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.


  1. At my current workplace, I'm the go-to techie. However, I've not had any training since joining the firm years ago - everything I know is either what I learnt at University, or what I've taught myself as part of my job.

    That, as it turns out, is quite a bit - I started as a programmer, but am now also a graphic designer, CD/DVD authoring guy, audio/video editor, sysadmin and web designer. :) And I'm happy to research if a particular requirement is feasible. But I will always say "No, I can't do that for you" if I'm asked to take on something I've absolutely zero knowledge of.

    1. I think the fact that you will be upfront about what you don't know is perhaps one of the reasons that you are trusted to do such a variety of things, they know that if you can't do it that you will say so.

  2. Is that how it is during your rotation? Pamela Vollmer actually watches over your shoulder like that? Wouldn't that feel a little creepy and unnerving? During my undergrad rotations, I worked side by side with the lead PA. She showed me how to dissect and dictate a specimen, then I did one on my own with her sweet guidance. Anybody who looks directly over my shoulder while I'm doing something is bound to get a backhand in the face. That's a major pet peeve of mine (let alone having to deal with their halitosis).

    Also, why does she "cringe" when you have to pick up a derm specimen to measure it? I think that's perfectly OK to do provided that you have a clean pair of gloves on to prevent cross-contamination. My philosophy is this: if you show me how to do it YOUR way, that's no problem. I'll just say "yes" and do it how you want me to do it in your presence. But if I know a different method that will accomplish the same end result, you bet that I'll be doing it my way when you're not looking!

    1. She is watching over three students working at the same time so she isn't exactly hovering. But ultimately she is the one responsible for our training so can you blame her for wanting to make sure we're doing it correctly? Also, for many of the students this is their first time in a surgical pathology lab and they are probably reassured by having someone readily available if they have a question.

      Backhanding your instructors sounds like a pretty sure way to get kicked out of your program... it'll be interesting to see how well it goes over at Drexel.

      Have you ever had to search for a specimen that's dropped out of your forceps or popped up when you've gone to snap the cassette shut or anything like that? That's why she cringes because picking it up to measure it means possibly dropping it, where as measuring it on the board means it stays on the cutting board. I've only had to go specimen hunting a couple times (and luckily never lost anything) but it is enough that I understand where she is coming from.

      Your philosophy is fine for you, but for me... there isn't an advantage to doing it the way I am used to, other than the fact that I am used to it, where as there is an advantage to doing it her way. So I don't see the point in continuing to do it the other way.

  3. As long as nobody is there breathing down my neck and making me feel uncomfortable, then I'm fine. But if that does happen, I like to say in a loud voice, "CAN I HELP YOU WITH SOMETHING?" and give a very nasty look. That seems to do the trick! Always better to resort to a curt verbal reprimand rather than physical abuse.

    And OH BOY, specimen hunting...those were the days! I remember when I first started out, I learned the hard way to NEVER pick up a GI biopsy to measure it! A skin shave is fine, but never for a GI bx. Trying to find those can be a super pain, especially they fall on the floor. I distinctly remember 2 GI bx's that popped out of my forceps and onto the floor. I spent a full 30 minutes trying to find them, and luckily, I found both of them. Whew...That night, I really got the best cardio workout of my life!