Tuesday, February 28, 2012

Planning for test 2

There are advantages to having tests every other week. For one thing everything is still relatively fresh in your mind, for another you get every other weekend where you still study but you can decompress a bit and relax.

Meanwhile, I'm trying to plan out my studying for next Monday so that I don't end up cloistered in my study room this weekend. We are done with classes at noon tomorrow and on Friday, so I am going to try to utilize those afternoons to go over the material from last week. I am still trying to figure out if there is any advantage is streaming the lecture more than once or if I should just stream once and then just use the annotated slides.

The workload remains steady, consistently busy but not horrible. I'm still withholding judgement on the educational value of the team based learning exercises. Some are more useful than others, but overall I worry that I get more out of studying on my own. It is a strange shift in perception since I've always preferred classroom learning.

In other news I finally have access for the slides to my autopsy case! We're going over them on Thursday, and it should be good since it was such a complex case. My lab professor is actually presenting the eyes to some of the ophthalmology staff today but I'll have to miss it for class. I will have to check back in with him to find out if they were able to diagnose the anomalies they found (which were oddly enough, not the anomalies they were expecting to find). This was an amazing case to be able to see/be able to present.

Sunday, February 26, 2012

Mostly non-school blog about my life.

I'd like to take a moment to assess my personal satisfaction with my life... And I feel pretty good :)

My sons' basketball season wrapped up yesterday and throughout the day my husband and I kept talking about how much we really like the *Orange County rec department. In a month they will start soccer season, which will run to the summer basketball season. Basketball was fun, but I grew up playing soccer so it is the sport I feel more comfortable training them in.

Speaking of sport-ish things... I've been squeezing in gym time. I spent 2009-2010 losing 60ish pounds, most of which I regained in 2011. I do miss my gym in my old town and the friend I used to workout with, but I am lucky that my apartment has a decent facility. I bought a pedometer/sleep track/gadget thingy that tracks what I do during the day and it has been interesting to see graphed out (like that sedentary time spent in class/studying). Also, I do occasionally sleep walk/talk/text, and it is neat to see that documented (so I can wonder what was I doing for that 8 minutes I was "awake" at 4 am this morning?).

And, we're half way through the spring loan disbursement and I'm sticking quite well to my budget. Hooray for me! Going from having a regular paycheck every two weeks to having to make a finite amount of money last for four months was hard. Especially since my husband was traditionally the one to write the checks and pay the bills. The fall disbursement seemed to disappear quickly but the expense of relocating was a big part of that. So, yes, you can live off the student loan allotment--even if you're me and have an enormous apartment (half of my classmates have roommates or significant others that they share expenses with, one rents an apartment that is part of a private home and the other two have one bedroom apartments.).

Living with my dad is fine. He is easy to get along with and the kids love having him here. He takes them to the playground and reads while they play or he sits outside on our patio and they ride bikes around our building.  He's lost a lot of weight since he moved in with us (I cook foods that work for his diet) and seems to be in better health than since before he retired; although, he has taken up cigar smoking. He sits on the patio in the sun while the kids are at school and smokes stinky cigars while reading. On the upside it provides an object lesson for the kids -- smoking smells really bad and everyone in our family will corner you at family events and lecture you about it of you do it.

Socially, I'm good. My husband is coming up on non-test weekends which means that we actually get to go out together, unlike what we did in the fall where he came and watched the kids and I locked myself in my study room. My classmates continue to be awesome and I can't imagine being in this program with any other group of people. I still miss my dog but he is coming up to visit me for spring break! I wanted to get a cat but my husband vetoed it even after I cited the research that they increased oxytocin levels and suppressed cortisol release. His rationale being that my dog at 120lbs was already the equivalent to having two normal sized dogs and several cats (and that I and our oldest child are allergic to them).

I'm so glad that I got into Duke, and I am insanely curious about the folks being interviewed for next year's class (I've seen a couple of them in random places during their interview days)! There was a 25% increase in the number of applicants this year, so it was a competitive year even to get to the interview stage. I am glad that some of them have read my blog--not just because I love getting blog traffic but more because it means that they've put enough effort into learning about the program to be able to ask more targeted questions when they're interviewed, at least about the didactic year. Hopefully that means the program is a good fit for the ones who get in and they will be happy here. Of course there are a lot of questions that they might not get answers to, since this year is a transitional one when it comes to class format and we have really just started this unit. The administration seems to be listening very keenly to the students, so all that can be said for sure if that next year will be different (and better, as long as this years class continues to give useful feedback).

*I was worried about living outside of Durham when I was apartment hunting but it has worked out really well. The commute to the parking garage is less than 15 minutes, the drive to classmates' apartments, movies and malls is 20 minutes or less, and I have been really pleased with the schools, parks, and everything else I have seen in my little town. 

PS: Sorry if you find this entry boring but I have family on three continents, friends on four continents, and I am horrible about returning emails/phone calls. This way everyone stays updated. :)

Thursday, February 23, 2012

Yet another Team Based Learning (TBL) update

Bluedocs screenshot from the instructional video someone posted
We've finished up another week since my last update and I have to say that I am a huge fan of doing the individual quizzes (IRAs) at home. They are still timed and closed notes, but just being able to do them right after I've finished studying (instead of 12 hours later in class) has helped immensely. And we can find out how we did/the correct answers right after we take our IRA through the same website where we do all of our school stuff (it is called Bluedocs, sort of like the blackboard program most schools I am familiar with use).

I am getting used to streaming the lectures online, which I was worried about in the beginning. I have always gone to class so the idea of just watching the lectures online and holding questions until the TBL exercise was worrying. I think it is working out okay though. One of the medical students said, and I agree, that the daily IRA is very helpful because it forces the students to keep up with the material to a greater extent than just going to class everyday did (because being present in class doesn't necessarily mean that you're paying attention).

And keeping up with the streaming isn't overwhelming. All the students except me* were done with classes at noon yesterday and we only had two lectures to stream (they run around 50 minutes but most people I know stream them at 1.5 times normal speed). Today we had morning lab which finished at noon and an option TBL session that only ended being half an hour in the afternoon. I watched one lecture while I ate lunch and would have gotten through most of today's lectures in the PA room before I went home except I somehow ended up reviewing the slides with a classmate's autopsy slides and the resident that assists in their path lab. 

Have I mentioned the autopsy requirement? All of the medical and PA students are put together in groups of four or five and have to go watch an autopsy**. They are given copies of the clinical history and the slides for the case. They have to go over the slides and present the case and results to the rest of the lab. Each student must also submit a written autopsy report as well. Our autopsy group went pretty early in the process but are still waiting for our slides, so I went along with my classmate to see if the resident had them/was going to be done with them soon.

The case my group observed was fascinating which is likely the reason the slides are still out. Also it was a complete autopsy so the brain and the eyes were held for special cuttings (brains are done on Monday, eyes on Tuesday), which would have delayed things as well. My lab instructor is the pathologist who does the eye cutting and he had found a few noteworthy things, so we spent some lab time today going over it as a class and postulating about the cause of some of the things noted on autopsy. It was an impromptu clinical correlation sort of thing--where everyone tried to trace the source of some blood clot (we had clot formation information on our last test). We had some decent theories, but we'll have to wait for the official diagnosis to find out for sure!

*We are still continuing our clinical rotations*** in surg path through the spring, with the groups alternating weeks. The rest of my group went home because the instructor was sick but I was scheduled for the VA hospital and wasn't effected. The VA is nice because we show up during case sign outs, which are interesting.

**I think it is more for the medical students than it is for us, since we spent January on autopsy rotation. Some of the medical students are a lot less comfortable with the idea of an autopsy than others (and none of the ones in my group seem nearly as interested in our case as I am, but that might also be because they don't realize just how much there is with this case to be fascinated with...) so it is probably good for them to have this experience. And we all get practice writing up an autopsy report, which I have never had to do before.

***Although Pam did give us the option of suspending them if we felt overwhelmed with the streaming/TBL class format. We unanimously voted to keep them, because PA students love grossing! Still, it is awesome that our administration gave us the option!

Wednesday, February 22, 2012

Talking about having a blog (or how I got officially outed)

It is interview season at Duke and two by two the applications are filing through to be interviewed by the administration, staff PAs, and the second year students. And apparently one of the applicants mentioned very nice things about my blog (awww, thanks!) to several of the people she interviewed with, who have in turn mentioned to me that she mentioned it to them. Except some of them weren't previously aware that I had this blog, which has led to some interesting conversations.

Not that I'm overly concerned that I've written anything that violates patient privacy, is universally offensive to people, or downright insane (of course if I were ranting like a crazy person would I really be aware of it?). It is just more the awkwardness of admitting to people that you have a blog. And for right now, at least, it makes me more conscious about what I write... For example: I have a half written draft about how I think the rotations we have ensure that the students have been exposed to a good variety of locations while also spending enough time at the Duke North location to guarantee that we get a lot of experience with very complex specimens. But now I'll just look like a complete brown-noser if I post it. Ha! So that will go on the back burner until I it has been long enough that I can forget anyone I know reads this :-D just like after Christmas when I found out my sister had read it (hi Tracy!).

It is silly, but it is easier to write when I don't have to consider the audience. I started this blog because when I was going through the application and interview process I tried to google to figure out what to expect and found nothing. There are tons of nurse/student nurse, physician, medical student/non traditional med student, etc etc blogs, but nothing really for pathologist assistant students or hopefuls (except for Forrest's blog which was still very new at the time I started mine). So I write about my experience and I hope that it helps/interests people curious about what PA school is like and those are the nebulous people I have in mind when I write. And extended conversations about the blog's existence (or heaven forbid, content!) really shatter that illusion that no one I know in person reads it :-)

Monday, February 20, 2012

Being non-traditional

Last week I managed to be walking by the yellow elevator (areas of the hospital are color coded) when the doors opened, and since I was heading up to the PA room I hopped on. The person who had actually summoned the elevator turned out to be an extremely friendly third year medical student. Since the yellow elevator is almost painfully slow, we had a nice chat. He introduced himself as a very old medical student (44), and I introduced myself as an old PA student. I'm fine being an older student. I figure even though I won't graduate until I'm 32, I'm going to be 32 anyway and I might as well be that age with the degree and the eligibility to sit for the PA exam than without it.

Myles built biceps out of stuffed animals and underoos.
Of course, I'm also doing this with kids which is different--not exceedingly rare but less common. And things happen because of them... like I have plans to get home and stream my lectures for the next day but find out instead that I have to craft a top hat with 100 of something attached to it for my youngest child. Or my oldest son's basketball team has a mid-week tournament. Or I'm studying for my test and the kids decide to be insane and hilarious and distracting (and want an audience/someone to take pictures of them).

I am more fortunate than most in that my father is living with me and is there for them when they come home from school/take care of them so I can go out with my classmates or my husband (or my classmates and my husband!). And I haven't had to miss any school because one of them is sick (Duke University sent out an email notification that Norovirus is going around and holy crap are kids disease vectors), and now that they are older I don't have to worry so much about them being ill as much as I did when they were infants. But if I had after school care and a trust worthy babysitter (which actually, a med student friend's girlfriend babysits and she's soooo nice!) this would be doable without my dad. Not easy but doable. And I can hope  that I am setting an example for my children and they appreciate the importance of education.

My brother-in-law is getting his CMA license so he can get clinical experience so he can apply to Physician's Assistant school next year and graduate in his late thirties. My father was in his 40s and had a major stroke by the time he graduated with his associates. I grossed during second shift and took the classes I need to reapply to PA school in the mornings. Plus, after I graduate it will be my husband's turn to go back to school, and he will be even less traditional than I am :-)

Wednesday, February 15, 2012

8 Days into Body and Disease

I said before that I was going to withhold judgement on the all TBL all the time format that we were going to be using for the five month Body and Disease portion of our didactic year, and I still am. Honestly it is still changing/being refined. The downside to being the first group doing anything is that all the kinks have to be worked out. I have no idea how many meetings have occurred between the students and the course directors, the students and the student leadership, the course directors and the administration, and the students and the administration. Then there have been the one on one conversations, the emails, and even the random run-ins in the hallway that turn into a feedback session.

The format started out with an IRA (individual quiz) followed immediately by the TBL groups discussing the questions to reach a group consensus. We got confirmation on the correct answers only after the group answers were submitted. Then there was an instructor guided Q&A session after that, some of which were more lecture-like than others, with a focus on addressing information related to the most commonly missed questions.

As of this morning we have moved to at-home IRAs (we are on the honor system to take the IRAs closed notes/book/online resources), no group quiz, and the class time being used for a clinical application problem (ie: a patient presents with these symptoms and test results so what is the disease, what causes it, what is the treatment, why would you run these tests, etc) in addition to the Q&A session.

The course material is from reading assignments and from previously recorded lectures (the 2010 and 2011 lectures are both available) that can be streamed online. The actual time in class is a lot less but that is balanced out by the time needed to stream lectures. I do like having the at-home IRA available the night before the TBL session since I was able go through the lectures, immediately take the quiz, and feel done for the day. With studying the night before and having the quiz the next day I felt like I had to use the time before class in the morning to go back over the material. Now I can use tomorrow morning to go to the gym *guilt free before heading to path lab.

Pathology lab has been interesting. My instructor is fantastic, he is funny and is good at reasoning through the case histories and questions. And he always has relevant information from actual cases to contribute.

Immunology has been so-so. I have to completely restudy the overview of immune response and inflammation for the test next Monday.

Meanwhile, I don't know if the microbiology lectures have just been really good or if I just really love microbiology... Hard to tell. But I want to say that they have been good overall and that microbiology being my favorite non-pathology subject has just made me more likely to enjoy them.

Oh, and interviews start on Friday for next year's class. It is exciting!

*I have honestly felt like **everything that I have done for the past week that wasn't studying was detracting from studying. But that sort of attitude is how you burn out... so yeah, not good. 

**Including blogging, sorry about that.

Tuesday, February 7, 2012

Organ Identification Trivial Pursuit

We started Body and Disease yesterday and had our first Basic Pathology Small Group (<-- that is the term on our schedule, but let's just call it Path Lab) today. It started off with gross identification of fixed normal tissues, some of which were hilar slices, some were mangled bits and some were more identifiable organs (like the heart).

We had to go around the room and say what organ we thought we had. The other PA student got the entire GU block and held a little impromptu walk through for all of the medical students. She did an amazing job and it was funny when the lab instructor asked her, "How do you know all this?" I chose to ID the spleen because they will always hold a special place in my heart as the first complex organ I ever got to *gross. There was a little accessory spleen in the attached hilar fat and I was so tickled that I was able to name it when our instructor asked if anyone knew what it was.

There was also a mangled bit of tissue that our instructor had set aside after announcing that it would be a tricky one. When they were going over the heart I picked it up just so I could look at it and blurted out, "Oh, it's a testicle." Note to self: Do not steal the instructor's thunder because no one likes a know-it-all.

I have to go back to studying now, we have 6 one hour lectures and 130+ pages of Janeway's Immunobiology to read for tomorrow's TBLs. I will definitely have to write about the TBL format more this weekend.

*I worked 2nd shift when I was grossing and we would **call in the pathologist to do complex specimens or hold them over for the next day if something was fatty and needed to fix more after being opened. I called the pathologist one night to tell her that there was a spleen and that I would put it in the fridge for her. She said that I knew what to do and to just go ahead and cut it in. It was terrifying and exciting and my dictation was probably at least 5 minutes long because it seems to be human nature that when you don't know what exactly to describe you just describe everything.

**As a point of pride when I first started working at the company they had just started the evening on-call thing for pathologists. They used to be called in nightly but over time as the other techs and I were able to be signed off on more and more specimens the need to have a pathologist come in at night dropped to a couple times a month.

Thursday, February 2, 2012

Guess who doesn't know everything?

You know who really doesn't know everything? You, me, anyone ever. Ever. And anyone who thinks they do is delusional.

Being a student means being humble. This is a thought I've had off and on over the past few months and was reminded of while studying for the quiz we had yesterday. There was a line that advised against telling future employers, "That's not the way they do it at Duke." There are people in PA programs who have years and years of experience and their instructors don't want to hear about how they are used to doing things, which is where the humility comes in. You have to be willing to take instruction and be flexible about doing things the way you are being told to do them. For people who have worked as traveling PAs or worked in a wide variety of places they are probably more used to adapting than others. Since all of my work experience comes from a single job I was used to doing things one way and only that way.

This past month we've had Pam watching over our shoulder during our surg path rotations to remind, correct, and direct us. When she tells us that we've done something wrong (or less correct, shall we say) we have to take that correction and do better next time. There is no room in this experience for ego. No one wants to try to teach someone who thinks they already know everything.

I have done thousands and thousands of small biopsies, but I haven't done them at Duke using their quick text/speed phrases with their guidelines (which are completely different from what I am used to!) and dictation format.  So I start over on fairly equal ground with my classmates except possibly with several ingrained habits that make Pam cringe (like picking up derms to measure them...).

It continues on well after graduation. I've previously blogged about the people I used to work with and we all used each other as resources. If something *different or unexpected came up we asked each other what they would dictate/what sections they would submit. If there was still a question then it went up the chain to a pathologist, either over the phone or by going to whoever was on call. At Duke the second year students ask the staff PAs, the residents ask the staff PAs, the staff PAs ask each other or the pathologists. Even the pathologists consult each other. Sometimes it is just a matter of making your best guess based on the collective wisdom of everyone's experience.

*And sometimes you call everyone over just to see the interesting thing you have, like the 8 kg liver mass or anytime there is a dermoid cyst because who knows what is going to be in there this time.