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. 

Lately, I have noticed how confident and trustworthy a clinician appears when he states that "recent data suggests" a particular treatment. Having now been exposed to the process of research and data analysis, I recognize and appreciate the importance of statistically significant results. There is a logical and economical component of treating based on the results of clinical studies that simply makes sense in patient care. When I know that data supports a clinician's decision, I am much more at ease than when a clinician makes a treatment decision because "it worked before." 

There is obviously a fine balance between personal judgment and evidence-based medicine. After all, there cannot be a randomized clinical trial for every possible scenario. However, with researchers taking the time to conduct studies to assure confidence in today's providers, we must work hard to stay up to date. Our patients and colleagues will stop and think when we are able to make decisions based on clinical evidence. It just makes sense.

My friend told me a story from a recent clinical encounter. His patient had an abscess in a personal area that carried a pungent odor. His internal response was inconsistent with the external. Despite being shocked on the inside, he made the patient very comfortable with his compassionate demeanor. My friend has never had an abscess, but the way he displayed empathy could have fooled us all. 

Whether we like it or not, one day we will be on the cold table with our parts exposed. Being clinicians, we can forget this reality and cease to recognize how our patients really feel. A practical method is to wonder how it would feel to be behind the gown. How would you feel if you were nearly naked, emitting a nauseating odor, or waiting almost an hour to see the doc?  Remember this next time you walk into a patient's room. We are all patients at one time or another, and so we must keep our perspectives grounded.  

Those who love to learn do so by their own initiative. It takes a hungry mind to read more, stay late, ask questions and fine tune practical skills. Each and every PA student enters PA school with a passion to learn; however, the learning process can easily mask the desire. Do we need reminders of this delight? Yes. Yet still, we must not equate our enthusiasm to learn with the feeling of learning.

I have said this before: We never stop being students. Will that eagerness to learn be present after graduation? Or will it be jaded by the learning process? We do our patients and supervising physicians a disservice by losing this desire. PA school is one continual learning process that can simply rob your craving to learn. The process is inevitable. You will experience pain, humility, introspection and disillusionment. Nevertheless, the ones who love to learn will get up and try again. Your passion is imperative to the field of medicine. Do not lose it during the process!

In the clinic, you are bound to encounter patients who provide information that is excessive or totally unrelated. But a working medical office operates under time constraints, so we have to take charge of the situation without being rude. 

How do we treat the volume of patients who filter through an office in one day without viewing them as numbers? Medicine is a business. The temptation to get patients in and out becomes quite attractive. 

If the waiting room seems like a packed holding tank and the exam room is a revolving door, the propensity to control patients rather than gently redirect them is evident. Too often, the patient becomes an ICD-9 code rather than an individual.  As students, we often wonder how we can see patients rapidly without, frankly, being a jerk. These are clinical skills that develop over time but can easily be countered by the "rushed" mentality. 

Something I try to do now in my clinical encounters is view each patient as someone close to me.  Would I be rude to my grandma or cut off my best friend?  There is obviously a way to kindly redirect the talkative patient. 

Cordial exam room skills take practice and keen observation. We are not predisposed to be like our preceptors, right? 

Students know that there are no PowerPoint presentations, objectives, or one-hour lectures that will cover everything one needs to know in the field of medicine. However, within the confines of a classroom, we are in a safe environment and specific direction is much appreciated. When you consider the two worlds that collide within that classroom-the professors with ample experience and students with very little-it is easy to see how the situation can become frustrating. As students, we are learning to be like our professors, but to get to that point we need a foundation. That is why it is much more favorable if we are taught specific guidelines rather than being told, "This is what worked for me." What works for one professor may have not worked for another, and may not work for a student. That is why consistent guidelines offer much solace, for right now, at least.

All too often, it feels like the students are trying to make sense of which professor is right and who is wrong. We get it that there is no 100% answer all the time and we have to make a "clinical" decision more often than not. But when studying for an exam, we love it when profs tell us how many questions will focus on this and that or to use specific material when studying. Some call it "economical studying," also known as efficiency. Again, we understand that life is not "textbook," but I find no problem with tests being so.

Maybe we take huge steps as PA students when we stop being particular and start being flexible. Grades tend to be the ball-and-chain while in school. Maybe we come to a point where forget they are even there?

Not everyone has experienced a “block” schedule before. This is where you have two to three classes at a time for three to four weeks. So, when you come to PA school, this type of setup might present some challenges. Every program is different, but most offer some sort of clinical medicine. This course is kind of like the classroom version of rotations. For instance, we had dermatology, OB/GYN and pulmonology all at once for four weeks, but as we are taking the finals a new class begins. Why is this type of layout tricky?

For our program, we may have two tests (midterm and final) per block. The final is typically comprehensive, which can be overwhelming because the midterm was over a week ago. The load seems immense; however, the material is still fresh. I mentioned before that new blocks begin as the old ones end. This is also a challenge because your ENT midterm can be the day after the OB/GYN final (true story). It is important to keep your head up, remember that the midterm material is still fresh and balance between cramming and progressive studying. It all seems insane in the moment but looking back provides assurance for the future.

Have you ever wondered why things are the way they are? One of my readers brought up a great point about reaping the benefits—or in her case, the detriments—from past students on rotations. Could it be that some negative opposition during rotations may be a result of a previous experience with a haughty student? The reality is that a harsh interaction with a nurse or preceptor may have nothing to do with us. How do we deal with that?

What about the positive encounters we have in the clinic? It probably has nothing to do with our stellar charm or good looks. Not considering the personality makeup of those in the clinic or hospital, the quality of the encounter can be related to previous conditioning. With this being the reality, we can play a part in the shifting of the winds. We can either maintain the momentum in the environment through negative/positive response or be an element of change. When seeking change, the results will not be immediate. It will take patience, even understanding, that we may not reap the benefits.

On the flip side, our laziness or pride can quickly affect the future for other students. The take-home message for those entering rotations or pre-clinical experience is to avoid being reactive creatures. Rather, make every effort to think through the response to a cold run-in. Also, we are in this together. We must continue to partner in representing the physician assistant name. Our decisions today will affect someone else tomorrow.

However, it is much harder to perform a physical exam on diseased patients. Our hands, eyes and ears are more comfortable assessing healthy patients. Our professors remind us often that the abnormalities in the physical exam will be obvious because of our anatomical/physiological foundation.

In my recent hands-on experience, the abnormal definitely jumped out at me. Things like a hernia the size of a bocce ball, a grade IV murmur and melanotic stool present on a digital exam proved there were physical findings outside of normal. The experience of finding an aberration for the first time is quite odd. You inwardly say, "Cool!" while outwardly you remain composed for professional purposes. We become sensitized to the abnormalities by learning the depths of normalcy. 

I guess our professors are right--if something is wrong with a patient, we will truly know it when we see it. 

It seems understandable that we were confronted with a "territorial" attitude. We were in their space and they could not do anything about it. So it was apparent to me that gratitude woudl be my best friend when entering the hospital. Nurses begin to warm up when they know you respect their place and are grateful for their help. 

This concept seems rudimentary but often is neglected. The hospital is where we can easily forget who is on our team and what roles they play. When we are in a position of being mostly in charge, we must never forget the people who make patient care possible. 

It was rare for me to be uncomfortable in the presence of a patient in all of my previous encounters. However, I noticed a strange feeling elicited by a certain patient. In short, the patient had multiple signs and symptoms that pointed to cancer. Both my preceptor and I had this diagnosis on our differential, yet the patient never once asked, "Could this be cancer?" I was nervous while the patient asked questions and my preceptor calmly answered with what was known, not with what was supposed. With full candor, the PA gave the patient assuring, eloquent, and educated information. I wondered how I would have responded if I was the provider. Would I have been overtly blunt or insensitive? I reassured myself that being a gentle carrier of bad news would take time to learn. Why did it seem so difficult?

We are taught about all the lethal and life-altering consequences of various diseases and conditions. After collecting the diagnostics and signs and symptoms, it seems the next step is all too easy. Just tell the patient what we found. How difficult is that? However, this delivery requires much more than the facts. We are dealing with real live human beings...like you and me. It takes more than the answers to be an effective healthcare provider.

Communication and empathy are everything when venturing into the intimate confines of a human. However, the reality is that we cannot learn this in the classroom. It takes the face of a sweet elderly woman with probable cancer to teach us how to communicate. When presented with all the answers, we must be careful not to be loose cannons. There are precious people who depend upon our ability to control our tongue. I hope to grow in this elusive skill.

A couple of weeks ago, we had our first dermatology scolding. The physician emphasized strongly the importance of sunscreen and exactly what happens to the skin when UV rays have their way. I felt somewhat frightened but, more than anything, I felt guilty for being laissez faire about the matter. I tend to tan better after the first burn of the season and rarely require sunscreen after that, or so I believe. Following two weeks of reading about the different dermatological diseases caused by UV damage, I have begun to reconsider my foolish ways. Aside from my own health, though, that moment of discomfort caused me to consider how many of my personal choices might invalidate the advice I give as a provider.

One day, we will be faced with the fact that the instruction we give to our patients is completely contradictory to the way we live our lives. Take, for example, habitual smoking, excessive drinking, consistent unwise diet choices or apathetically being in the obese status of the BMI. Does it bother us a little when we virtually lie to our patients? They can smell the smoke on our clothes or see that we could use some exercise. I don't know about you, but that makes me a little uncomfortable. I know we are not perfect models of health, but shouldn't we at least be models of healthy living?

Part of PA school for me has consisted of self-examination. I love to do things my way and have not suffered any serious consequences. I am still considered young and at times a little stupid. When am I going to wake up to the fact that my health decisions will catch up to me? Have we not learned all throughout PA school what happens to the body when we inflict damage upon ourselves? PA school causes you to take a look at yourself. Are we proactively aware of the consequences of our own choices? And are we seeking to be consistent with what we teach our patients?

It is a tough road to travel when entering the health care profession. We are confronted with personal issues that impact all who surround us, including ourselves. Let this be my mea culpa as I seek to turn from my unhealthy ways. Our patients depend upon their health care providers. We owe it to them to live long and be dependable when offering advice.