#didactic year

Didactic year is the first year of hell PA school, and generally it varies 12 to 16 months in duration. It’s mostly classroom, and it can be rough. In the moment (my program was mandatory attendance MTWRF 8-8 plus weekend anatomy lab), it feels like it’s crawling. Looking back, however, it almost seemed to fly by.

Almost.

I wrote The Giant Ass Summary Post of Didactic Year at the conclusion of my first year of PA school. In it I discuss some of the non-clinical lessons I learned, from discovering my weaknesses to getting along with classmates.

Speaking of getting along with classmates, that is crucial for didactic year. Because you spend over 60h/wk with them, and- as a PA, you’re a teammate, and you have to be able to work with people of different personalities and backgrounds. You’re all in this together. Sometimes it can be tough, other times you laugh and cry together. 

I also have a few miscellaneous posts from nights when I was procrastinating on studying for an exam: Random Semester 2 Thoughts More Random Semester 2 Thoughts Random Semester 3 Thoughts My #PAblr posts when I first joined tumblr are much more starry-eyed, and that’s partly because my program gave us a unique opportunity: a clinical rotation that we attended once a week during didactic year to get a feel for clinical year. As if exams weren’t already humbling enough, this intro-to-rotations setup really showed me that I still had a lot to learn.

In preparation for clinical year, we also met our standardized patients during didactic year. Standardized patients- aka the people who are paid by our school (my tuition) to be poked, prodded, and questioned for hours on end. They provide interesting feedback. Some of the feedback feels like it comes out of nowhere, but even the weird information is useful. You’re going to have some oddball patients when you’re on rotations and in practice, so working with standardized patients is a great way to learn how to interact with patients in all kinds of situations.

One interesting phenomenon during my didactic year- Despite my non-licensed, bright-eyed student status, family and friends took my word on anything healthcare related as gold. With great power comes great responsibility.

I’ll be real here- no one in my class breezed through PA school. Even the one classmate with a 4.0 didactic year came close to failing a clinical rotation. So if you meet some self-proclaimed hotshot who acts as though PA school is the easiest thing he/she has ever done, don’t buy it, and don’t be discouraged. They’re struggling just as much as you are but overcompensating.

Now as a PA-C, looking back at didactic, Here are the biggest lessons that I learned: - Study early, and study by quizzing. - Don’t get caught up in class drama. - Sleep. No, you’re never going to study enough. So fuck it, and sleep. - Get a counselor. I have no mental health diagnoses, did this, and it saved my sanity in PA school. I kept a biweekly appointment with the school’s counseling services (included in my tuition) just to vent. Best decision I ever made. - Stay in touch with family and non-PA school friends. They’ll keep you in touch with reality when PA school takes over your world. - YOU GOT THIS!  - The #PAblr community is always here to help. @populationpensive and @simplysupergirl / @emedpa created a wonderful community of people who are rooting for you.

I successfully passed my third semester of PA school!!! And I find myself now in my LAST semester of didactic. It is absolutely CRAZY to think that I did my white coat ceremony and that I’ll be on rotations in 3 months! As I’ve discussed in other tips posts, my school doesn’t do block; rather we do semesters. We do a lot of the same things each semester but we build on previous knowledge and get more in-depth as we go.

Be adaptable: I say this every term, but seriously, this is probably the most important thing that you can do as a PA student. Even between different exams and lectures, be ready to approach material differently and adapt to learning and note taking. 

Accept that you can’t retain everything: It is such a burden to be a walking encyclopedia of medical knowledge but accept that you won’t retain everything, especially as you go through more and more material. If you accept this and commit yourself to lifelong learning, you’ll be better off. Since you can’t retain all the things, know great resources to FIND all the things.

Epocrates: this app has a free version and a paid version. The free version is 100% enough for a student. You can search meds, look up ACLS protocol, and normal labs. HAVE this on your phone or whatever you want to use as a quick reference.

Medscape: great reference if your school doesn’t pay for UptoDate

UptoDate: if your school has this, use it. There is an app version you can download as well. #lifesaver

Repetition is key: I have to say that I didn’t go about this the right way given the volume of material I had. Be SELECTIVE. Don’t review stuff you already know. Pay VERY close attention to things your profs or lecturers deem important or testable.

Try to make time for yourself and don’t die: but really, please make time for yourself for the things you love to do. Work out. Craft. Play music. Make time for things that feed your soul otherwise you will literally shrivel and be sad.

Me: [returning from bathroom, sample in cup] All right. I got my sample.

Classmate: That's not urine.

Me: Yes, it is.

Classmate: I don't believe you. It's clear.

Me: I drink a lot of water!

Classmate: You totally filled that from the sink.

Me: Dude, it's my urine sample!

Classmate: Liar. [turns to front of classroom] Professor, Hangry won't pee in a cup. We should test her for drugs.

Me: We're not even doing a drug test, dumbass.

Classmate: Professor!

Me: Has anyone ever told you that you're a pain in the ass?

What a year.

What I Learned:

- IT’S IMPORTANT TO TAKE BRAIN BREAKS: Which in my case, meant Netflix binges (note all New Girl gifs), working out, and painting. Yes, there is limited time, especially when you spend the majority of your waking hours in the classroom. I tried my first semester without any breaks and got burnt out very quickly. My second semester, I forced myself to take several breaks a day of at least 20 minutes each. I would set a timer and not think about school until the timer brought me back to reality. Even though our second semester was busier than our first, my grades looked better, and I retained much more.

-  CARDIOLOGY IS TERRIFYING: I know, I know. Come on, Hangry! It’s the heart! It’s an organ with four chambers. Yep, I know. But whenever I have to figure out the squiggle of an EKG (forget PQRST, it’s a freaking squiggle) or figure out how to get a patient’s pulse back (anyone who saw me during ACLS watched me basically sweat a puddle around myself) or decipher a murmur (I’m sorry, but you cannot seriously tell me that that noise sounds like it’s a click; there’s nothing click-ish about it). This is my weakest system, which is not good considering that the heart is a superduper important organ that many living things have. And cardiology is also the largest portion of the PANCE, the PA certifying exam. Yipes. This is something I’ll have to review every night through every rotation.

- DRAMA IS EVERYWHERE: Students talk about each other. Faculty talk about each other. Students talk about faculty. Faculty talk about students. Lots of opportunities to burn bridges, and I saw a lot of promising relationships (in the nonromantic sense) destroyed by just a few simple words. Lesson here: don’t talk about other people.

- IT’S THE SIMPLE THINGS: I get to school early to watch the sunrise from the top floor of our building. It’s a beautiful sight- our city line warmed by the yellow rays of the sun slowly rising above the horizon. Between classes during the winter, I go outside, make a snowball, and roll it into a snow boulder. It’s purposeless, yet it brings me an odd sense of accomplishment. Are these strange things to do? Maybe, but I don’t care. I’m happy, and that’s what matters.

- THERE’S STILL A LOT TO LEARN: When I was leaving to start PA school, everyone was telling me, “You’re going to do great!” and “You already know a lot. You got this!” Meanwhile I was trying my best not to crap my pants. I knew it would be tough, and it is. As someone who’s never worked in emergency care, things like aortic aneurysms and Battle’s sign were entirely new to me. OBGYN scares me beyond words, and kidneys still barely make sense to me (to the patients I’ll be seeing soon: please don’t worry, I’ve been studying electrolytes, and I’ll have a preceptor who will watch my every move). 

What Changed About Me:

- MY OUTWARD PERSONALITY: I am a stubborn, impulsive person, but I’ve learned to suppress the stubbornness and impulsiveness over the years. I’ve made an extra effort to do so during this program. Also since starting PA school, I’ve become far less talkative. I’ve never been a chatty person, but I’ve found that by being silent 75% of the time, I can take in what is happening around me and stay out of trouble. Ironically, whenever I do speak in class or clinic, people get really quiet. Whether that’s a good thing, well, haven’t quite figured that out yet.  ¯\_(ツ)_/¯

- MY STUDY METHODS: I used to read and reread my notes. I found out quickly that this would not work for me in PA school (thought it does work for others). Now I study only by quizzing. I don’t organize my notes. I don’t rewrite anything. I don’t read. I quiz. By using textbook questions and PANCE practice questions, I am forced to think through the material and use critical thinking to find an answer. It also induces a sense of panic many days prior to the exam and tricks me into thinking that I don’t know anything and that I absolutely have to learn it right then and there, keeping me from procrastinating. This method made it easier for me to recall material both during exams and on clinical days.

- MY WEIGHT AND BODY COMPOSITION: As a way to deal with stress, I started lifting heavy weights during PA school. I also started eating a ton. As a result of this, I gained weight during school (more muscle, some fat). Luckily I still fit in most of my clothes (there are some skinny jeans that I just can barely pull over my quads), and it’s interesting because I can see more definition in my arms and legs. As someone who used to count every calorie, this was a good change for me. 

- MY GOALS: I came into school thinking, “I’m going to go into neurosurgery!” Several cadaver lab hours later, I realized that surgery is not my thing. Now I’m more interested in critical care. I have a rotation in the MICU and one in the PICU, so I will find out more about it soon. I also used to think that I would want to work a full-time job as well as pick up a part-time (20 hours) somewhere else. Now I’m not sure. Good thing I have a year to decide.

Thoughts:

- DATING/HOOKING UP: No one in my cohort hooked up with or dated anyone else in our class. However, in another class, there were two people who did, and it turned ugly. I’m not saying that you can’t find The One in your PA class. You can. But remember that you’ll be stuck with the person for the next 2 years. In our program’s situation, the failed relationship/FWB/whatever-it-was led to a huge scream fest at a party the other week, and one of them may or may not have resorted to throwing things.

- SHARE: Doing something as simple as sending a copy of your notes to your classmates every so often or sharing Quizlet sets can be helpful to your classmates. Why would I share my hard work? Good question, especially when you find that no one else is, it can seem pointless. But here’s how I see it: every shared piece of information benefits a patient. Let’s say that you’re in class learning about managing a pleural effusion. You’re diligently taking notes, but Jamie over there is sleeping and basically missed everything. He also doesn’t seem to care. You send the class your notes. Later that night, Jamie is scrolling through his email and happens to see your notes and takes a quick read. For some reason, the way you phrased your notes made the pleural effusion management material really stick. Four months later, Jamie is on his ED rotation. It’s crazy busy, and someone comes in with a pleural effusion. The patient is panicking Jamie remembers your notes on managing pleural effusions and tells the preceptor, “Hey, I can take care of that.” And he does. The patient stops gasping for air and feels much better. And that’s all because of your notes. Sure, Jamie should have paid attention in class. Sure, you might not get direct credit for taking care of the patient. But at the end of the day, it’s all about the patient. As long as the patient gets better, everyone wins.

- DON’T COMPLAIN/GOSSIP (at least not to any students or faculty in the program): Whenever we, the students, have a complaint/criticism of the program...it backfires. Our faculty tells us to suck it up and deal. Literally. Personally, I have a lot of beef with the program, but I don’t talk to anyone in the class about it. When I’m feeling really incensed, I’ll call up family or friends outside of the PA program and drop every single expletive in the dictionary. Or I’ll just type something up on this blog (THANK YOU, PAblr). Also, gossiping about another person will bite you in the ass. The reality of PA school is that people often turn cliquey, and many are also quick to stab each other in the back. Maintain some distance. Save the rants for your family and non-PA school friends (and then buy them a ton of chocolate as a thank you for the listening ear).

- BE NICE: I know that I just said people stab each other in the back and get cliquey. They do. And, yes, I said to maintain some distance. But it’s still important to be nice even if you’re the only nice person in the room. As a class of only 20-something students, we spent at least 12 hours a day, 5 days a week together. And this doesn’t even include weekends when we had outreach events or cadaver lab. When you put a bunch of stressed out people in the same room, people tend to snap or explode at each other. Don’t let that happen. Whenever I found myself close to my breaking point, I left the room and walked the stairs to burn off angry energy. When I returned to the room, my legs would be a little sore, but I found it easier to deal with people. Some of my classmates will be my colleagues one day. Being a PA is about being a teammate. And to be a cohesive team, it’s important to be kind to each other. 

- DON’T CALCULATE YOUR GRADE: I mean, definitely check them from time to time, but don’t sit there and do calculus to determine how many A’s you need this semester to maintain a certain GPA. It’ll stress you out on all levels. You’ll be taking an exam, get freaked out by one question, and think to yourself, “Shit! How many more can I get wrong and still keep a B on this test? Wait! No, I need an A on this test to keep a B in the class! SHIT! I HAVE TO GET 100% ON THIS EXAM!” And then you’ll probably forget all the material you need to know while you sit there calculating and recalculating how many questions you can get wrong on this test. Do not panic yourself. Just focus on learning.

- FLOWERS, CHOCOLATES, AND CARDS: A large bunch of flowers at the grocery store is $5, 1 pack of 10 mini Kit-Kat bars is $2, and a pack of 15 generic cards is $5. In the middle of a stressful week, give everyone - faculty, staff, and students, both male and female - a single stem from the flower bunch and a mini Kit-Kat bar. Write a simple “Happy Birthday, Jamie! Thanks for being an awesome classmate!” on a generic card and give it to Jamie on his birthday. At the end of the semester, on a generic card, write each faculty and staff member, saying, “Thanks so much for your help this semester!” They’re simple gestures that require little money and minimal time, yet they can make a difference in someone’s day. My male faculty and classmates picked on me a little bit for getting them flowers, but it still made them smile. PA school is a stressful time for everyone, and just a little effort on your part can help alleviate some of that tension and stress.

Takeaway Message:

PA school is tough, and there are many ups and downs- academically, professionally, and personally. Am I better than the person I was one year ago? Am I more knowledgeable? Am I a better provider? Yes, I am.

And now I shall go celebrate my one-year anniversary as a PA student.

I’m usually very good at sleeping through the night. But my cat doesn’t want that. So every day at approximately 3am or 4am, he’ll walk across my chest and then proceed to run in circles around my head. What a jerk.

Aside from the whole sleeping thing, I’m liking this semester. I’m in class less than 12h/day (THANK HOLY FREAKING HEAVENS), and I don’t have any more non-PA program classes (my brain simply does not have the capacity for retaining PhD-level anatomy, physiology, histology, and embryology on top of our PA courses). 

This semester my weekly rotation is inpatient internal medicine. Which is insanity that I somehow still love. The other day in less than a 3h span, I saw pyelonephritis, hydrocephalus, orchitis, atrial fibrillation, and DVT. And then the attending turned to me and asked, “What’s included in Beck’s triad?”

Um...

^This gif is a recurring theme of my PA education experience.

Beck’s triad consists of muffled heart sounds, JVD, and hypotension. And I learned it at some point in time, but I think I lost a few brain cells over break from all the Netflixing I did.

Anyhow, this semester is a lot of building upon material from last semester. So what do we have? We have: - OB/GYN: Women’s health is my worst nightmare. My women’s health rotation last semester was eyeopening in a way that makes me wonder how much easier life would be if I had never undergone puberty. - Pediatrics: Little humans! An added bonus is that, since I babysit, I get to see how my three year old kiddo lines up with the developmental milestones. - Psych: My experience with psych patients has been...well, my past clinical experience includes a lot of people who were hospitalized for medical noncompliance. So there’s that. But our first class was about different genetic disorders and their psychological consequences, which was pretty cool. I can see myself learning a lot in this class. - Emergency Med: Nevermind, women’s health is not my worst nightmare. Emergency medicine is. Life threatening situations, thinking on my feet, a generally highly stressful environment --> AHHH - Surgery: The thought of keeping a person alive while I’m cutting him/her open stresses me out a little bit. A lot, actually.  - Ethics: Terri Schiavo and Andrea Yates are two of the many people whose cases we’ll be studying. I’m actually pretty pumped for this class.

Then after this semester, I have one more semester of didactic. And then I get turned loose in hospital and clinic. 

Craziness.