my overall GPA at all.

So that’s my semester in the books. What’s Spring look like?

  • Medicine II – 6 credits this time – more of the above
  • Physical Diagnosis II – 3 credits this time – more of the above
  • Pharmacology and Therapeutics III – 3 credits – Hope to do better this time
  • Clinical Decision Making in Primary Care – 3 credits – This will be less multiple choice and more written answers so should be interesting
  • Diagnostics and Clinical Procedures II Certification – 3 credits – One detail here, is I get ACLS certified. Which means in theory I can run a cardiac code. In practice I can’t because I don’t have my PA certification
  • Emergency Medicine – 3 credits – Ironically, because of my experience, I expect this to be a difficult class. Not because of the material but because I’ll definitely have to separate what I learned and saw from what they are testing us on.
  • Surgery – 3 credits – I look forward to this. As a PA I can’t do surgery without supervision, but I will be able to assist and I will be able to do things like sutures, etc. So this should be fun.
  • Professional Practice III – 1 credit – more of the same.

If you do the math, you’ll see it’s another 25 credits. Then on to clinical rotations which I’ll write more about in the future.

Overcoming the Scarcity Mindset

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I realized years ago, that at times, I’m driven by what I might call a scarcity mindset. This isn’t just being frugal, but that’s definitely part of it. I don’t like wasting things. I can often be frugal. I’ve been known to drive the extra mile to save a penny a gallon on a tank of gas. I’ll buy in bulk often when I can.

No, the scarcity mindset to me is more of a “don’t let something to go to waste because you don’t know when you’ll be able to replace it.” Coupled with this, is “don’t buy something you won’t fully use.” That’s partly where the frugality mindset comes into play.

The above is a photo of green foam blocks that a florist might use. It’s an example of an early manifestation of my scarcity mindset. When I was a kid, I’m guessing around 6 or 7, I got my hands on one. I’m guessing it was left over from one my of aunt’s weddings. In any case, all I knew was I had one. And I didn’t know where to get more. I didn’t necessarily have a use for it. But because I only had the one, I didn’t dare use it or handle it too much, lest I wanted it later on for some more important reason. To this idea I have no idea what that reason that might have been, but still I didn’t use it. It was scarce to me. Why I never asked my mom where more could be found I’ll never know. Instead I simply held on to it. I never did end up using it and at some point it was lost. Now, of course years later, I know where I could get as many as I need or can afford.

But that mindset has stuck with me. I realized that earlier this semester when I decided I wanted to go old-school and start taking notes on some 3″x5″ index cards I had. I must have grabbed some from my office in New York before I moved into my apartment and set up my study area here. I started taking notes on them, but I was parsimonious at first since I only had 50 of them. Of course I knew where I could get more, but I didn’t have the time and I wasn’t sure how many I really wanted to buy. I finally went on to Amazon one night and realized I could buy a package of 500 for under $8.00. I of course being frugal, hunted for the least expensive pack of 500 I could find. But even then I resisted. “What if I don’t use them all? That’s a waste.” But I realized that $8.00 was a small drop in the bucket of my educational expenses and if they helped me pass some tests, it was a wise investment. And counter to that, if I didn’t spend $8.00 and failed a test, that wouldn’t be a wise savings. I’ll add that I’m now on my second pack of 500 and I’ve bought a dozen different index card boxes to hold them grouped by test and or subject.

There have been a few other items I resisted ponying up money for for school. One example is a subscription to ChatGPT. I at first tried to be frugal and use the free model, but I’d hit limits on usage. I’d question myself if it was worth paying the $23/month it would cost for a subscription. Now months later, I’m so glad I ponied up.

At times I still resist using something because “I don’t know how I’ll replace it” or “is it worth the cost of replacing it” but I’m overcoming that. Within limits, I’m trying to get into the mindset that yes, spending a bit of money here and there to drive the mission forward is worth it. Don’t be pennywise and pound foolish. The mission here of course is graduating PA school and having enough retained knowledge to pass the PANCE exam.

I’m still working on overcoming some of these built-in mindsets and that’s one of them.

Half-way, Quarter-way, Some-way

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Most of the members of my PA school cohort are in a group chat. It was in this chat I received one of the better messages lately: “Today marks the halfway point of our didactic year!!” Now, this is a two year program, so it also marks approximately the one-quarter mark of our progress (the schedule for the clinical year is a bit more complex). In either case, it was a nice landmark to reach, especially considering that in 9 days we had 5 tests. And of that 9 days, 2 were the weekend. Of the 5 tests, 3 were, at least for me, particularly difficult. I passed all of them, one just barely. So it’s fair to say it’s been a particularly stressful part of the semester. Now it’s Friday night and I’m relaxing and starting to plan out how to finish up the rest of the semester.

I mentioned in a previous post about life being on hold. And often I still feel that way. I’d be lying if I said there weren’t times I have doubts about continuing on for the next half or three-quarters. It’s not about the grades. While I’d like to be doing a bit better, the truth is, based on what my professors tell me and what I’ve read, I’m well prepared for my clinicals next year and for eventually passing the PANCE. I rarely have doubts about my ability to get where I want to go.

What I wonder at times is a more existential question: Is it worth it? I’ve reflected upon this a bit in the past. I’ll be 59 by the time I become a PA. I know I’m going to enjoy it. But, for how long will I enjoy it? How long do I need to enjoy it to make two years of my life and over a $100,000 worth it? In terms of economic investment, while I haven’t done the math, I think if I had simply continued as an ED Tech for these two years and then three additional years and retired at 62 I’d be better off financially. In terms of time committed to something, I certainly could have worked far fewer hours in IT than the time I’m spending in school or as an ED Tech and come out ahead financially and in terms of leisure time.

So, unlike my classmates, who statistically will spend much of their career as a PA, I’ll spend perhaps 10 years as one. In terms of finances, it’s probably not the greatest career choice this late in life. In terms of work-life balance, at least for two years, it’s definitely not a great choice. I have no real work-life balance for now.

But you know what? Even with those doubts, I’m still confident I’m on the right course. I really enjoy medicine. While sometimes I’m frustrated, especially about pharmacy, I enjoy what I’m learning. I enjoy the problem solving that goes into making a diagnosis. I enjoy the work I know that will be involved. It will be worth it.

I’ll have my doubts at times. I’ll have the exams I’m sure I’m about to fail and I might even fail one or two (several professors have told me, “everyone fails at least one exam in PA school, I did.”). But I’ll get there. I’m half-way through the didactic year and about one quarter of the way through the whole process. Some way, I’ll finish it and be able to add PA-C after my name. I can’t wait.

“Life, Please Hold”

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My fellow students and I just completed what some called a week from hell. Two of our hardest test. Well for me one wasn’t too bad, but the other was on Pharmacology, and I’ll be honest, that is NOT my strong suite. On Monday night, I literally was trembling because I was sure I was going to fail the exam. Now I could fail it and still pass the others and be fine for staying in school. But if I failed it and any others in that class, odds would be high that my PA school effort would come to an end. But, it turns out I passed and honestly did better than I had even dare hope for. So one Pharm exam down, three to go. The next one I don’t expect to be nearly as bad, which does help.

And now, I have a 5 day weekend. It couldn’t come at a better time. We all needed the break before heading into the rest of the semester. We actually have more exams in the last half of the semester than the first, so it won’t be a walk in the park, but at least we have a breather here. But then we pick up the pace again.

A few weekends ago I had to miss a square dance event that I’ve been to for several years. I haven’t had the opportunity to do some of my favorite fall hikes in New York and New England.

Back from 2007 to 2011, I had a job in Washington DC that kept me away from home quite a bit. But even with that I was generally home 3 out of every 4 weekends. So not only was I seeing my family on a regular basis, i was able to get out on weekend hikes, go caving once in awhile and in general catch up with friends and the like. Yes, I wasn’t as active locally as I would have liked to be, but I felt like life was moving on. I could also take vacations when I wanted.

But now? Life is on hold. Other than scheduled breaks during or between semesters and a quick trip home for a family memorial, I haven’t taken a break and won’t have many in the future. Much of every day is spent studying. Even my weekends have been spent studying. I am actually spending much of this 5 day weekend studying and catching up.

So for about 24 months of my life, 2 whole years, my life is on hold. As much as I’d love to see many of you and do fun things, please understand, my life is on hold.

“Remote DBA Wanted”

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Since I have not really deactivated or updated my LinkedIn profile, I still get emails and the occasional text tempting me with a job offer of some sort. And as I sit here, trying to contemplate my study plans for the night and weekend, I have to say the idea of responding to one of them is appealing. For one thing, the money would be far better. Instead of burning through savings, I’d be building savings back up.

But the truth be told, that thought is only a fleeting one. Firstly, I’ve been away from active DBA work for a couple of years now. I’d have to take time to come up to speed and that would be stressful in and of itself. But also, ultimately I suspect I’d be bored or frustrated again.

And there are definitely nights I miss working as a Tech in the ED. Yeah, there were shifts I hated, but overall I enjoyed it. However, I’ll still pick up some over holidays over the course of the next year. That should sate some of my desire.

My biggest doubts come on nights like tonight where the doubts creep into my head. One of my classmates has tracked how many tests and quizzes we’ve had and the approximate number left in our didactic year. I don’t know the number, but it’s up there. Each one brings a new period of stress. And of course, after our didactic year comes our clinical year, 10 rotations, 4 weeks each. Not only will I be stressed about each area I’ll be assigned to, I may often have to figure out housing for that period of time (and how to pay for it!)

But I remind myself, that it’ll be worth it. That the ED is where I want to be, and while I think I’ve done a lot of good as a Tech, I hope to do even more as a PA.

But those regular hours, and higher pay, they are tempting. Just not like they used to.

One Semester Down

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My final exam of the semester was yesterday (Wednesday morning) at 8:30 AM. It was our 5th exam of the semester in Anatomy. I’m not sure why, but stuff wasn’t really clicking for it. I did about as well as I estimated I would do, but not nearly as well as I would have liked. But I’ll live with it.

I’m waiting for two final grades that represent 35% of the grade in a 2 credit class. I expect them to be decent and assuming no surprised, that means I’ll finish this semester with a 3.2. In a previous post I mentioned we need a 2.7 or better to continue So I’m good on that. That said, it’s not the 3.7 I thought I was looking at mid-semester. I should be happy and proud, but honestly, I’m still a bit stressed. My last two anatomy exams definitely had a bit of a drop and two of my exams (including one of the anatomy ones) that I thought I did really well on, I didn’t.

I’ve mentioned this to a few folks, but needed to elaborate a bit. It’s not the grade per-se that bothers me. It’s fact that I thought I had done much better than I actually did. I’ve walked out of one or two tests (including this last anatomy exam) not feeling great about it, and the final grade reflected my feelings. But when I think I did great and didn’t, that’s another whole story. It’s giving me a lot of self-doubt.

But my advisor and other faculty have assured me not to worry. But, I will.

That said, I’ve been analyzing some of the reasons for not doing as well on the exams as I would have liked. Some is simply “this ain’t easy.” I didn’t expect it to be and some of it is rote memorization and that’s honestly harder for me. Don’t ask me about all the muscles in the lower leg and foot and their innervation or vasculature.

Some of it, I honestly was trying some different study techniques that didn’t work. I honestly should have taken my own advice and gone back to what I wrote about here. I had started to rely a bit too much on using ChatGPT in a particular way (basically a “quiz” mode) that I ended up being a bit biased in what I felt confident one. That I think explains a lot of the issue with the two exams where I walked in really confident but didn’t walk out with a great grade. I’ve gone back to some of my basics and also modified how I work with ChatGTP. While my last anatomy exam wasn’t nearly as high as I’d have liked, I think it was far better than it would have been had I not adopted these changes to my study methods.

My advisor and mentor and our didactic coordinator have been great. They’ve given me some good advice and guidance. A common them I’ve heard is that while the work gets harder in some ways (and more of it, 25 credits vs 18), there’s less memorization and more integration and honestly, I think I’m better at that. So we’ll see.

I should note, nearly one-third of those credits is Medicine 1, an eight credit class. So a lot is riding on me doing well in that class!

I think if I can make it through the second semester, then I’ll be set. Not to say it’ll be easy, but I’ll be that much closer.

My biggest stress about my clinical year will be the logistics. But that’s about nine months away.

That said, the other emotion running through my head is, “I should be studying.” I’ve spent pretty much every waking hour of the last 10 weeks studying. Not having something immediately study for is really wreaking havoc on my brain. I’m trying to get a bit more into “relax” mode and having difficulty.

I wouldn’t exactly say it’s trauma, but in a sense it is. I haven’t really been hyped on adrenaline for the past 10 weeks, but it does feel a bit like withdrawal.

So I’m home for about 10 more days. What am I going to do? Pick up some shifts in the ED. Partly for the money, partly to keep my skills sharp, and really honestly, to catch up with my coworkers. I honestly miss them.

I’m going to take a bunch of incoming freshman at RPI on a caving trip.

And I’m having a pool party.

And then at 9:00 AM on August 25th we start fall orientation. That’s of an hour and then it’s straight into our first lecture: “Evidence Based Practice.”

Near the End of the First Semester

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Well, the first semester is almost over. It’s been over a month since my last blog entry. I had hoped to blog more often, but well honestly I haven’t had the time or energy. To give you an example, this past Saturday I never left my apartment. I spent pretty much the entire day studying, and most of that for a single exam which was this morning.

And to be honest, I’m not sure I did as well on the exam as I had hoped. And a week ago, I walked out of an anatomy exam, thinking I had aced it, only to discover the next day I had barely passed it. By far my lowest grade yet.

I’ve tried to tell myself, “it’s only one grade” but truth is, it’s rattled me a bit. Scratch that, a lot. And not knowing this morning’s exam grade has me on tenterhooks.

Compound with that this Wednesday is another exam that I definitely do not feel prepared for. And strangely, I wouldn’t say it’s necessarily the hardest subject or even hardest exam, but it’s perhaps the most objectives we’ve had in a single exam. So after taking a short break, I’ll get back to studying for it. I’ve already spent close to two hours on it today and will spend at least four more today and probably eight tomorrow. And even with that, I know it won’t be easy.

But enough of my complaining. I wanted to share something else.

While I sit here and question my life choices between two hard exams, I thought I’d share one update.

I blogged earlier that when I got accepted at Arcadia, their program was on “Accreditation – Probationary”. This was a bit concerning because in theory their accreditation could have been yanked and I’d be out money and time.

But, I talked to a couple of faculty and staff and chatted online with one of the students at the time. No one could make any guarantees, but their comments and answers did give me a good feeling. So, between that and the honest fact no other school was willing to take a risk on me, I accepted and obviously am now attending.

Well about two weeks ago we finally got an update. Arcadia is now “Accreditation-Continued”. This is excellent news. This means barring a catastrophe (like the entire faculty coming down with Ebola at once) when I graduate, I can set for the PANCE (our certification exam). So that’s one bit of good news.

So I’ll close on that.

PA School: Learning and Teaching

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There’s a time when you’re whitewater boating where you’re just above the rapids, trying to figure out the line you want to take. The water around you is calm, but you know eventually you’ll be in rapids and at that point you’ll have hopefully picked out that line because it can be very hard, downright dangerous to change your line through the rapids once among them.

I’ve left that area just above the rapids and now I’m in them. So far the line I’ve picked to navigate the rapids appears to be working. I’ve got some Class III maybe some Class IV rapids ahead, but I’ve navigated one class III already and just passed some Class II rapids and the boat is still upright with me in it.

I am of course talking about my first semester of PA school so far. I mentioned in a previous post about trying to figure out where the return on benefits for studying is for each class. At some point doing more studying one topic won’t make that much of a change to my grade so I spend that time on a different topic. So far, based on my last few test, I think I’ve hit that mark. Yeah, I could get a marginally better grade on a few of the tests, but I’d have to steal the time from elsewhere.

At the start of the semester they mentioned there were some Grad Assistant (GA) positions available that included a stipend. One of the positions is to lead what they call Study Sessions. I applied for that position and I’m one of 3 in my cohort at this campus (we have 3 counterparts in Glenside) get the position. While they’re called Study Sessions, they’re more accurately (and I’m working to get the name changed) Student Led Review sessions. The idea is that for a particular upcoming exam one of us will work with our counterpart at the other campus and develop a slide deck of practice questions covering objectives that we feel are critical for us and our peers to understand for the next exam. We submit our deck to the course professors for review. After they’ve signed off on it, then we use a tool called “Pear Deck” to make it into an interactive slide show that students can run on their computer to submit answers to the questions while we can then show the results. It’s pretty cool.

The first three Study Sessions were run by professors. I was the first GA at my campus to run a student led one. From the feedback I received, it went really well. This was good to hear. There are several reasons I signed up for the GA position. The stipend, while minor was among them, but a small reason. Another was because, as many of my readers are probably aware, I love to teach. So being in front of a classroom, especially of my peers, is something I enjoy. But there was also a final, somewhat selfish reason for signing up: I can’t teach what I don’t know.

Now, to be fair, the topic for the first lecture was Genetics. I had taken an entire course in this as one of my pre-reqs and as a result found the objectives covered to be pretty much review. That certainly helped me in preparing the slide deck, but even then I found myself referring to my notes and the lecture notes to confirm I really understood a specific point. Nothing would be more embarrassing than asking a question and then confidently telling the students the wrong answer!

The next topic I will be covering is Cardio-physiology and pathophysiology. I have not taken a class in this specifically in the past, but some I learned previously in my undergrad A&P and some from working in the ED. But there’s definitely some I need to review before I present.

I have one or two more opportunities to present more during this semester. I’ll decide in the next 48 hours what I will end up doing.

But that’s it for now. So far it appears I’m putting in about the right amount of effort for the grades I want to get and I’m helping my fellow students review for particular exams so we can all do the best we possibly can.

And I’m still loving it!

PA School: Tools I’m Using

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So my first exam for Mechanisms of Disease (we just call it MOD, it’s easier) is out of the way. Due to how they grade things, it may be a few days before I get a grade on it. This is a bit frustrating, but I can’t do much about it. So, rather than talk about that or whether I’m on the right track when it comes to how I’m spending my study time, I thought I’d talk about some of the tools I’m using.

OneNote

I’ve mentioned this multiple times in the past. It’s nice in that it allows me to free-form write notes draw images, do outlines, add checkmarks, etc. It’s still a heavy go to to help me keep things organized.

Screenshot of my OneNote page for Human Gross Anatomy
OneNote Screen Shot

This is a current page out of my OneNote. You can see across the top I have a tab for various classes or important topics. On the right I have pages for each lecture plus some other details I want to track. The main section is a portion of the objectives for Exam 1. You can see here I’m using checkboxes instead of colors to mark what I think I know and I don’t. I obviously still have a bit to review here (and note that the scroll bar shows I’ve got a lot more objectives to look at.)

Whiteboards

I mentioned this in my previous post. Once I get to my newer apartment, I’ll get more sheets of whiteboard paper to put on the wall or even some actual whiteboards to mount on the wall. I find this HUGELY useful to help me draw out structures or organize notes. Sometimes just putting “pen to paper” makes a big difference here. One can’t have too many whiteboards in my opinion. I’ve even seen one of the attendings where I work wheel one down so he can teach residents a few things.

I should note, at one company I consulted at as a Database Administrator, their IT/Dev department had very few whiteboards. I never really understood how they got things done.

Quizlet

Some of my fellow students love this app. I’ll admit I use it and sometimes I use old-fashioned notecards. But I find it has limitations. It’s useful for learning “facts” but harder in my mind for learning interactions. Yes, it can be done that way, but it’s more work. So, for example, it’s useful to quiz me on what artery serves the trapezius muscle (main ones are the transverse cervical artery and the dorsal scapular artery in case you’re interested). But less so on fully visualizing where it is and what it does (though I do have a card asking about action). What it has limited use for in my opinion is what are called second-order questions. This might be, “patient is stabbed in the back along the upper back near the neck, what muscle might be show limited to no movement?” The answer (especially if it’s multiple choice and some are obviously wrong) is most likely the trapezius because the nerve that runs to it is in that area. Here it helps to understand where things are and how things operate.

Complete Anatomy

I’ve previously mentioned the Anatomage tables we use for anatomy class. These are awesome, but there’s only two per campus and they’re not portable so I can’t take them with me. Enter Complete Anatomy from Elsevier. I have a copy on my phone and on my desktop. It’s incredible. Very much like the Anatomage tables, I can select a specific structure to examine, add in or remove surrounding structures, look up details on a specific structure and more. I can even tell it to show me how specific muscles move. This is an EXTREMELY useful tool for anatomy. For $40 I would recommend it to anyone who has to study anatomy. I’ve been using it all this morning to help me get a handle on all the muscles in the thoracic cavity and back that I need to know for next week’s exam. It’s definitely helping.

ChatGPT

Or as one of our professors likes to call it, “Professor Chat”. I find the fact that I’m using this a bit ironic because just within the last two years, every PA school application process has had to add a disclaimer that you can NOT use ChatGPT or other LLMs to write your essays. But once here, they’ve encouraged its use. It’s NOT perfect and I’ll be honest, it wasn’t until a fellow student pulled it up in a study session over the weekend that I had given it much thought. My early playing with LLMs had not left me very impressed. It seemed like a gimmick (e.g. “Write me a short love story in the manner of Stephen King”) that while fun, I didn’t find overly useful.

But that study session changed my thoughts. I started playing with ChatGPT Sunday night (the night before my MOD exam). I did several things. In one case I took a slide about skin diseases and copied it into the ChatGPT window and said, “Give me a 10 question multiple choice quiz on this material”. Not only did it, when I got an answer wrong it attempted to explain why I go tit wrong. At one point I put in the entire list of objectives to be covered for the MOD exam and asked it to give me a 30 question quiz with at least 5 second order questions. It did, and then it graded it.

Now it’s FAR from perfect. More then once I’ve found it’ll mark the right answer wrong (which is strange enough) but also it’ll mark the wrong answer as correct occasionally. Honestly, though I found this useful as it forced me to engage with the LLM. For example one question was poorly worded and I told the LLM that and it came back with a better worded question making the same point.

I find ChatGPT very useful for second order questions because it’ll craft decent ones and then after I attempt to answer them, explaining the reasoning to all the available answers, why the one that is correct is correct and why the others are not correct. This forces me to think a lot about systems.

Yes, ChatGPT can be used like an advanced search engine, but that’s only scratching the surface of what it can do.

I suspect I’ll be using ChatGPT a lot over the coming year to help prepare for tests. I also suspect that at times during my clinical rotations, if the preceptor allows it, I will use it to help verify my diagnosis or give me more information to make a better one. I don’t think it’s quite ready to be the sole source of truth though when it comes to making a diagnosis. I will note there are some AI tools that in limited cases can be better than humans, but those tend to be fairly constrained areas of medicine and even then they often have errors.

Study Groups

This is not really a technology or object. But study groups can be critical to helping “polish” my thinking. Sometimes I’ll see how others are approaching problems, sometimes I can share my knowledge with others (which seems to help them, at least in some cases.) Once I get to my newer apartment, I hope to host these once a week or so.

Classroom Study Sessions

This one, honestly, several of us believe if misnamed and we were talking with a professor about yesterday. They’re honestly more instructor (and soon Grad Assistant) led review sessions. For my campus, I’m one of three selected Grad Assistants who will eventually be helping to lead these. The reason some of us think they’re misnamed is because the format is really more a review of material than an actual study of it. We’ve had two so far and the format is the professor(s) create “slide” deck in what’s essentially an interactive PowerPoint like program (I can’t find the name or link right now). They’ll put up a slide with a question and often answers and anyone logged in can select an answer. After some time (generally after about 10 seconds have passed) they’ll show the results, give us the right answer and maybe a very quick comment and then move on. We generally do about 50 questions in one hour. So as you can see, it’s not really studying as much as reviewing. These sessions are completely voluntary, but I think very useful. There were two reasons I signed up to be a GA for these. The first was I want to help my fellow student succeed. The second was because it would force me to make sure I was more familiar with the material. Oh and we get a small stipend, so there is that too.

In Conclusion

There’s probably other tools I used I didn’t think to add and over time I’ll learn to use some tools more than others or add or remove tools to the mix. For example, once done with the Human Gross Anatomy class, I probably won’t use Complete Anatomy as much as I do now. And I’m sure when I’m taking the pharmacology class, I’ll pick up a new tool specific to that.

One thing I’ve very quickly learning is that I have to continually work on my study habits and adapt them as needed. This will be especially true in the second semester when I’m taking 25 credit hours!

PA School: Studying

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To state the obvious, any grad program, but I think among them, especially PA school requires intense studying. In some ways, PA students will cover more in a semester than many med students in the same amount of time. Time is at a definite premium. As mentioned previously, for every hour we spend in lecture, we’re expected to spend roughly two hours outside of lecture on that same subject. So if we have a single hour on a topic like Inflammation, we should probably plan for two hours or more of studying on that outside of class.

Related to that though is some advice they’ve given us very early in the semester and that is to a point, grades don’t really matter. Obviously they do, there are some program minimal requirements and the like. For example, to continue to the next semester or next year will require a minimum GPA of a 2.70. In order to be eligible for the overseas service trip requires a GPA of 3.0. But, for an individual subject, they’ve told us if we get a 70% or better on it, we should be OK for the PANCE. That said, I think everyone wants to do well and to do better than “just enough.” I know I do. But, we don’t have class ranking and we’re not competing for residencies, so honestly, they’re right, beyond a certain minimum doesn’t matter.

I say this because it does impact my approach. I mentioned in a previous blog how I had a major test on Tuesday (Medical Terminology) and hoped to do well. We were all nervous about it and several of us, including myself, had dreams about it. Mine was particularly weird. But we all took it. I don’t think any of us required the full amount of time. They’ve warned us that often tests will take several days to grade (there’s a complex process to it, even though the tests are given electronically). But today, it only took a couple of hours. I’m proud to say I got an 89.69. Yeah, just short of a 90. But I’m ok with it. Yes, I’d have loved to have gotten higher, and honestly where were two questions I know I got wrong that I probably should have known a bit better. But, the reason I’m ok with it is, I based on the amount of time I spent, I got a grade I’m happy with. I was hitting a cost/benefit ratio on time. Had I spent another 5 hours studying, I might have gotten those two right. Another 10 hours, perhaps four more right. But, in the end, there were a couple of terms that I honestly never would have thought to study, so it’s unlikely I would have gotten a 100% on it. And I’m ok with that.

And that leads me into my part of this post. HOW I am studying. For medical terminology, one of the approaches I took was to ensure I knew a number of Latin roots and prefixes and suffixes. This meant that if I encountered a term I had not studied for, I had a better chance of figuring them out. Sure enough there was at least a few terms I had not specifically studied for, but that I was able to figure out. I’ll probably talk more about the “language” of medicine in a future post.

Now, that said, the medical terminology exam was a critical one to pass, but honestly, I didn’t think it was hard to study for. Coming up tomorrow is our first major exam in a class called Mechanism of Disease. This has been far harder to study for.

Below are two pictures of some of the things I’m doing to study. I’m going to work on this process over the coming months as I realize what works and doesn’t work.

Since I started taking my prereqs, I’ve gotten quite adept at using Microsoft’s OneNote for taking notes and outlining things. Here I’ve taken all the objectives from various lectures that are covered in this first exam and put them in one place. I’m slowly going through and color coding what I feel very comfortable with (green), only moderately comfortable with (orange, or not at all comfortable with (red). Black is for stuff I haven’t reviewed yet. This images is from Tuesday night.

Using this will hopefully allow me to decide where over the next few days I need to focus my limited time. If it’s already green, I’ll spend very little time on it. If it’s red, I’ll definitely spend time on it, and if it’s orange, I’ll have to determine how much time to allocate to it.

You’ll note that I don’t have any actual comments within the objectives. That’s generally elsewhere in my notes on other tabs.

But I also have a second thing I’m looking at. That’s the whiteboard shown in the following photograph. This is definitely something I’m going to be changing over time as I find out what works and doesn’t work.

I’ve broken out each lecture that will be covered on this exam. Then below it I’ve put several items (and this is the area most subject to change). Here, the colors mean nothing. They’re simply the markers I had available.

But to decode it:

  • Notes – Have I reviewed my notes (or in a few cases, even made them!)
  • PPT – Have I reviewed the PowerPoint slides. I’ll be honest here without naming names, but some professors make better PowerPoints than others. For example some will include notes with the slide. This can be very useful so that I can put the contents of the slide in context.
  • Book – Have I read the assigned chapters in the book? If not, I need to go back to it. Sometimes the book will explain things the lecture didn’t cover or explain it differently which will help.
  • O – Outline – have I outlined notes and organized them in a readable fashion.
  • AAR – Alternative Academic Resources – did they provide a link to a video. Are there videos I need to read.
  • Quiz – Have I made or looked for a Quizlet? To be honest, I find this hit or miss because if someone else is making them, they put in topics I don’t need to know or alternatively not put in stuff I do need to know.
  • LTT – This is the critical one and ultimately the only one I’m going to care about at the end.
    • Learn – Do I feel like I’ve learned the material? This will be true when I have all, or perhaps mostly green in my OneNote outline.
    • Teach – Do I feel like I can teach the material to someone else, or even better, have I. If I feel comfortable teaching it, then I’m going to be comfortable that I’m ready for the final T
    • Test – How did I do on the test? This of course is the ultimate metric.

For the whiteboard, I don’t necessarily plan on or hitting every single mark there. They’re more of reminders. “Hey, you’re having trouble with this topic, have you tried all these ways of learning it?” The only one I really care about is being confident in the LT portion of LTT.

The combination of these two resources will hopefully help me make sure I don’t go down a rabbit hole of a particular lecture and forget to study for another. For example, if I wake up Sunday morning finding I’m green on almost everything, but perhaps orange on two things and red on one, I’ll focus on the red topics first, so I can at least get them to what I consider an orange level.

What’s this translate to in the end? I can’t put hard numbers on it, but my thinking is something like:

  • Everything green – I feel like I should walk into the exam expecting something solidly in the 90s.
  • A majority of green with a few oranges – ok now I’m talking solidly the 80s, perhaps approaching 90.
  • Mostly oranges but no reds – I’ll start to worry. I’ll probably pass, but not solidly in the 80s.
  • Mostly oranges with some reds – I’ll be in panic mode. I’ll have to spend more time.

But, this is a feedback. If I think I’m green at that amount of effort and I’m getting a much lower grade on tests than I expect, that means in the future I’m going to have to increase my study time, or change how I study.

Alternatively, if I find myself in the orange a lot because I ran out of time, but doing really well on tests, then perhaps it means I’m overestimating how much I don’t know and need to revise.

I started this blog Tuesday night and am posting Sunday night. At this point, I’m green on most items and I think I’m ready to go. But we won’t know for sure until tomorrow!