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13. Peds, EORs and everything in between
153 Plays3 years ago
This episode explores a PA student's journey to school through didactic year and into clinicals. We talk about pediatric rotations and a perspective on how to tackle EOR exams.
--- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
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Transcript
Introduction to the PA School Experience Podcast
00:00:13
Speaker
Welcome to the PA School Experience Podcast. I'm your host, Sebring Sands, and I take you through the behind the scenes look of PA School and explore what it takes to become a PA.
00:00:33
Speaker
If you have been wondering how I could do this podcast in PA School, I'll tell you, I use an anchor. This is the easiest way to make a podcast. Let me explain. First, it is a free hosting platform which allows anyone to start a podcast with no upfront cost. It has built-in tools which allow you to edit and record a podcast. You can even record it from your phone.
00:00:56
Speaker
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Meet Angelica: Journey to Becoming a PA
00:01:27
Speaker
Welcome everyone to another episode of the PA School Experience Podcast. And no, I'm not dead. I'm alive. I didn't get kicked out of PA school, even though it was a little dicey there sometimes, but we made it. We're all good. So, you know, I know it's been a while.
00:01:45
Speaker
It was really busy at the beginning and then I just kind of start falling out of habit and I needed to get in touch with people to do the podcast with me because it's boring, just watching me, listening to me rant about different things. So today I have a special, very special, you know, I say this to everyone, very special guest with me. Angelica, do you want to introduce yourself? Hi, I'm Angelica. Okay.
00:02:14
Speaker
Awesome. Thank you for joining me today, Angelica. So we're going to kick things off. Um, maybe just talk a little bit about yourself, where you're from, things you like to do to start out nice and slow. So I'm from a small town in Massachusetts. It's called a Sona. Um, I lived there my whole life, born and raised.
00:02:40
Speaker
for hobbies, I like to travel, I like to garden, and you have to put Netflix in there, spend a lot of time doing that in PA school. Awesome, yeah, that sounds like fun, and I do the same thing. So I don't do the gardening thing though, but because I really like to, I don't know anything for it, but awesome. So Massachusetts, there's a few people from Massachusetts,
00:03:08
Speaker
So that's really fun. So how did you end up in PE school? How did this thing all start? Were you interested from birth or were you interested halfway through undergrad? How'd that begin? So for undergrad, I went to Bridgewater State University. I started at that university majoring in chemistry. I thought I wanted to go into chemistry, but
00:03:38
Speaker
I found that I really liked the human body during that time and I thought it was really interesting. So then I became an EMT and that's kind of when I realized I wanted to be a PA.
Angelica's EMT Experiences and Choosing PA
00:03:56
Speaker
I wanted to have more of an impact and spend a little bit more time with my patients. I wanted to be able to
00:04:06
Speaker
just do more in general for them instead of just a short ambulance ride. Awesome. Yeah. Awesome. And so you're one of the many that are, or EMT is fun.
00:04:18
Speaker
So chemistry, man, I knew you were smart, but I didn't know you were that kind of smart. Chemistry is quite the field to want to go into. Research is a big deal, and even the crazy biochemistry stuff. I took a watered-down version, and that was actually pretty fun.
00:04:43
Speaker
But the crazy major biochemistry? No, not for me. So that's really cool. So human body EMT. How do you, how do you like being EMT? Was it, did you get burnt out in your first year or was it, how long were you doing it for? I was an EMT for about five years. It was a while to be on a truck. Um, most days I, I loved it. I,
00:05:12
Speaker
loved the adrenaline of it when it did happen. Um, it's not as crazy of a job as it sounds like. Um, and other days are really hard. You obviously get those tough calls and, um, it really shows you about your social issues in your community as well as resources that are lacking. And it's tough on your body too. It's a lot of hard work. Yeah.
00:05:41
Speaker
I know a lot of times we're exposed to paramedic and EMT and just the ambulance and pre-hospital and TV shows and they're extremely extreme, like a thousand percent more than usually what you deal with just to get the wow factor. But yeah, that's crazy. My sister-in-law is EMT right now.
00:06:04
Speaker
hearing kind of some of the things she's been doing with homelessness and all these other issues that you don't really see unless you're like dealing with it on a day-to-day basis, which is sad, but it's hard. It's a hard thing to fix. So did you interact with any PAs in like the ER when you were working and were you exposed to it that way or just kind of heard about it?
00:06:28
Speaker
you know, not like gossip, but just kind of heard about it trickle down through the, through the people you worked with. So I did meet some PAs and ERs and like other like specialty floors. And we brought patients to appointments, but I think I really got into the PA thing with the people I was surrounded with at my school. I did a lot of biochemistry research. So I was surrounded by a lot of pre-meds and
00:06:58
Speaker
When I looked into becoming a doctor, it just didn't really seem like something I wanted to do. I definitely like a lot of different things. So I wanted the opportunity to switch specialties. And being a PA was an option that was like always brought up among the people I went to school with. And the more I looked into it, the more I realized that was probably the best fit for me.
Applying to and Choosing Sacred Heart University
00:07:26
Speaker
Yeah, we heard about it as a pre-PA, the lateral mobility, and when you say it in an interview, it sounds so cliche, but when you're actually in clinicals, when you see it, other PAs doing lateral mobility, it's amazing. This is such an underrated thing where we can pick up and apply to a different job and a different specialty and just pick and just bring up all our skills in that area.
00:07:54
Speaker
It's quite amazing. And we'll talk more about that later in the podcast, but, and also especially becoming, going the doctor route, we have some like interesting things to say about this because we interact with residents a lot in our program. So we have lots of things to say about this. Did you ever struggle in undergrad academically or was that always kind of something strong, a strong suit for you?
00:08:23
Speaker
I actually did a lot worse in undergrad than I'm doing in PA school, especially when it came to math, like pre-calculus, trigonometry, they were the death of me. The science courses I did okay in, but math just seemed to be really hard. I was good at it in high school, and when college came around, it just was not the same.
00:08:51
Speaker
Yeah, well, me, I was the opposite. I did really good at math, but it was crappy because a lot of those math tests didn't count for my science GPA. So I like had to go retake math, the sciences to up my GPA. So kind of the opposite. That's so funny. Well, that just goes to show how different people are. Okay, so now we get to peace. How was interviews and applying to peace school for you?
00:09:20
Speaker
Applying to PA school was a nightmare. Um, it, the first time I applied, I applied very late in the season. It was almost like, I would say August and those people actually apply in March. I just didn't realize how early you had to apply. So I was kind of behind the ball in that. And I didn't get accepted my first year. Okay. My second time applying, I did get accepted. Um,
00:09:48
Speaker
The interviews were very stressful too. It's a high stakes time, but when I went to our program's interview, it was an amazing program. And that's kind of why I settled on it. Okay. If you don't mind me asking, how many, the second time around, how many places did you get interviews at? I think I applied to about 10 my second time around.
00:10:16
Speaker
I think I got three or four interviews. Okay. So other than that, just being an amazing program, what kind of some of the things that set apart Sacred Heart with the other schools that you interviewed at? So the first thing I noticed was the warmth from the program, um, and kind of their emphasis on patient care and
00:10:46
Speaker
what their values were as a program and they really focused on diversity in the community as well as supporting their students. The faculty just seemed very open and I had an experience in undergrad where I got to travel abroad and I traveled abroad twice actually but the people I met in Nicaragua on one of my trips were
00:11:15
Speaker
the most phenomenal people I've ever met in the programs feel as a whole kind of reminded me of that time in Nicaragua. And it just felt like a good program. And I know that's like not really giving you an answer, but it just felt good, like a wholesome holistic. They wanted you to be good providers. They didn't want to just pump out students. They really seem to care about their students as well as
00:11:44
Speaker
the patients that their students would be treating in the future?
The PA School Journey: Didactic to Clinical
00:11:47
Speaker
That's a great answer. And there's been so many people that I've interviewed that go to Sacred Heart. So there's a variety of answers. So it's cool to see your opinion and your perspective on the thing.
00:12:01
Speaker
What I know everyone's probably heard me say this 10 times already, but for me, it was that collaboration. It didn't feel like I was competing with other people. It felt very collaborative. I love that. And it was very de-stressful because we did when I went through, I did my interview in October.
00:12:22
Speaker
I, we did all the group stuff first and then at the very end we had our like solo interviews. So by that time I was very relaxed and not stressed at all. Even the interview was very non stressful. I kind of tripped over my words a couple of times.
00:12:38
Speaker
But he said, like, it's fine. Calm down. Just breathe. Continue when you're ready. It was really great. So very good interview experience. And yes, it's a very personal program. And yeah, it's just it's just amazing. But we're biased, obviously. Right, right.
00:12:58
Speaker
But that's our perspective. So Sacred Heart University definitely should be top on your list if you don't mind the East Coast too much. Okay, awesome. So how's PA school been for you so far? PA school is PA school. It's hard. It's exactly what I thought it would be. It's very rigorous. The material I thought I would favor organ systems a lot more than I
00:13:29
Speaker
like specific organ systems more than I thought I would. Like I walked into it thinking I would hate cardiology and I loved cardiology. And as far as the amount of tests and the workload, it's exactly what I expected. It's just a lot, but didactic gear was rough. And then as far as my clinical year goes, it's been a really good experience. I've had a lot of,
00:13:59
Speaker
phenomenal opportunities and I've gotten to do a lot of interesting things. I'm excited for the rest of clinical year seeing what else I'll be doing.
00:14:12
Speaker
Yeah, we're coming kind of close to an end. We're just like six months out from graduation, which is crazy. It's, I know everyone's like, it's been a while since the last part. It was right before we started clinically here. So it's, it's been a while. So let's just, let's take a step back. What was your hardest thing of didactic gear and your most enjoyable thing about didactic here? I think the hardest thing about didactic gear
00:14:45
Speaker
Probably just having to show up every single day and sitting through lecture all day is very difficult. Sometimes they're just long days and there's no days off, especially first trimester when it was six days a week. It was difficult to do that and not have really any time to do anything on your own or anything not pay school related.
00:15:15
Speaker
And then probably the best part of PA school, I just liked learning about everything, especially like physical exam, learning how to do physical exam was really interesting for me. All the things you can tell about a person without even like ordering a test. I thought that was very cool to learn.
00:15:40
Speaker
Yeah, it was, I'm not sure how other programs are, but for us, it's very scripted on what we say. So we kind of get the motions down, which is very, you're basically talking out loud all the time through these like exams we do for physical or for the physical exam, but doing the workshops are very fun, learning about, you know, different tests to do, special tests, especially for ortho and things like that. It was very cool.
00:16:10
Speaker
And just it's being different than being a lecture all day, which is nice. Gotta not wear nicer clothes, even though like halfway through didactic your people stop wearing business casual, which is fine.
00:16:26
Speaker
but more like gym clothes and stuff, which is nice. And yeah, that was some good times, some very good times. Okay, well, let's talk about clinical year. So we are on clinical roadblock, is it seven? Are there seven? We're already on our seventh one. In our school, we have 11. Me too. And that's including capstone and that's including elective. So,
00:16:55
Speaker
which we're going to talk about one specific rotation. I don't know if everyone remembers my philosophy is, especially in clinical year, every rotation is so different and every person going to rotation is so different has such a different experience.
00:17:14
Speaker
even if they're doing at the same time, it'd be so drastically different. So I'm not going to spend so much time on their experiences. Some of it's going to be like that, but not to base anything off of experiences because whoever is listening to this is going to have a different experience. You can't base anything off of anyone else's experiences but your own. So we're going to talk about
00:17:37
Speaker
things to kind of think about and prepare for, how to succeed in some areas of clinical years. Because every clinical block is the same in how you bring yourself or when you prepare to go and just kind of the same formats. But obviously you have to change it to the rotation because those topics and everything changes. So what rotation do you want to talk about Angelica?
00:18:03
Speaker
I think I want to talk about my pediatric rotation and in my pediatric rotation, I was in a pediatric ER, so it was a pretty awesome experience. Okay. So what's kind of things did you do from a day-to-day basis in the ER and the pediatric ER? So whenever a patient came in, an ER physician always allowed me to go see them first.
00:18:29
Speaker
So I was able to evaluate the situation, get an HNP, and then I would come back and present to my preceptor. And at that point, I would already have like a list of differentials, what tests I wanted to order, as well as what medications, if any, I'd want to give. And then the preceptor would give me feedback, and then we'd both go see the patient, and they would either confirm or
00:18:58
Speaker
alter my diagnosis, my plan. And then we would follow through for the rest of their treatment or their stay in the ER. And sometimes that included procedures, which were very interesting to do on the pediatric population. And sometimes it was a lot of psych too, which I was surprised about how many psychiatric psych cases came into the ER.
00:19:26
Speaker
Interesting. So how many hours, what was your shift kind of like? So this rotation actually gave me probably the most flexibility I've had. I just had to do four days a week and there were 10 hour days and I could pick any four days I wanted to, including the weekends.
00:19:46
Speaker
Okay, so that's not so bad. And some rotations are gonna be like my biggest rotation, which we actually have done the same rotation, but just different times, like 60 plus hours. Some might be less than that, like 36 hours. Some might be around 40, 45, but it's a mix. And it's always gonna be different for everyone. So just keep that in mind. Some are probably gonna be more than others. So keep that in mind. But that's so cool.
00:20:14
Speaker
The rotations I liked the best, even though they were hard, was when the preceptor empowered me to go and do basically what a provider does, an HMP, go back and actually give the plan of what you're gonna do, medications, treatments, tests, everything. And then they just kind of like, okay, actually this is, and especially like differentials,
00:20:39
Speaker
is actually, this is probably more this than that, and maybe we should do this more than this, and tweak it a little bit. I always like do it when they actually like, and especially when you got it right, and you actually did what you planned on doing, it feels so, so good. And it feels like you can actually do this. What block did you do this rotation? I did it my stick, nope.
00:21:06
Speaker
It was my fifth block. Fifth block. OK, so a couple blocks ago. OK, yeah, so.
00:21:11
Speaker
When you first start out in clinical year, you're not gonna have pretty much any skills at all. And that's totally fine. You're supposed to be that way. But once you go through each block, you're gonna get more confidence and you're gonna go and be better presenting, better HMPs, everything.
Navigating Clinical Rotations and Patient Cases
00:21:30
Speaker
So you just have to breathe, everyone breathe and just relax. And sometimes the fear of the unknown brings a lot of anxiety, especially to me and a lot of other people.
00:21:41
Speaker
You just kind of have to take it, just go under day one, just be open to understand the rotation and then just go for it. Right. My first day of my first clinical rotation, I did orthopedics first and in diadactically orthopedics was my worst organ system. I didn't understand it. I was very overwhelmed. I felt like I still knew nothing about it going into my ortho rotation. And then
00:22:11
Speaker
My particular rotation was a surgical-based rotation. So I was in the OR within three hours of showing up. And I've never been in OR before, so it was a crazy day. But after I got used to it, after a few days, it became one of my favorite rotations. And I feel a lot more comfortable with ortho now. I got to do so much.
00:22:39
Speaker
put so much trust into me and kind of let me direct my rotation towards what I wanted to learn and what I wanted to get out of it, which I really appreciated and think that is a great approach to precepting students.
00:22:55
Speaker
Oh yeah, I definitely, like in the future, I think it would be really cool to be a preceptor and definitely no ways to do something like what I loved and what I hated preceptors did. And that's one of them is just empowering you to do stuff and actually participate rather than just kind of watch and kind of participate, but not really making any difference in the team. I don't like those rotations as much, but the ones where you do a lot
00:23:24
Speaker
for the team, actually, like, you're writing notes and writing other things actually make a difference. I like those a lot better. So presenting, how did you go about presenting in this rotation, the pediatric rotation? Because you're probably doing this a lot, because that's what it is, is you're getting someone's chief complaint, you're trying to figure out what's going on, and then presenting it to the preceptor. Right. So
00:23:53
Speaker
Presenting two preceptors is challenging. They all want a different format and they all want a different amount of information. For the ER in general, most of the providers wanted a very short presentation, chief complaint, minimal information that was pertinent and leave everything else out. On the other hand,
00:24:23
Speaker
when I did like my OBGYN rotation, it was very specific and they wanted the entire OBGYN history as well as family history and like a very detailed OBGYN history as well. So those presentations were a lot longer.
00:24:45
Speaker
Yeah, I think that's my least favorite thing to do in medicine is presenting. But it's kind of an essential skill because you'll be doing it for the rest of your life, unfortunately. But you have to be chameleon with this because
00:25:02
Speaker
even from like preceptor to preceptor in the same rotation they want something different from one resident to the other they want something different and then you might get into some rotations where they first want you to do something really detailed and then over time they like trust you more they want it shorter and shorter and shorter and shorter and the pre-shoots you just like to two words and like you're off to the races so that is the very challenging thing and
00:25:29
Speaker
sometimes preceptors really like focus in on presenting and might like give you feedback especially in like a mid-rotation evaluation if your school does that like you're presenting schools are weak or something like that and like then that could be something to focus on but what I've done in a home over time was just doing the same kind of
00:25:56
Speaker
layout and format and structure to it so that you can give it more detail or shorter one depending and then you just practice. It develops over rotations to rotations and then you get more comfortable and less stressed when you do it and especially that's happened for me. Definitely a lot less stress than my first rotation after that. Awesome. So what
00:26:25
Speaker
What kind of things did you do to like to prepare for the rotation? So as far as preparing for the rotation, I didn't. I started my studying and my preparation on my first day of the rotation. I think it's important, especially between harder rotations to take that weekend off and spend it on yourself.
00:26:54
Speaker
But the first week of the rotation, I always printed out the blueprint. I usually did all of my assignments for the block during my first week. And I did a lot of rush questions. And then my second week, I'd usually do the blueprint. And I would go through each of the diseases listed and just write like,
00:27:21
Speaker
three or four words about each of the diseases, like the three big things you have to know. And I did it on the actual paper that the blueprint is printed on. So it kept it down to a minimal and it needed a lot more manageable to study at the end of it. And then by the end of the rotation, I would have this one page of blueprint with every disease addressed on it.
00:27:47
Speaker
Okay, man, that's actually quite interesting way to do it. And it's very smart with me. So in our program, we have to do like three, four assignments, as well as at a rotation exam, we do 10 medications where I do like magnetic of action, indications, dosages, adult and pediatric, stuff like that.
00:28:14
Speaker
it's a whole thing, no one likes doing it. And also we do an HMP where we're supposed to find something interesting about either like, it's a case like a case presentation, we find something interesting, we make a whole HMP, like a very, very detailed HMP, way more than you would actually do for an HMP.
00:28:35
Speaker
That's what we would do. And also at the end of the rotation, we would do a self-reflection. And then we do, so our program buys rush for us, which is really nice. And we have to do either like a hundred questions or they also bought all the pre-tests for all the end of rotation exams. So we usually do that. We have to get over like 80%.
Studying and Test-Taking Strategies in PA School
00:29:01
Speaker
And then we screenshot it, and then that's it. So we have to do all these things. So that's very awesome of you. I hate doing them, so I put them off. I usually do a little bit at a time and makes it more doable. So I buy the last week. I try to have it done, but that's awesome for you to get that out of the way. And that's so cool to really minimize your knowledge for all those things.
00:29:26
Speaker
I think that's the biggest thing I get trapped in a lot is I feel like I have to like, you know, everything about everything on the blueprint and some rotations that's impossible like family medicine, internal medicine. There's just so much stuff I just skip. I just had family medicine and just skip a bunch of stuff. I skip all the derm.
00:29:45
Speaker
And what the thing about the blueprint that's really nice is gives you how many questions each basically big topic is covering. So you might, you know, for family medicine, cardiology is one of the biggest. So you focus a lot on cardiology, like surgery, half of it's GI. So if you do GI, you'll probably pass.
00:30:06
Speaker
and you can skip some of the later ones where it's only like a few questions. So you always think of, look at that, okay, and it could, finally, I'm gonna skip neurology, dermatology, because they're only like three or four questions, and they probably would be very common topics, anyways, a lot easier to understand and know already. But yeah, I get trapped in knowing everything, but really, it's the stuff that you don't really know you should review. Right, I agree with that.
00:30:35
Speaker
I mean, my approach during didactic year to studying, my study guides were all very brief. Even if there was a ton of information, like a thousand slides, I would get it down to a matter of papers. Because reading a thousand slides is overwhelming. And I feel like if you just know the major points about all of the diseases, you can kind of rationalize out the rest of it.
00:31:03
Speaker
And that seemed to work pretty well for me. But as far as the blueprint topics, I agree, you definitely want to strategize and study what the biggest percentage organ modules are on each of the EORs because it really does make a difference.
00:31:23
Speaker
Yeah, it really does. And also through all the end of rotation exams, most everyone knows everything that you need to know. The problem is trying to understand the question and what it's asking. That is the issue.
00:31:44
Speaker
That is the biggest, that's the hardest part. You might know exactly what the disease and everything is talking about, but it has to be something more obscure or some different thing you didn't think about, and you have to think through it
Pediatric ER Rotation Experience
00:32:00
Speaker
in order to get the right answer. That's a lot of it, just knowing how to take the test
00:32:06
Speaker
But we focus so much on content. I always focus so much on content, but it's taking the test. So taking practice questions is so important and understanding how to answer questions.
00:32:22
Speaker
That's such a big thing. And you're one of the best. You get done, I take the whole time just because I like taking the whole time. Cause with the end of rotation exams, you have two sections, 60 questions, 60 minutes per section. You're done like in like the first 40 minutes, the whole thing. Yeah. So my, my approach to test taking has been the same throughout PA school. And I was lucky that it always worked.
00:32:53
Speaker
I do probably hundreds of questions from a whole bunch of different resources before the exam. But when I sit down and take the exam, I skim the question. I don't even read it, which sounds terrible, but I skim for buzzwords and I just read the last sentence. And by that point, I can usually pick an answer and then I just read the question to make sure I'm right. And then if I don't,
00:33:21
Speaker
then when I'm actually reading the question thoroughly, I already know where the question wants me to look. So it has me thinking in that direction already. And then I don't go back and check any of my questions. I've even gotten to the point where I'm not checking my flagged questions because
00:33:42
Speaker
I change it to the wrong answer. That's hardcore. That's hardcore right there. It's just, that's what has worked for me because like first trimester I would go back and I would redo like check all my answers and I changed things and get them wrong. And then I realized also the flags questions. It was 50, 50. I either was changing it to the right answer or changing it to the wrong answer. So I decided just to leave it.
00:34:12
Speaker
Yeah, that's a good policy. What I do is I flag everything. I'm not 100% sure.
00:34:19
Speaker
And then I go through those and I never change it unless I have a very good reason to change it. And that's, you know, and that is a good strategy. If you realize you read through the questions like, oh, dang, I missed something big here. And some other questions might trigger something. So that's, those are good reasons to change it. But if you have no good reason to change it, you just feel like maybe, because hunches are very good. If you go through a rush or any question set, a lot of the times your first hunch is
00:34:49
Speaker
right, even though if you don't know why it is or how it is, a lot of that's right. So definitely do not change it. You have no good reason to change it because it's just going to bring you heartache. And sometimes, you know, you feel like you could change it and you realize when you look back and are anxious about what you got wrong and you find that, Oh, I got this question wrong, but it's just a good policy. So that's, that's really awesome.
00:35:13
Speaker
Yeah, buzzwords exist, but the problem with buzzwords is a lot of times they're hidden in either medical language. Sometimes they actually use buzzwords, so that's a thing. That's the biggest thing with
00:35:31
Speaker
Content is knowing just the biggest things about stuff. It's gonna be on there. I was listening to something podcast or something like this. Like they want you to get the question right. And then you put everything that you need to get the question right. You just have to recognize those right things, but that's the hard part. That's the very hard part is to recognize what's right and what's gonna lead you to the right answer. Sometimes it feels just like reading a different language.
00:36:00
Speaker
The exams have changed. There's less buzzwords, but in my opinion, there's still buzzwords. I'm trying to think of an example off the top of my head, but if you see pink frothy sputum, you think CHF, it's things like that, even though it's not really a buzzword, you kind of think that root.
00:36:28
Speaker
if someone's traveling to Ohio River Valley,
00:36:35
Speaker
and infectious is buzzword. Like you just know the area and you already know where that question's going. Yes, very true. Some things you can't describe in any other way other than the buzzword. There are buzzwords for reasons. And even like we use so many buzzwords in practice actually, because there's no good way to describe it other than the buzzword. So that is a very important thing.
00:37:02
Speaker
So how did you prepare for each day of your rotation? Do you feel like you got pimped a lot or quizzed a lot? I feel like pimping is the more abusive use of the Socratic method than quizzing. How did you navigate that or was that even an issue for that for you for that? I for the most part never get pimped and that was something I was very like ready for.
00:37:32
Speaker
It's probably, like maybe once a day I'll get asked like one question, but no one ever asked me questions, which I was very surprised about. Pimping definitely hasn't been an issue at all. Yeah, you hear horror stories a lot. That's why I deleted Reddit, because it's just really real life. And once they have even good information, so biased because you get the survivor bias or you get the,
00:38:01
Speaker
man this was really crappy so I'm gonna write about it and the people that write on it and are already a certain type of people so it's just not a good place for most of their information but here are these horror stories and like I had a couple bad experiences a couple bad rotations where they would mercilessly like quiz you and you really felt like you're an idiot
00:38:22
Speaker
And that's never fun, but sometimes they did it but for good reason to really help you understand like why this treatment and why this pathology and everything like that.
00:38:34
Speaker
for me to prepare for some of these things, you really had to go and the things either get wrong, look up or common diseases and common stuff that you saw from day to day, kind of knowing those things because they pop up a lot. What were some of the common things that you saw in the pediatric ER that you had to deal with a lot? The first one on the top of my head was nursemaid's elbow.
00:39:02
Speaker
And this is something I thought was going to be rare, not rare, but just like uncommon, like maybe like one a week, but we'd get like three a shift. And I was able to just walking into the room, see a patient, like holding their arm a certain way and I immediately knew. And I worked with an amazing provider that actually let me put one back in. And so I was very excited about that. Um, so I got very good at nursemaids elbows. Another issue.
00:39:32
Speaker
in pediatric populations a lot is always vomiting, diarrhea, nausea, have a whole bunch of different things. The differentialist is very big for that, but typically gastritis, you always think of appendicitis, something like that. And also just fevers, patients would come in with a fever and that's a big workup, especially if it's an infant or a newborn,
Learning and Growing Through Clinical Challenges
00:40:02
Speaker
And then we saw a lot of like asthma patients as well, like asthma exacerbations. We had kids with head strikes a lot. That was common as well. Just some like falling out of their crib or rolling off a changing table or falling down the stairs because someone left a gate open. Those are very common as well. And then
00:40:30
Speaker
Um, pediatrics, like issues like suicidal ideation was also pretty common, sadly. Yeah. Yeah. So understanding those, even, you can even ask your preceptor, even though like you might be like, you're going to know, I'm not knowing anything, but ask your preceptor like the first time, like what are some of the big things I should know? And it'll tell you.
00:40:52
Speaker
And then you just know those really well. You review them, you do everything you possibly do to remember those things, and you'll be fine. And then if you do, they do ask you questions, you'll be fine. You'll be able to ask your answer with confidence. I was on the other hand, I was in inpatient pediatrics. So we got all the really bad asmas and a lot of RSV stuff.
00:41:15
Speaker
bronchiolitis and things like that. Some like secondary things were dermatitis, like skin rashes were always secondary because they weren't in the hospital for rashes.
00:41:27
Speaker
We saw some Kawasaki stuff and some MIS-C stuff, but that was very rare and very ambiguous at it as it was, and it stumped even the attendings there. That was some of the stuff that we saw in pediatric inpatient. It was a good time. Pediatric is fun, but it's way different in the hospital, different than outpatient.
00:41:52
Speaker
Right. Outpatient is going to be completely different. So don't know how to speak to that because we both never did outpatient pediatrics. Awesome. That's really funny. Pediatrics is fun because you can interact with kids. Sometimes the parents are difficult, but the kids are so fun, especially when they're little, like,
00:42:16
Speaker
from like four to six. That's a fun age because they're able to talk and interact, but they like to play and you can play with them and build that rapport with them. That was so important to build some sort of rapport. This is my strength is I can talk to a patient, no problem. I love doing that. I just don't like talking to my colleagues.
00:42:38
Speaker
Because you feel this constant judgment, like, oh, they're constantly evaluating and that's also one of the hard things I feel like with clinical rotations is that the underlying anxiety of constant evaluation like they're always looking at you to evaluate you.
00:42:54
Speaker
And that may or may not be true, but that feeling of you have to perform, you have to show off, you have to do all these things to impress them all the time for like five weeks. That is so hard. How do you handle that? So how I handle that is actually two different ways. So on the rotations where I did feel like I was performing like that and like really trying to like
00:43:24
Speaker
be a Connor kid and do exactly what they wanted and felt like I was under constant scrutiny. I actually did pretty poorly. I succeeded in the rotation, don't get me wrong, but as far as what my feedback was at the end of it, it wasn't equal to the amount of effort I put in.
00:43:49
Speaker
But on the clinical rotations where I was very comfortable and developed a relationship with my preceptors and it was a more relaxed environment, I felt like I did a lot better. And I also got a lot more out of it because we're not only there to learn about how to treat patients and how to care for them and make people feel better, but we're learning how to be a good provider. We're learning how to interact with our colleagues and how to develop these working relationships.
00:44:20
Speaker
Yeah, that's a good point to remember that. Yeah, I think this mindset shift has been slowly over the last few blocks of going from just doing enough to get a good evaluation to actually
00:44:37
Speaker
making sure I can practice the some of these skills so I can get a job after PA school. Now that's my focus is being able to work to be able to be efficient and proficient and a lot of skills that I can then take to find a job afterwards and that I feel like
00:44:58
Speaker
especially this rotation, I've been thinking about that a lot. And that's been actually being more enjoyable going to the rotation to learn rather than just to get through it, which is hard to do sometimes in some of the rotations because they're long hours and it's just stressful sometimes. But another thing to remember is no matter what specialty you want to go into, you can always learn something from the rotation. I mean,
00:45:28
Speaker
I know I'm not going to go into pediatrics, but for me, I want to go into emergency medicine. So the ability to treat acute pediatric patients was invaluable for me. And I also don't really agree with the advice of not telling your preceptor what you're interested in. We're always told to tell them that their specialty is the one you want because then they'll teach you more.
00:45:54
Speaker
But I find that if you are honest and you tell your preceptor what you're interested in, then they'll hone their teaching and what they want you to focus on based on what your interests are. And they really kind of wrap the rotation around what you want to get out of it. And it seems like it's a lot more beneficial that way.
00:46:15
Speaker
Yeah, I think rather than like, I wanna do the specialty, maybe like, I wanna learn how to do ultrasound. I mean, women's health at the same place that Angelica went to. I wanna ultrasound. I want to be at the vaginal deliveries. I wanna do all these things. It shows that excitement because those are the more important things that you wanna get out of it. I wanna do pelvic exam says, I wanna build that skill to be able to use that in the future. And they're gonna take, they're gonna love that.
00:46:44
Speaker
and really like give you opportunities rather than just blanketly like, I just want to focus on, you know, orthopedics or something else, but actually skills or procedures you want to do could be a way to get in with, without like lying to yourself, but also being interested in the rotation. Right. I think every day you show up to the rotation, you have to show enthusiasm.
00:47:11
Speaker
You have to want to participate and you have to be seeking out your own opportunities. But as long as you are there and you're ready to learn and you're excited about whatever's going on, people really will go out of their way to make sure you're learning and you're getting something out of it.
00:47:32
Speaker
Yeah, that's true. That's true. Amen. Awesome. Well, it's been a very good chat Angelica. It's nice to see your face because I think I've only seen it really at school and we're still having to wear masks for some reason at school. But it's good to see your face. Any last words of wisdom? Anyone that would want to watch or want to hear this?
00:47:58
Speaker
Well, I think I do. So I'm on my internal medicine rotation right now and it's been really hard for me. There's a lot of death and something I think I've picked up along my road as an EMT and my clinical year is that there's a lot of suffering and it's a privilege to be able to have the knowledge and the ability
Conclusion and Final Thoughts on PA School
00:48:27
Speaker
to treat people. And even though you're not gonna be able to care everything, you can always make someone feel better. And I think as a provider, that's important to remember because even if there's medically nothing left to do, you can always make someone feel better. Yeah, that's really cool. Really cool to think about.
00:48:52
Speaker
Well, thank you so much for joining me and talking with me. And it's also not been so bad over Zoom because we're doing this over Zoom because it's just so hard to be in person like the good old days of didactic year. But it's been so nice to talk to you.
00:49:08
Speaker
I hope you have a wonderful two weeks left of your rotation. We do five-week blocks, so we're going to be turning another one in a few weeks. They're going by fast now, which is kind of scary, but exciting at the same time.
00:49:24
Speaker
Awesome. Well, thanks everyone for listening to this podcast. I hope you had a good time. Hopefully this was entertaining and educational and hopefully it's helped somebody out there. So we'll have a good week. Whatever you're doing, Dedekic, you're a clinical year. Keep going, keep working at it. You'll have a great time. So see you later, everyone. Bye. See you next time. Talk to you next time.