How to Study in PA School

     Everyone knows that PA school can be one of the most stressful times in your life, but it can also be the most rewarding.  The key is to try and find a work-life balance (easier said than done, I know)!  You spend all day on a clinical rotation, come home to study for the EOR (end-of-rotation) exam, complete the assignments for that rotation, and then you have to try and find time to eat... all this while still trying to prepare to the PANCE!  It can seem overwhelming at times 😓.  Hopefully I can ease your conscious some by providing some resources you can pull from to aid your current study habits.

     My classmates always knew I was "extra" when it came to studying.  I enjoy making study guides, printing them out, and then handwriting notes on top of them.  All while jamming to the Halo soundtrack; Michael Salvatori was my #3 Spotify artist of 2019 behind NF and Taylor Swift.  While this worked for ME,  it may not be a method in which you feel you can succeed.  There are COUNTLESS options available to help you succeed for your EOR examinations, and eventually the PANCE.  Options both myself and fellow University of Kentucky classmates utilized, included:

1. Paid subscription courses from Rosh Review or HIPPO Education
1. These sites provide sample questions, study guides, video education and more!
1. *you can share an account login, but you didn't hear this from me*
2. Educational video through my BOY, Dustyn Williams at Online MedEd, or otherwise.
1. This man has helped me with so much.
3. Texts such as CMDT (Current Medical Diagnosis and Treatment) 2020, "The Green Book", or PANCE Prep Pearls
1. CMDT was my go-to, but it definitely isn't the most user-friendly textbook.
4. The University of Kentucky had access to UpToDate, which was a game changer!  They also has access to various literature review sites as well.
1. This was probably my BIGGEST resource in PA school.  Having quick access to the most current information on my computer or smartphone.
5. Lastly my personal study guides found here at PA School Study Stuff.  I hope you can find them helpful!!
1. These are based on the EOR guidelines for each rotation: Internal Medicine, Family Medicine, Pediatrics, Psychiatry, Women's Health, Emergency Medicine and General Surgery.
2. The study guides are a mix of all the resources found above and all credit goes to the original authors and publishers.

     As an indicator of performance, I did well on each EOR exam, finishing above the national average on all but 1 exam.  I then passed the PANCE on my 1st attempt with room to spare!  I hope this information helps.  Please feel free to reach out to me with any questions concerning PA school.  I would be more than happy to help you in your journey to PA school, during PA school, or beginning your job search!

You'll make it through, I promise!  You'll walk across that stage, same as I did.  I just know it!

Trauma Surgery & Orthopaedic Trauma Surgery

POP QUIZ: What nerve must you watch out for when performing an anterior-approached ORIF of the lateral malleolus? And what would happen if you were to dissect this nerve?

     My 10th rotation (of 12 total) consisted of a mixture of trauma surgery and orthopaedic trauma surgery. During our PA school clinical rotations at the University of Kentucky, we get the opportunity to pursue two separate "elective" rotations in fields we are interested in. I spent the first two weeks of the rotation with the trauma surgery team and the second two weeks with the orthopaedic trauma surgery team. I chose these fields due to my background and future interest in orthopaedics, specifically in a trauma setting. I got to be part of both of these teams at a level one trauma center.

     While both fields are related to trauma, they manage very different aspects of the patient. Trauma surgery is a sub-specialty of general surgery while orthopaedic trauma surgery is a sub-specialty of orthopaedics. A trauma surgeon and team manages extensive damage to various body tissues and organ systems while the orthopaedic trauma surgeon and team manages the bones, joints, ligaments and tendons related to the trauma. The trauma team typically consults with the orthopaedic team to manage related musculoskeletal injuries.

     As a part of the trauma surgery team, I was a member of morning conference at 5:45am where we discussed any patients that came during the overnight shift. We then broke into our teams (A, B, C, ICU) and rounded on our patients to see what needed to be done throughout the day.  I was assigned two or three patients each day and was responsible for their care, including notes, orders, consults, and a member of the operating team if necessary. I then presented the patients to my preceptor along with my assessment and plan. Days were typically 12 hours, with 3-day weeks.

     Some interesting things I got to see/do with the trauma surgery team:

• I was able to participate in a "trauma alert red" (highest level trauma at our facility) where the patient coded. I was 2nd in line to perform chest compressions, and the patient was able to achieve ROSC rather quickly. Their FAST exam was negative and the patient was stable on mechanical ventilation. 
• I saw a patient follow-up at the clinic s/p surgical debridement from Fournier's gangrene secondary to a perirectal abscess. This was his first follow up and he had extensive skin debridement including portions of his penis and the removal of his entire scrotum... I was not part of his surgery, but that does NOT sound fun.

     I then spent some time with the orthopaedic trauma surgery team which consisted of the operating room three days per week and one day of outpatient clinic. The surgical team consisted of the attending physician, a fellow, and myself. We would arrive around 6:00am to round on patients we consult with. We would then visit pre-op to visit the patient as they prepared for surgery. We then performed the required orthopaedic surgery, and visited with the patient and family post-op once the patient was conscious after sedation wore off. Days ranged from 10 hours to 14 hours, 4 days per week.

     Some interesting things I got to see/do with the orthopaedic trauma surgery team:

• A patient presented with a fractured humerus due to an MVC. Upon opening her arm for ORIF plate-fixation, we saw what looked to be cancerous bone. We sent samples to pathology, and her fracture was a result of a weakened humerus due to adenocarcinoma that metastasized from her lung.
• I got to use the mallet and adjust an intermedullary nail. I didn't get to actually hammer in the nail, I simply made some minor adjustments to ensure proper placement. However, that still took some good whacks. Orthopaedics is like wood-working... power drills, screws, nails, plates, it's such a unique and precise surgical field!

     Follow this link to the University of Kentucky Trauma Blog if you have any interest in current trauma care/management: http://uktraumaprotocol.blogspot.com/

     If you have any interest in orthopaedics, I LOVED this resource: https://www.orthobullets.com/

POP QUIZ ANSWER: The superficial peroneal nerve, located just anterior to the lateral malleolus. If dissected, you would lose sensation to the dorsum of the foot. You would NOT lose and eversion due to being past the point of muscular innervation.

Internal Medicine Clinical Rotation

POP QUIZ: What is the only lipid-lowering medication class not contraindicated in pregnancy?

     For Internal Medicine, our program has two, four-week rotations. While it's ideal that we do both rotations at the same clinic, that's not always an option. I was at a Cardiology clinic for my 1st rotation, and I was at an out-patient primary care clinic for my 2nd rotation! I did not think I would enjoy primary care as much as I did, but I saw something new/interesting every day!

     As a provider at an out-patient internal medicine clinic, you are the patient's go-to for healthcare and also the "middle-man" between the patient's various doctors. If a patient has numerous medical conditions (i.e. congestive heart failure, chronic obstructive pulmonary disease, osteoarthritis), you are to ensure they are being referred to/seen and treated by their Cardiologist, Pulmonologist, Orthopedist, and so on. You also see the patient for annual physicals, acute illnesses, chronic medical problems, lab work, medication adjustments and so much more! 

     As a primary care provider, it's important to build a positive rapport with your patients. I noticed very quickly how much my physician's patients meant to him, and how well-respected he was by patients. He cared for each patient as an individual, helping them with medical problems as well as life in general. He has gone on mission trips with his patients, long-distance bike marathons with others, and even attended events/parties when his patients asked him to join. As a medical provider it's important to always remember that you are treating people; people with emotions, feelings, concerns, stressors, and anything else you can think of. Compassion is the best way to develop a positive rapport with patients. Studies actually show that patient overall health and disease outcomes are linked to a better patient-provider relationship.

     We had a couple of very interesting patients that came into the clinic...

• Female that was born with esophageal atresia and developed a fistula. For treatment, they took a portion of her jejunum and made a new esophagus that ran on top of her sternum. Looked WILD.
• Male patient with hypokalemia that says he drinks 2-3..... POTS of coffee each day. Does anyone else drink that much coffee!?
• Male that has debilitating headaches with orgasm, recent-onset.

     We have assignments that we do for the class portion of rotations, and one of those assignments is to type up a SOAP (subjective, objective, assessment, plan) note on a patient that we saw in clinic. For those interested in the male patient that has headaches with orgasm or if you want to see how a provider's clinic note is typically typed up, CLICK HERE (*please note: all HIPAA standards have been followed)

     Our program uses PAEA Exams, and they post a topic list and blueprint for each exam. Below are those categories if you want to see what we are responsible for (the IM topic list is a unreal):

• IM Topic List
• IM Exam Blueprint

 Books that helped me ROCK this exam include (the latter two are books for all PANCE topics, not just IM):

• Washington Manual Internal Medicine
• The Green Book
• PANCE Prep Pearls

POP QUIZ ANSWER: Bile Acid Sequestrants (cholestyramine, colestipol, and colesevelam)
- Be sure to monitor fat-soluble vitamin levels as these drugs may impede their absorption

Family Medicine Clinical Rotation

POP QUIZ: What's the most common cause of chest pain?

     For Family Medicine, our program has two four-week rotations. While it's ideal that we do both rotations at the same clinic, that's not always an option. I am at an Urgent Care clinic for my 1st rotation, and I'll be at a Family Practice Clinic for my 2nd rotation in the Spring semester.

     At the Urgent Care, you see a wide variety of age groups and complaints. From infants a month old to a 98-year-old woman (yes, you read that correctly) who's more active than I am!! It's much more fast-paced than traditional family medicine, and you don't get to focus much on the preventative side of medicine. A patient comes in with a complaint, you diagnose the complaint, and you treat the complaint. It's a "greet em, treat em & street em" way of  looking at medicine.

     Common complaints/diagnoses I saw while working:

• streptococcal pharyngitis (strep throat), influenza A&B, upper respiratory viruses, seasonal allergies, chronic bronchitis exacerbations, depression, cuts/scrapes, and orthopaedic injuries (my personal favorite!).

     I got to have a little fun at the office for college football opening day! Yes, I am based in Lexington at the University of Kentucky and do most of my rotations in Wildcat Country, but I will always be a Georgia Bulldawg at heart. I got some flak for wearing this to the clinic, but I was born in GA and went to undergrad there! I will always support the Kentucky Wildcats.....except when they play the Dawgs! #GoDawgs

     I did learn an interesting new technique for wound care, that I'd personally never seen before! It was actually for the 98-year-old mentioned earlier who injured herself while tending to her garden! When dealing with scrapes, try use as much of the patient's leftover skin to cover the wound. The BEST band-aid is your own skin, so we spent plenty of time trying to cover up the patient's wound with her own skin and then using steri-strips to hold it in place before dealing with the remaining open wound. This took plenty of patience as the scraped skin loves to roll up on itself! It's best with two sterile cotton swabs and some normal saline. Use one of the cotton swabs underneath the skin and twist the swab away from you to help unroll the skin before placing down to cover the wound. This ensures the most amount of skin possible is being used to cover the wound. It was definitely an interesting approach to wound care I'd never seen before, but it makes so much sense!! So if you have a big wound, try NOT picking off the skin before getting seen by a medical professional.

     Our program uses PAEA Exams, and they post a topic list and blueprint for each exam. Below are those categories if you want to see what we are responsible for (the FM topic list is a beast):

• FM Topic List
• FM Exam Blueprint

     Books that helped me ROCK this exam include (the latter two are books for all PANCE topics, not just FM):

• CURRENT Practice Guidelines in Primary Care
• The Green Book
• PANCE Prep Pearls

POP QUIZ ANSWER: Chest wall pain, AKA muscle soreness.

Characterized by at least 2 of the following: Localized muscle tension; Stinging pain; Pain is reproducible by palpation; Absence of cough.

Pediatrics Clinical Rotation

POP QUIZ: What pediatric condition is characterized by 3-4 days of a high fever (>103.5F), an abrupt cessation of fever, followed by a non-pruritic maculopapular rash on the neck & trunk?

     I recently finished up my pediatric rotation, and I LOVED every moment of it! For some reason, children in healthcare are so much more enjoyable to work with and treat than adults... I spent the rotation at two different clinics with two different patient populations. I was at an Adolescent Clinic and a General Peds Clinic. I spent 3 days/week at the adolescent clinic seeing patients 10-23 years old and 2 days/week at the general peds clinic seeing patients 1 day old through 4 years old.

Adolescent Clinic:

• Well-child checks, immunizations, sport's physicals, birth control, STI's

General Peds Clinic:

• Well-child checks, acute illnesses, rashes, fevers, education/counseling for feeding & growth/development

     Both locations were phenomenal and my preceptors consisted of MD's, DO's and PA-C's. Each had their own unique way of approaching the patient with the same end goal of total patient health and prevention of disease. I enjoy pediatrics because it is a different approach to typical healthcare. Pediatrics is largely focused on disease prevention or primary prevention while most adult medicine is focused on disease treatment or tertiary prevention. 

     Helpful Information for the Pediatric Rotation:

• Developmental Milestones
• Immunization Schedule

     Our program uses PAEA Exams, and they post a topic list and blueprint for each exam. Below are those categories if you want to see what we are responsible for:

• Peds Topic List
• Peds Exam Blueprint

     Books that helped me ROCK this exam include (the latter two are books for all PANCE topics, not just pediatrics but give a good summary of common pediatric conditions):

• Nelson Essentials of Pediatrics
• The Green Book
• PANCE Prep Pearls

POP QUIZ ANSWER: Roseola (“Roseola Infantum”)