#clinicalyear

Tumblr fam, before I spam you with my excitement over officially graduating (🎉), I must ask those of you who took the PANCE in 2019 (or earlier, but it changed this year), if you’ve got any advice.

I did a three day review course through my school last week that I think helped. I’m presently trying to finish the blueprint (going through one to two systems a day pending length) without wasting too much time reviewing stuff I already know, or skipping stuff I shouldn’t. Since my final two rotations were internal med and surgery, I had to do a pretty good review for those EORs. I round out each day of review with 50+ rosh questions on the topic(s) at night and then another round in the AM to see if it stuck. Any other advice?

It is finally winter break and I have some time to relax. I can’t believe that I am halfway to becoming a doctor!! (doesn’t feel like it tho) It is so scary but exciting at the same time. It feels like I just started college and here we are now. ((:

This semester was pretty tough as it was my first clinical year where I had to juggle hospital rotations along with studying for the exams. I actually had such a good time, during parts of the rotations.

I have officially accepted a job! I will be doing in patient TPN management and working with the GI group in inpatient. I am super excited, as this will allow me to use my skills as a dietitian, but do quite a bit more. I love inpatient rounding, and I have also requested to get privileged for line placement and NJ tube placement, which sounds like it should work out.

I knew the team before I interviewed, as I used to work in the same department (with about 250 other folks - big hospital), so I am happy that it will be a comfortable place to return to, but will challenge me in all new ways. I’m mildly anxious about my attending, but by the sounds of it I will work mostly with the fellows which should be wonderful.

In 6 weeks, I will return to my favorite city, and move in to the cutest duplex with the best dog around. While I was on rotation last month, I was able to go check out a place and signed a lease! It’s less than half a mile walk from my favorite spin studio, and a boxing gym that I will learn to love, as well as my fave coffee shop, great restaurants, and the popular place to go in the city for going out. It has the world’s smallest back yard, but big enough for a patio table and chairs, and a little bit of grass for my sweet pup, all enclosed by a privacy fence. It is literally surrounded by schools and a huge park, which, when I checked it out while I was there was filled with kiddos and dogs and looked to be a perfect place to take the Bean bag on long walks. In six weeks, I can unpack after a year’s worth of traveling month to month to rotation sites. I’ll begin receiving a paycheck for the first time in 28 months. I will have a home, and stability, and the opportunity to do the things that make me happy again (other than school... which did make me happy, but caused me to sacrifice a lot of “my” time).

I am spending my Memorial Day Weekend studying for my Pediatrics EOR on Tuesday, followed by three days of OSCEs (for my non PAblrs, these are videotaped exams with standardized patients where we are graded on our ability to diagnose and treat conditions). Feeling the major stress that my last three months have been Women’s Health, Hospice, and Peds. I haven’t had anything general in so long!! But I am trying to keep in mind the words of one of my favorite preceptors, which was, in essence “just ask questions and listen. Your patient will tell you what is wrong.” MAN do I hope that’s the case next week!

OSCEs are our first big “almost time to graduate” task. I have rotations left for June (Internal Med) and July (Surgery), and then we do the summative and our senior capstone in July, and then... graduation in August. HOW. DID. WE. GET. HERE. Every minute of PA school felt long and like a trial, and yet... here I am, almost on the other side. I just. WOW.

Man, what a FUN rotation! I did a good portion of the month outpatient with a pediatrician who is on faculty with us at school, about about 1/3 inpatient at a big teaching children’s hospital doing neuro and I just.. WOW. 

I found that I liked kiddos more than I expected, and was surprisingly good with (most of) them. My preceptor seemed pleased with my growth over the month, and while I spent a lot of time second guessing my exams and diagnoses (will this EVER end?) her review of me was insanely kind and really built me up.

It’s wild to me how much my nutrition background helped with kiddos. For outpatient, it was challenges with feeding, eating disorders, deficiencies, etc. For inpatient, it was the ketogenic diet for epilepsy (HELLO this is where keto started, folks). I am so incredibly grateful to have spent the amount of time in GI as I did. I remember a thousand years ago, a undergrad friend (now a PA) told me how much they felt my background would help me in clinicals, and during the stress of didactic I was unable to see it.. but it’s true. It’s so true.

I got to see lots of wild seizure disorders (including one cause by Mosquitoes..) and neuro issues. I sort of understand what EEGs do now. I looked in a trillion tiny ears and finally got the hang of ear infections. May was allergy season, and this is something I have a hard time with, so I learned a lot here too.

And let’s not forget about the real heros in this rotation: to every kiddo who endured double ear exams (the pits, I know!), answered my exhaustive questions, and trusted me to take care of you, thank you. And to the parents who provided additional insight and encouragement- you are the best. I think what I learned most in this rotation is that kids are the coolest and love you.. until they don’t. And that is just awesome. 

I’m now in the throws of internal med and as expected... I love it. I love it so much.

I just keep getting later and later on these recaps, don’t I?

I finished up internal medicine at the end of June, and as suspected, it was absolutely perfect. I loved the rotation, but I fully expected to going in to it. I was at a satellite campus of a big hospital system in the city I love (and as it turns out, am returning to here in 6 short weeks!) and I just lovedloveloved the work. I was precepted by all PA-Cs with the exception of one NP on a night shift, and I really enjoyed that. it is so beneficial for me to see how PAs fit into the system.

This rotation was cool because the hospitalist PAs do regular hospitalist rounding, there is a house coverage shift, and there are shifts in the obs unit. I was able to do day and night shifts, and was put in each of these positions. It was really good for me to see what this role required, and I think it is a good goal for an “eventually” job for me. I got to see lots more murmurs, a good bit of GI stuff, and some cool pulm and rheum stuff, as well as endocrine stuff (which worked out well for me, because I have the hardest time learning the parathyroid stuff, so seeing it in person helped a great deal!)

Yesterday, I bumped into one of the OB docs (a young woman) while trying to grab booties for over my shoes for the OR. I apologized and she turned and stared at me. I waited for an eruption. She looked me right in the eye and said, “NEVER apologize for existing. As women, we spend too much time apologizing for things. If we were two men here, would we be apologizing to each other? No, we wouldn’t.”

THIS. This means everything. As a student, it’s very easy to feel in the way, idiotic, and just a general nuisance. I continue to be blown away by how kind the providers are who surround me. Midlevels, doctors, nurses, techs, etc. I am so fortunate.

And of course, the additional layer here is the empowerment of me as a female student. She then spent the entire c-section explaining to me exactly what she was doing, making sure I could see, and having me hold retractors, help suture, and generally be very involved.