The UNTHSC PA class of 2011 is counting down the days until we head out the door for rotations. On March 29^th, we will go our separate ways for 3 ½ weeks at a time and come together every 4 weeks for testing, presentations and re-connecting with each other. 

Each student has 12 rotations ranging from 1-2 months each. Our core rotations consist of family medicine, internal medicine, surgery, pediatrics, inpatient, psychiatry, OB/GYN, emergency medicine and an underserved practicum. The internal medicine and surgery clinicals have an extra 4 weeks tacked on for a sub-specialty exposure. Every student has the opportunity to choose an elective for 4 weeks, which takes place toward the end.

The countdown system we posted in our classroom.  

The moment every 2011 student has been waiting for finally came last week...WE GOT OUR SCHEDULES!!!  You would think it was Christmas or our birthdays. Opening the Word document was like unwrapping a mysterious gift. We had no idea what the schedule would be like. Would we be far away? Did we get a rotation that was on our preference list? What is our first rotation? It was an exciting time, indeed! The clinical coordinator reminded us all that our schedules are subject to change and it would be in our best interest to remain patient throughout the process. Yet simply having somewhat of an idea of what remains for PA school was more than we could have asked for! 

I'm so glad I get to bring you all with me for the next 14 months. Stay tuned!  My first rotation will be emergency medicine and my last one will be trauma pediatric surgery. It's going to be a fun ride!

Is pharmacology in PA school the same as regular college pharmacology where you need to solve certain equations in a very specific way? 

I guarantee that pharmacology in PA school is completely different. In the first section we learn about dosage calculations and pharmacodynamic/pharmacokinetic formulas. The majority of pharm focuses on drug classes within the context of medical disciplines (i.e. cardiology, urology, GI, etc...). The primary focus is mechanism of action in relation to disease and how the physiology is altered.

How much studying do you regularly do?  Can you still manage to have a life while in PA school? 

The amount of studying varies amongst the student population. For me, on average I put in 4 hours each weekday and around 8-10 hours on the weekends. Total: 20-30 hours per week...seems like a lot. I try to treat school like a full-time job, helping me to have a life outside of PA school. Managing school with the rest of life is a matter of balance and priorities...it's a custom project for everyone.

Was there ever anything in the beginning of PA school that made you very uncomfortable or made you think about quitting?

The sheer increase in workload. PA school is tough as it is, but then add on the fact that we were taking 20 credit hours made it seem impossible. I often wondered that first semester if I was cut out for this. I kept telling myself to hold on and there are many who have gone before me and survived.

What was the first time in gross anatomy like? Did you get dizzy? 

I loved it!  How many people get the opportunity to see what remains hidden for a lifetime? Yes, initially there is a creepy factor of working with a cadaver but that goes away when you see the connection between lecture and lab. I was never dizzy but frequently felt an adrenaline rush from the sheer excitement of being one of the few who gets to be in an anatomy lab.

What has been your favorite class so far and why? Which one did/do you enjoy the least? 

We had a class in the 2^nd semester called Physical Diagnosis. It was our first exposure to a clinical scenario where the H&P was presented and we had to give a justified diagnosis. Each week centered on a common chief complaint like back pain, headache, or abdominal pain. We had multiple differential diagnoses that we organized in a grid with signs/symptoms, common lab results, and risk factors. We used the grids to analyze the case studies and give the patient a diagnosis. First time I actually felt like a PA. With regard to my least favorite class, I had none...only because my perspective continued to adjust.

Have you ever had doubts pertaining to the career you have chosen? Or was there a particular moment when you were 100% sure this is what I should be doing? 

Definitely leading up to the PA school, I had doubts, only because my focus was originally limited to being a physician. However, the first semester of PA school quickly got rid of all doubt. I began to see the solid future for PAs in the country and the many opportunities in the Dallas/Fort Worth area. There have been moments of doubt when I see doctors or the general public look down on PAs or simply have no idea what a PA is. Yet those moments teach me to continue to advocate for the PA profession and be patient with the ones who are set in their ways.

Is there any advice you could give me? 

Continue on with an open mind and become a lover of learning. We grow in the process, so be careful not to curse it. When we work towards our dreams, it takes time, determination and a commitment to today. 

I have truly enjoyed this interview. If there are any pre-PAs, PA-students, practicing PAs or anyone else who has questions for me, I am more than happy to answer them. Maybe I will post another interview down the road. Thanks for reading!

As the days in the classroom pass us by, we look ahead to the next chapter. With rotations only 63 days away, we still have much to learn. 

Our geriatrics block wrapped up last week and GI and renal continue on. The only clinical med classes left are hematology and pediatrics. I often find myself believing that rotations should start today and sitting in class is pointless. However, in those moments I stop myself, remembering there is still work to be done. 

In PA school, it is all too common to desire a change in schedule. We want to be done! We want to be out of the classroom! Can't we just be PAs already? 

I believe this is a common reaction to the pain of enduring the learning process. Even though this attitude is common, we all realize there are 63 days left in the classroom to learn as much as we can. Thankfully, our class is made up of reasonable people who understand that there is work to be done. Sure, we may complain a little here and there, but we all understand the importance of the process. The goal will be to finish strong, because we have no idea what lies beyond March 29^th. The UNTHSC PA class of 2011 is hanging in there!

This week I finally saw the movie adaptation of Sherlock Holmes. I was amazed Holmes' incredible powers of observation and ability to process the small details that would lead him to solve a case. And I couldn't help thinking how my clinical practice would be affected if I could process information like Holmes. Currently, I try to wrap my mind around as much data as possible and make a judgment that seems consistent with the material in the book or a lecture. How would it look if I used what I knew as the backdrop? What if I asked myself simple questions like "What's missing?" or "How should the physiology work?" I know it seems rudimentary, but it is a simplicity that I feel has evaded me. I tend to make things more complicated than they should be.

I admit that wanting to be like Sherlock Holmes seems a little weird, but I like the way he thinks. He has reminded me to slow down and not jump to conclusions without thinking through the whole picture. Easier said than done. We can get comfortable with thinking in terms of templates, but it takes real talent to reason through the problems at hand.

Over the next 6 weeks, my classmates and I will spend time in a small group setting where we discuss complex/everyday cases in primary care. How do you handle the patient with six different problems on multiple medications? It was easy when we only focused on cardiology or endocrine, because that was the only problem. Now there are many issues and they all seem to overlap. Is this what the professor meant when he said "You will think like us"?

It is pretty hard to believe that in 17 months, I will be a PA. The idea of thinking like one of my professors seems like a huge task. I am already amazed at how far we have come as students. In just more than a year, we will have made even more progress. We will actually be thinking like a PA. Hopefully I will learn to handle the problems of a complex/everyday patient with ease rather than puzzlement. Until then, we keep placing one foot in front of the other.

Climbers who are eligible for the summit spend many days in training, going up and down parts of the mountain and allowing their bodies to adjust to the altitude. In the end, their efforts culminate in a final push to the summit.

This is my summit year. All of the classroom training and lab exercises have stretched my brain to the limit in preparation for full-time rotations. In 12 weeks, we begin the final clinical portion of PA school. The didactic piece prepared us for the last push. We all wait in anticipation, wondering if we have what it takes to save a life. Yes, rotations will be exciting, but the true test will be on the other side. Everest experts say the hardest part is coming down. You are exhausted, dehydrated and dealing with high oxygen demands. Only if you make it down can you say that you climbed Mt. Everest. I see the rest of PA school as the same. In 2010 we make our summit attempt!  I am excited to take you with me!

Thus far, my December break from PA school has been exciting and will now transition from time spent shadowing in the hospital to conventional R&R.

Looking back on the most memorable moments from the two weeks I spent shadowing in pediatric CT surgery, I am surprised by what stands out most in my mind. Not the pulmonary vein reconstruction I observed on a 20 month old, or the sutures I removed from the wiggling infants, or even the chest tubes I pulled on a couple of kids. What moved me the most was watching clinicians care for their young patients as if they were their own children.

Each day, a nurse practitioner and I rounded early before the surgeons arrived on the floor. One morning we came upon a fussy baby with tubes and wires attached. I watched as the clinician unwrapped the child to examine the surgical wounds. What she did next caused me to stand in awe. The baby was not crying about the tubes or wires but because of a dirty diaper. I watched as the NP calmly changed the baby's diaper, rather than calling for a nurse to take care of the dirty business. Things like diaper and linen changes are not considered the job of a clinician. Patient care reaches a whole new level when medical professionals do what's best for the patient, regardless of their job description.

Each member of the treatment team has a certain set of duties expected of them. Most of these tasks require special training that limits who can and cannot carry them out. However, there are things that everyone can do. The fallacy is that those "higher up" on the chain of command are exempt from the more menial tasks. It is true that things like diaper changes and dirty linen removal are not typical tasks for a clinician, but the practitioner who tends to the simple needs of the patient goes above and beyond. In my book, that NP is a great clinician.

Until I enrolled in PA school, my exposure to pediatrics consisted of one year on a general medicine floor and about four years of clinical psychiatry. Same story, different chapter. No matter what the circumstance, it is hard to watch a child suffer. Whether the child has a behavioral disorder or severe illness, it never seems right to see a young person in pain. I am amazed by the way doctors, PAs, nurses and support staff care for the children and their families throughout such difficult circumstances. I have learned that it is OK to hurt when kids hurt. It is OK to hurt when their families hurt. You do not want to become numb to a sick or dying child.

For the medical staff, emotion is a good thing, yet it cannot inhibit quality care. Even though I saw clinicians affected by this child's death, I also saw them come together to better serve and protect their patients. They are perfect examples of how health care can be run by humans rather than cold machines. When a child is very ill or dies, somebody has to be there. I have so much respect for the strong health care professionals who still feel sadness.

I have mentioned before that shadowing during a break is a great way to spend your time. This December I am observing a clinician in cardiothoracic surgery at a children's hospital.

PA students will often recognize that time in the clinic continues to change as we progress through the didactic year. We learn to follow the medical lingo and treatment modalities. We can actually answer our preceptors when being pimped (a.k.a.: being asked tough medical questions). At this point in my education, I feel relatively comfortable in the clinical setting. Comfortable enough to realize there are deeper lessons that cannot be taught in the classroom.

Today I observed the multi-faceted nature of a true practitioner. Aside from this person's ability to hone in on clinical features, they were very perceptive of the needs of the patients. Maybe it was because this was a children's hospital or more likely because this was an incredible clinician. Either way, I look forward to sharing more of my experiences as a shadowing vet!

How many times have you been called "doctor" or asked by friends and family, "Aren't you in medical school?" It seems like the opportunities to explain what a PA is and does will never end. When you have the chance to advocate for PAs, how often do you experience frustration or indifference because the task seems futile? The reality is that there are many who do not know what a PA is. Regardless of how many times you tell them, they need to be told again. If we give up because we think they will never get it, then they will never get it.

The battle of advocacy is met with many variables. Are PAs and NPs the same? Why didn't you just become a doctor? Oh, so you will do the PA thing for awhile and then become an MD? When asked questions of equality and hierarchy, it makes sense that our natural response would be that of indifference or frustration. To explain what a PA is for the thousandth time takes patience, perseverance and pride for the profession. We may not have a lot of time or we may have had a rough day, but we cannot neglect opportunities to advocate for physician assistants. It has taken over 40 years to get this far, but we still have a long way to go. Keep your heads up and keep having those conversations.

1. The love and grace of my Father!
2. The most amazing wife! Because of her love, respect and desire to tag-team life with me, our marriage continues to thrive. She is the most patient, encouraging, creative, gentle and beautiful woman I know. Thank you, Little!
3. Friends and family who seek to know me and allow themselves to be known by me.
4. The opportunity to learn at an institution that is pushing the frontiers of medicine.
5. The UNTHSC PA studies program. Thank you for giving me the chance to become a physician assistant!
6. The faculty here who have given more than just their time and effort to create an optimal learning environment.
7. The editors who take the time to refine my thoughts. Many thanks to Heather, Terri and Michael!
8. My classmates, who support and encourage one another and celebrate the lives of others.
9. The student leaders who carry additional responsibilities while in school to improve their surroundings.
10. The people who seek to challenge the methods of medicine for the sake of doing what is best for the patient.

What are you most thankful for?

I wonder how other programs across the nation deal with this issue. Are you known as a "medical school" or as a legitimate "health science center"? Sitting in that meeting made me appreciate my fellow collaborators of the medical sciences.

Students in PA school encounter many opportunities to participate in community outreach events. Participation varies due to perceived or actual time constraints (see my previous post).

Last week I spoke with a medical student who is highly involved in community outreach programs. He is always talking about how the medical school is doing this and that. Meanwhile, I wondered how he and other med students were able to inspire involvement with everyone being so busy. That's when he explained to me that med students are required to obtain a certain number of community service hours as part of their curriculum. Because of this, they have developed a sense of ownership for the community, he said. I bet PA students would find the same benefit.

The truth is that students who want to participate in community outreach will. However, many students choose not to, probably because they feel they lack the time. I think PA students should be doing so much more than learning about practicing medicine--we should strive to make a difference in our communities. This could even help students appreciate the population they treat. 

This problem of not finding time to volunteer can be solved by working community service into a course that teaches students about the surrounding cultures (some programs may have this type of class already).  I would like to be more involved in the community but my commute, four leadership positions and marriage make me less inclined. I know that, for students like myself, a required amount of community service would help. Type-A readers can understand. Community involvement should not be something we wait to do but rather something we cannot wait to do. I like the requirement idea from the med students, and I wonder if our program would go for something like that.

In orientation, just about every faculty members says some version of the same thing: "Kiss your wife and kids goodbye, because you are mine for the next 34 months." I realize now that this was only a scare tactic to readjust priorities. However, many pre-PAs and, unfortunately, PA students take that statement literally. The reality of PA school is that YOU WILL HAVE A LIFE!  Come on people!  It is ridiculous to cut off the outside world and do nothing but school. The obvious approach is to find balance. You must constantly evaluate your time, commitments and relationships. Priorities shift throughout PA school. As a married man, my opinion is that your spouse always comes first. This does not mean that you neglect studying to spend time with your wife. The key is to communicate with your spouse when it is necessary to study rather than spend time with her. You are not saying that studies are more important than her. This is a matter of disclosing needs and expectations (another topic altogether).

PA school takes up less than three years of your life. This does not give you a license to neglect your responsibilities to yourself and others. How you handle your time in PA school will affect how you handle your time as a PA. You must learn to balance life while in school. If you have no life in PA school, you are probably dying. Rant over.

There seem to be two general methods of dealing with a problem: the initial, emotionally-driven reaction or a careful, thought-out response. It is natural to internalize emotions when we are either hurt or have a disagreement. However, the residual effects of that internalization linger when moving forward into the professional world. The fact is that we will have disagreements with our supervising physicians, so we must learn to deal with them well.

Last year, I was elected president of my class. Part of my job is to be the liaison between the students and the faculty. Over the past year I have noticed how students can be affected by the teaching methods of our professors. A student's natural response to something about a teaching method they don't like is to grumble and complain within the confines of a student circle. My goal has been to encourage classmates to channel their feelings into constructive feedback. Most of the time, they come to realize that the problem actually lies within. However, when a problem is truly external, I have seen students come together and devise a professional approach to the matter. We may not attain the results we are looking for, but we all learn about dealing with conflict in a professional way.

Conflict is inevitable in the field of medicine. Hopefully we will always find the opportunity to carry out a professional discussion with our colleagues. The first step is to reign in that initial, emotion-driven reaction to a situation. What follows from there is up to you.