Blast From the Past: Why Is Review Necessary?
The first year of PA school may seem like a blur to most. Once into the second year, you are haunted by old material constantly. Lecturers make reference to certain drugs and their mechanisms, specific landmarks of the body, detailed physiological functions and special physical exam tests named after some guy. We all laugh when we realize how easily basic courses such as A&P and PE skills slip our mind. At what point does a scenario like that stop being "cute"?
A buddy of mine recently brought up a striking reality about school. He is a graduate from seminary and now works with college students. He said, "Tim, I do not remember everything I learned from seminary, and that is okay. If I come to something I don't remember, I just look it up. It does not affect anyone immediately because I can always tell them I will get back to them. You don't have that luxury."
He has a point. I cannot tell a diabetic patient, "Well, I do not remember that one drug that helps lower blood sugar, but I know insulin will always do the trick." I cannot simply refer a patient out with left homonymous hemianopsia because the location of the lesion was something I once knew... The information is somewhere in my brain, right? To be an effective PA, review can no longer be perceived as a well-intentioned suggestion-it is a critical requirement.
We are now on break and I have zero plans to travel or any gut-wrenching deadlines looming over my head. It seemed apparent to me that reviewing material from the first year might not be a bad idea. Initially, review seemed like a daunting task, but slowly I noticed how different A&P and PE skills appeared. There was now a strong application element that linked everything together. Understanding the relationship of abnormalities to normal anatomical features brought to life clinical material I am learning now. So, what keeps us from reviewing stuff from the past?
When learning complex new material, the thought of going back to the beginning seems overwhelming. Why would we add on more? That would be crazy! Although reviewing is difficult, it can be done and it is necessary. Review takes sacrifice and strategic planning. It may be more realistic to go over old material on the break rather than during the semester. There are always the quick Google moments during class where I have to go back to refresh my memory.
Another obstacle of review is pride. We initially go through the musculoskeletal portion of anatomy and think all those insertions and origins are a joke. Or we believe we can get by without learning all of the nauseating details of neuroanatomy. I once saw a patient who came in unconscious with one blown pupil. The ER doc explained to me the reason for the dilated eye: the Edinger-Westphal nucleus. Do you remember that one? Did it not seem like an unnecessary fact at the time? If I start telling myself that "I don't need to know this stuff," another person could suffer from my pride. It takes humility to say, "I need to go back and review because I am not above anything."
I would like to know what the students think. Do you review things like A&P, PE skills, pharmacology, or microbiology? If there are seasoned physician assistants who can speak with some wisdom on this topic, please respond.
In the meantime, I believe review is a non-negotiable if going into the field of medicine. Our patients will suffer because of our lack of initiative. Repetition is the fertile soil for lasting knowledge.