The Real Fun Begins

Winter quarter is here, and with it, all the brain-bending goodness of what everyone tells us is the the hardest quarter of our PA training program.

We hear that this is because:

study group UCD

Winter quarter of year I is where things start to get crazy.

  1. Now that we are two quarters (6 months) into the program, our instructors feel secure that we know what we’ve gotten ourselves into, and they’re ready to open up on us with both barrels.
  2. Our instruction (among other things) covers some of the most challenging material inmedicine: cardiology, gastroenterology, and nephrology (heart, digestive, and kidney systems).  We’ve covered their basic physiologyalready, and we’ll do it again in an even more advanced form next year, making three times in all.
  3. We begin our preceptorships this week, so two days per week we will be seeing patients in the clinic and charting our work (“SOAP” notes).  Our program requires lots of documentation, so there’s a time commitment there too.

There’s a lot going on for us in the next 12 weeks or so.  Cardiology is fascinating, so far.  We’ve had lectures from our own faculty, practicing physician assistants, and physicians who specialize in cardiology, cardiothoracic surgery, and emergency medicine.  We are starting the process of learning to read 12-lead EKGs (which feels to me like trying to decipher really bad handwriting that lacks any punctuation), and we’re also learning about cardiac drugs.  Needless to say, I have much studying to do.

The Preceptorship

My preceptorship begins this week, and if you aren’t familiar with the term, you can think of it as internshipin internship, or –more simply– on the job training.  I will be seeing patients two mornings per week at my home clinic in Mendocino County, CA.

It’s a family practice clinic, so I should be seeing patients of all ages, and with all kinds of problems.  There are plenty of experiences that I need to have to in order to prove that I’ve received adequate training during my first year.  To wit, I’ve received a list of 400+ clinical requirements that I need to fulfill in the clinic.  These “minimum clinical requirements” (MCRs) are basically diagnoses and problems that I need to see and treat.  Some of these I only need to do once this year, and some many times.  Next year’s list is much longer, and includes more procedures.  This way, by the time I complete the program, I will have seen several thousand patients.

Learning in the clinic with a preceptor

Preceptorships bring the material in to the real world.

Just for kicks, I picked one of these MCRs from each letter of the alphabet (that has one) to give you an idea what types of things I’ll be doing.  It’s a nice cross section, IMHO. Most of them have separate requirements within them (neonatal, pediatric, adult, geriatric).  Here’s the list:

  1. Abdominal pain (adult)
  2. Bladder Training.  Wait, what?
  3. Complete neurological exam
  4. Diagnostic pelvic exam
  5. Episodic (someone coming in for a new episode of a problem – “knee hurts, cut hand, fever, etc.)
  6. Fungal infection
  7. Gastroenteritis
  8. Heart murmur
  9. Infant feeding
  10. Lower back pain
  11. Menstrual problems
  12. Nutritional problems
  13. Orthopedic trauma
  14. Pharyngitis
  15. R/O (means “rule out,”) skin cancer
  16. Serous otitis media
  17. Thyroid disease
  18. Upper respiratory infection
  19. Vaginitis
  20. Well child visit (basically a checkup)
  21. X-ray reports (interpreting them, I assume)

We have to keep detailed online records of everything we do in clinic (without all the personal/HIPPA information that could compromise confidentiality).  This means I won’t be blogging about particular patients, per se, but I will be blogging about experiences, what I’m learning, interesting facets of medicine as a field, and of course, how to get into PA school.  Obviously, long I can’t provide any patient information.  You’ll recall I did this when I posted about my first real patient (link).

Next Up:  An (anonymous) introduction to my preceptor, whom I will be calling… The Thin Man.

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