I thought it was time for a brief update of our program activities.

We’ve now been PA students for 14 months, and we’ll be done in only 9 more.  Our first year flew by, and was dominated by lecture, study, and exams (both computerized written exams and oral practica with flesh-and-blood standardized patients).

We did some work in the clinic, but between January until July was a very modest 260 hours.  This summer, however, we’ve been pouring it on.  The requirement for the summer is to put in 400 hours in our clinics, and we’ve only met for two days per month for class.

Unfortunately, relocating to Placer County required me to find a new preceptorship clinic.  Searching for a clinic took precious weeks.  Then there was a site visit by a faculty member to check it out.  Then mandatory paperwork (memoranda of understanding between UC Davis and the clinic, preceptor agreements, etc.) that couldn’t be signed by my preceptors for several weeks because they were busy, or weren’t clear on what was needed.  By the time everything was in order for me to start at the new clinic, I had lost most of the Spring quarter, and that put me – well, behind.  Now I have forced to play catch up.

Thankfully, my program has made some changes this year, and once I have checked out with all my first year hours, there will be no more MCRs (minimum clinical requirements – needing to see 6 patients with pharyngitis and 4 with anemia, etc.).  Instead, in our second year we will just see what comes our way, and document the patent’s demographic information and chief complaint.  This should free up some keyboarding time in order to be around patients more. We will of course have class and exams, but these will be less of a factor in year two.  Finally, our hospital rotations will be squeezed in there somewhere.

I learned a lot in the classroom.  But no matter how many times you read about an illness in a textbook it’s seeing it that makes it stick.  Even today I was reminded that sore throat + swollen lymph nodes + fever + no cough usually = streptococcal pharyngitis.  Jeez, I thought I knew that!  I did, but only in the book sense.  That’s the way it works; the hands-on clinic learning seems much harder to forget.

The downside of learning in the clinic is the complexity.  Patients rarely come in with a simple case of Strep.  Instead they come in with a history of asthma and seasonal allergies, having just had an ear infection last month for which they never finished their antibiotics, plus smoker’s cough, symptoms that relate to one or all of these problems, and no insurance.  With the help of your preceptor, you parse out the history and exam findings, and decide they have illness X that you only arrived at by working through illnesses A through W. Then you decide what you can treat them with that they will actually use because they can afford it.

The result is that the more time I spent in clinic the more confused I feel — really — which can be frustrating.  I told my preceptor this just today.  His response?  “Get used to it, man.  You’re going to feel that way for the next four or five years.”

Ouch. I’m not sure if that makes me feel much better or much worse.

Anyway, our year 1 comprehensive exam is next week, and then the new first year students will have their white coat ceremony.  I will speak briefly at the ceremony on the subject of the history of the white coat and its ceremony.  It’s something I enjoyed researching for the blog, and it just made sense to offer it up.  Hopefully I can get it on video to share with you all.

Please keep commenting, asking questions, and participating in the forum – it’s been a breathtaking, insane, wonderful, and fun year, and you, dear reader, have been a huge part of it.  Thanks to you for that.  -P