Application of Knowledge!

Histamine releasing from mast cells.

While walking with one of the medical students today we started discussing the burgeoning allergy season. Last week (or maybe earlier this week?) we learned about inflammation in the body, including Type 1 hypersensitivity reactions like allergies. She mentioned that she's starting to have allergies in NC, but she didn't have them the last time she lived in NC. But since sensitization occurs through exposure, it makes sense that she's developing allergies now that she's being reexposed the antigens. Success! We manged to apply some knowledge imparted to us through streaming lectures to real life scenarios. :-D

Also, and I know that googling symptoms to self-diagnose is a huge irritant for physicians, but I have to say that our success rate is pretty high with google assistance. Of course, in real life with a given set of symptoms you probably just have a virus but in hypothetical case studies the more exciting results are the way to go.

Actual life is much more like discussing allergies than it is discovering a retrovirus that may have a causative link to cancer, in case you were wondering. :-)

My beautiful boy in my former living room. <3

In completely unrelated news, my husband had my dog shaved today. It is silly how missing small things like that make me sad but the picking up and moving to a different state isn't an issue at all. I'm not a huge fan of being apart from half of my family but most of the time I try not to think about it. My mom is heavily suggesting that the kids spend the summer with her, five hours away. I still have a couple months to figure it out, but I don't like the idea of them being that far apart from me for that long. It would mean driving 10 hours round trip every non-test weekend for a couple months just for the chance to spend a day with them. Right now, it just sounds like a super way to make things more stressful than they need to be. We'll have to figure it out so they can get some time with their Lola/my dad can spend more time at home but they're not gone the entire summer.

The Next 10 Days

We have ten days until spring break! Of course we also have two tests before that happens as well. The one next Monday is going to be rough, but this is a good week for me and I'm done at noon tomorrow and Friday. Conceivably I should have enough time on those days to study a lot. And I'm planning to go in a couple hours early tomorrow and Thursday. Whatever downtime I can scrounge up I will try to fit something into, except for Thursday night. I'm giving myself Thursday night off to relax because school/life balance is necessary for sanity!

The other test will be strange since there will only be three days of classes between it and the previous test, but they can cram a lot of information into three days. At least everything will still be fresh in our minds and our actual scheduled class time is pretty minimal that week.

My spring break plans consist of hanging out with my dog who will be visiting for the week, updating the unofficial guide for new students*, writing my autopsy report, and trying to study ahead. My plans would be significantly more fun if my children's spring break matched up with mine instead of being the week after. :( It is okay though, I think the time spent catching up on sleep, movies and life in general will be more beneficial long term than going somewhere. And my husband and I have already started planning a trip for the break we'll have in the summer between first and second year (it is close enough to our ten year wedding anniversary that we're considering it our anniversary celebration) so I don't feel completely cheated on fun trips this year.

Anyway, lab was interesting today. Our instructor is great and he's trying to teach us the keywords that go along with describing different disease processes, like shortened, thickened chordae tendineae indicates rheumatic heart disease. Yesterday's Clinical Pathological Correlation was good too since it focused on the effects of HPV and goodness knows HPV generates a ton of specimens for pathological evaluation!

So that's all for now, not too exciting. Study, study, study, night off, study, study, study lol

*We should get the official mailing list soonish, which means that the incoming first years can expect the deluge of welcome/congratulations emails to start up this weekend or next week sometime. :-)  I, for one, am really curious about them all!

Heads up for future students...

Unfortunately, I'm still mired in the didactic year of school and while a necessary part of PA school, the interesting bits are the clinical rotations. And, this year is really unusual because they have debuted the all TBL all the time set up (which has already seen several revisions). I am sure more changes are pending and next year's class will have a different format from what we have this year.

So keep in mind when you're reading, if you're following along as I write as opposed to looking back at this from sometime in the future, that the entirety of the PA school experience is the combination of the didactic portion and the clinical. The clinical rotations are the part of PA school that I'm mostly here for, while the classroom portion gives background information on some pathological processes and fulfills licensing requirements.

I do feel lucky that we got to start grossing as early as we did and sharing the student rooms with the second years means that we get to hear about their rotations. Our continued rotations through the spring are honestly sustenance for my psyche, because it is a familiar place doing familiar things and it reminds me why I went to grad school. I love surg path. <3
 
Next year's blogging will be more exciting, the meat of the experience, but this year's is still part of the program. I just don't want anyone to think that this is all there is. Next year will be whipples, livers, lungs, kidneys, autopsies and leg and "next year" is actually only a few months away. Like most things in life, Body and Disease seems to be taking forever to get through it while I'm doing it. I'm sure by this time next year it will seem like it went by so fast!

Path lab Roadshow

I updated the post from earlier in the week about what a TBL is, you can see it here.

My autopsy presentation is tomorrow, which should be fun! We are lucky that our lab instructor cut in the eyes so he is is going to present that part of it. His enthusiasm level is really pretty awesome.

Abdominal aortic aneurism illustration

And we had a good roadshow this week! Roadshows are where a pathologist will have multiple specimens showing different stages of a disease process (and sometimes do a cheer!) and present it to each lab. Last time it was clot formation which included an epically long, solid clot that had branch points and everything. This time it was about atherosclerosis and we were able to see aortas in various stages of atherosclerosis as well as examples of what can happen when you have it. There were huge clots, aneurisms, aortic dissections and examples of surgical repair.

It was really well done. The room had a long central stretch of tables with covered pans lining the middle and as you progressed down the table each pan was uncovered to show worsening stages of aortic disease. We started with clean, elastic aorta to ones with fatty streaks, to some that were just hardened to hardening and plaque formation all the way down to one that had multiple previous surgical repairs.

As for actual classes, we're in the middle of immunology right now and it is a busy week. I miss virology and bacteriology (last week and two weeks ago feels so far away!) but every subject we study can't be my favorites. And my group was on surg path this afternoon, which was great! My last rotation was at the VA so I was worried that I wouldn't remember Duke procedures but it went well. I've missed grossing so much!

Also, I am looking forward to this weekend! Last weekend was spent studying for the test and then right after it I had to start studying for the next day's IRA which meant not very much time to decompress. Saturday, I'm having a dinner party and my husband will actually get to come to this one! Should be fun. :-D

TBL Website, Video, and personal explanation

For people who are still unsure what the TBL format is like, there is a helpful website with a lot of information that should answer all of your questions. Team-based Learning Collaborative.

A video from the Duke-NUS campus is here:

Update: After talking to my husband I realized that other people still really don't understand what the TBL format is like so here is an example:

During a TBL session the students are in groups of 4-6 students. We are given a sheet with a patient's pertinent medical history (age, chronic conditions) and the symptoms for the current illness. The groups talk and list out their top possible diagnoses, which are turned in to the proctors who hand out part two. In the second part the groups are asked what tests they would perform and why. In part three they suggest their top five treatment steps. In part four they might get blood work results, an EKG or be told newly developed symptoms and have to explain what that indicates. In part five they might have to alter their diagnosis based on changing symptoms/test results/response to treatment.

Then the entire class goes over the various groups' answers and groups might be asked why they choose a certain test given the symptoms, etc. Sometimes we find out what the actual diagnosis is, but other times the case is based on a recent patient and tests are still pending.