PA School.... Rotations

 

So, the first year of PA school is didactic, the second year, is clinical rotations.  Depending on the school, rotations usually last anywhere from 5-9 weeks.  I believe there are certain requirements that PA schools have as far as mandatory rotations for every student.  I am not certain about this, but I know we all had family practice, emergency medicine, pediatrics, surgery, OB/GYN, internal medicine, and primary care rotations.  I also did an elective rotation in sports medicine.  These were all pertinent rotations, and after about half way through the year I actually began to see the light at the end of the tunnel and got excited about the end of school and my future as a PA. 

At the end of each rotation we had to return to the Penn College campus for a written and hands on practical test.  The practical test included a live patient with complaints and pertinent diagnostic tests.  It was our responsibility to evaluate the patient, extract a history, perform and exam, and come up with a working differential diagnosis before finally diagnosing and treating the patient appropriately.  These days were the most stressful.  The days working through the clinical rotations was somewhat relaxing, and other than an ignorant physician or two from time to time, it was a good experience and a benefit in the overall aspect of the PA education.  But those few days back on campus, with the written exams and practical application of the job, they were what most students dreaded.  Unfortunately, the practical part of the exam process is completed by a evaluator, who is a licenced PA.  One drawback to the process is that the evaluating PA may, or may not be, a subject matter expert in the diagnosis they are grading.  Another complication with the grading of the practical exercise is the fact that every PA develops there own idea of how to practice and their individual practice techniques.  This can cause some grader bias, even though they have a checklist that they are working with, to make sure the student hits all the important details of the history and exam.  It can be easy to get caught up in the individual evaluating PAs frame of reference of how to practice and that can reflect in the overall grade for the practical exercise.




PA school is certainly not the most difficult part of becoming a PA, the board exam is not either.  The most difficult part is learning how to practice, and learning the specific practice one chooses.  School is just a foundation, there is no way to understand medicine or learn all there is to know in 2 years of school, or in 25 years of practice for that matter.  Don't let anyone fool you, anyone who feels they have medicine figured out is setting themselves up for a huge reality check and failure.  Hopefully that doesn't translate into someones death, but at times it does.  Always know your limitations and when and where to look for help.  That is the single most important piece of information I can share.
School sets the foundation, passing the boards certifies you to practice, developing a practice, that takes time and learning, not just the cerebral aspect, but the mental and emotional aspect also.  More to follow on that in the coming posts.

One of the best programs is this program run by the U.S. military
http://www.cs.amedd.army.mil/ipap/





PA School

PA school is essentially broken into a year of didactic classroom study, followed by a year of clinical rotations.  The basic concept allows a foundation of medical knowledge based on study through the first year to support the student as they move through their clinical year.  I personally would prefer the two years to be mixed, but without prior medical experience, the current curriculum and organization of PA school is appropriate.  Not all students have a medical background, and honestly, being a medic in the military, or a nurse, will not prepare you to function as a PA without the didactic portion.  There is a ridiculous amount of information they cram into that first year, it is impossible to retain it all, but what resides in the memory gives you the basic principle and foundation for what an individual will need for clinical rotations and eventual employment as a certified PA.

Now, I had taken science courses, Chemistry - 4 semesters (3 introductory/general, 1 organic), Biology (3 semesters - introductory/general/cell), Anatomy (2 semesters - intro to anat/physiology, and human anatomy plus human physiology), all with labs, but I wasn't really expecting what PA school threw at me once I got there.  Hell, during the first semester of PA school we had Pathophysiology, with all my science background you would think this class would be easily managed.  Not so, it was very demanding and difficult.  I knew from the start that PA school would be very difficult, especially with trying to devote time to my wife and kids also. 

I have decided to not include the personal nature of my struggles in PA school in this blog, those struggles are detailed in my book (Combat Support "The True Burden Of Sacrifice") and I feel that writing about them once is enough.  Needless to say the first year of PA school was difficult, it was difficult for me to maintain the grades asked of me, and it was difficult for me to keep my sanity as a student to try and get through the first year with the knowledge I needed to continue. 

For anyone interested in PA school, I have a couple of tips:
1. Be prepared to do nothing but devote your time to study, this is vital to building a strong medical foundation
2. Try not to allow other aspects of your life to sway you from devoting the time you need to studying, many students have families, it is important to continue to be a mother or father, but make sure you have a good 2 hours a night to devote to increasing your knowledge.
3. If you struggle, ask for help, from fellow students, or from faculty, regardless of your delusions, no one is interested in seeing you fail.
4. If you are young, 25 years or younger, and your have the appropriate GPA and can score well on the MCAT.  Apply to medical school, we need more physicians, and as great as the PA profession has become, you are not a doctor, nor will you ever be one with a PA degree.
5. Dedication, motivation, persistence, all will benefit you, and always get back up when you get knocked down.

Starting PA school

In the Fall of 2007 I began my journey to become a physician assistant.  It was something I was not necessarily ready to complete for two simple reasons.  One, I was fresh from a deployment to Iraq and had not had any closure from my overseas tour.  Second, I was in my early thirties with a family who happened to be going through adjustment pains of their own.  It would be a long journey, mostly painful, but in the end I was just hopeful it would be worth it.

Prior to deploying to Iraq I had been accepted into the Pennsylvania College of Technology (Penn College) Physician Assistant Program.  It is one of the few remaining four year programs in the country, most PA schools are masters programs, you need to have bachelors prior to starting.  However, Penn College, still being a bachelors program, only requires you to meet the pre-requisites prior to being accepted into the professional phase of the program that consists of what would be the junior and senior years of the bachelors degree.  I had nailed down all but five classes that I needed prior to deploying to Iraq, I would complete microbiology while deployed, and then complete one semester at Penn College prior to starting the professional phase in August 2007.  Luckily, since I had been accepted prior to deploying, I was granted an automatic seat into the program, this meant I would not have to got through the interview process like many of the other students applying.  As long as I finished my pre-requisites and kept my grades at the required level I would start the program without the need to fight other candidates for my seat.

I completed statistics, cell biology, organic chemistry, and a communications requirement without too much difficulty.  It was as simple as that, I qualified for my automatic seat and started the program on time.  I had no idea what I was getting myself into.  The pace of the school would be much more than I expected, I was about to try and complete this medical professionals program all while recovering from my deployment to Iraq and trying to be a father and husband, it was an uphill battle and one that my family and I almost lost.  Those details are in the book also.


I will elaborate on the curriculum of PA school next.  Not a simple task for someone who was in their right mind, much more difficult for those who do not have all the pieces of their life in place when they begin the school.  It can be unforgiving, and I came close to flushing all I had managed to accomplish down the toilet.  It would be a painful ride.

The decision to pursue a career as a physician assistant

Personally, I would not recommend to any young kid coming out of high school, with aspirations of working in the medical field, to become a physician assistant.  That is just my opinion, if you are young, have the proper grades, score well on the MCAT, and can tolerate eight years of school, then a 3-6 year residency, I would recommend medical school.  However, with the cost of school these days, medical school for those eligible, but without the financing, is just a pipe dream.  Scholarship money, and grants may take those a long way if they can get into medical school, but just an undergraduate degree in today's world costs well over 25,000 dollars.  It is a burden on the pocket book and certainly we need to do more to allow education to reach individuals who may, through no fault of their own, be without the monetary means to pay for school.

I, as a young enlisted man in the Army, had worked with a couple PAs, and heard about PA school, but as a medic, and with little college under my belt, was not interested in my early 20's to pursue any higher educational goals. It wasn't until I was married, had children, and realized I could do much more with my life, that I began to look at options. 

In the beginning, in my late 20's I was considering both medical and PA school, wasn't sure which it would be, but knew if I could get into medical school the road would be much longer and painful than PA school.  That was part of the decision making process, simply, I was getting older, had to finish undergrad, and then start medical school?  No thanks.  I deployed to Iraq with my National Guard unit and while there I began to weigh my options, which included not furthering my education at all.  The decision came while deployed, it is detailed in my book - Combat Support "The True Burden Of Sacrifice" - unfortunately I did not realize what a stress it would be returning from a combat zone deployment to the role of a student, it was difficult, again, detailed in my book. 

I will further compare and contrast medical doctors and physician assistants along with other medical providers.  All have their benefits, and some drawbacks.  But eventually I will lead to the present day and discuss my current job, that of a Neurosurgical Physician Assistant.  The most difficult job to maintain as a PA.  But of course, I may be biased.  Stay tuned, this will be fun.

Also check my Author/Soldier blog here.