Happy Birthday Blog!

Soooo, around this time last year I was at work and thought it would be a super good idea to start a blog to document this whole PA school experience.

In one year I've posted (including this one) 96 entries, but have written 102.

I've had 16,187 total visitors.

My highest number of visitors for a 30 day period was 3,268 and my highest in a single day was 237 (application season was a particularly busy time for blog traffic). It used to tickle me when I broke 25 viewers a day, so while I don't know who all of the readers are I think you're all awesome and I'm completely amazed that you are out there reading.

This post on interviewing at Duke is my single most popular with 986 views, followed by the posts on TBLs.

I'm glad I started the blog, I hope prospective students have found it helpful and the random curious folks have at least managed not to be too bored :)

I hope you all hang around until we finish up our didactic year in June and can start in on the very exciting clinical rotation year. :-D  Thanks for a great first year!

Good Day!

Spring cleaning is done (except for figuring out what the weird smell in the freezer is). I hung out with the dog on the floor watching movies. He is like a floor pillow that breathes and occasionally needs walking, and I will miss him after he leaves on Sunday. Maybe he will come live with me if the kids spend the summer with my mom.

Coaching soccer yesterday was great! The parents were very complimentary about our practice and the kids didn't want to stop when it was time to go, all in all it was a success. Hooray! I ran the kids through drills again this afternoon. We're all doped up on allergy medication but it is good being outside.

This week I learned that Durham has a cheese store. Oh. My. Goodness. Seriously? How did I not know this before? I'm having a dinner party on Wednesday but it will actually be the first one without a cheese plate (it doesn't fit the theme). Oh well, maybe in May. And maybe in May or June or July when I'll have spare time I'll take one of the classes (yay cheese classes!).

It has been frustrating trying to do school work, between bluedocs only occasionally loading (thank goodness for *dropbox!) and not having all the information I need for my autopsy report I've stopped trying to get ahead. We don't actually have pathology lab next week so the autopsy report isn't that pressing. Still I would have enjoyed being ahead for once! :)

I have worked on the unofficial guide and am on track to email it out either late tonight or tomorrow morning sometime. It is strange how when your day is completely full you can accomplish things so quickly but when you have literally nothing else to do, it takes forever to get even the smallest thing done.



*The student annotated powerpoints are shared via dropbox and those files are available even when you don't have an internet connection, which comes in handy when Murphy's Law kicks in and your internet dies at the absolute worst time!

Technology doesn't want me to study

Bluedocs, the aforementioned gateway to all that is educational, is sluggish to not working. I have taken that as a sign that I am not supposed to be studying this week.

Having so much extra time this week means I was able to volunteer to coach my youngest son's soccer team tomorrow. Their coach is in Vegas all week at the same IT convention as my husband. I'm so glad that everyone else is spending my spring break in Vegas while I dog sit and cover their coaching duties ;)  But really, I'm excited about it. If I had a more consistent schedule I would have volunteered to be an assistant coach--maybe in the fall! I do love soccer. I picked up a pair of cleats this past weekend and have had a lot of fun playing with the kids! I'm not as rusty as I thought I would be. I can't juggle the ball at all, but to be honest it was never my strong point.

I'm glad I don't work second shift anymore. I loved my actual job and being on that shift gave me a lot of freedom to gross specimens I wouldn't have otherwise gotten, but it was hard missing out on the kid's lives. One of the great things about this field is that after finishing the program I will have significantly more employment options/control.

I also love than whenever I bring up job hunting my friends all pipe up with how we should come live near them if we can't stay in NC. <3 You guys are fantastic.

Relaxed state of being

The kids and I were extremely idle this weekend. We saw a movie, hit up Chuck E. Cheese, practiced soccer, and played with the dog.

Foot prints in the pollen

They went to school today and I treated myself to a few things and finished off a Game of Thrones (thanks Jimmy!). Soccer season starts tomorrow so tonight we're just going to work on basics more. I'm taking the day off tomorrow too. There is a fine line between utter relaxation and boredom, four days is about my limit for not having any thing major to do. After that it will be autopsy report, updating the unofficial student guide for the incoming class, and spring cleaning.

Allergy season is upon us (the fifth season in the southeast! Summer, fall, winter, the yellow death, and spring) so I'm striking a balance between airing out the apartment and controlling the amount of exposure to the deluge of pinophytal reproductive material.

After we get back from spring break we have another three months of Body and Disease! It is going by quickly, which is nice considering how long this unit is. Of course that is how it feels on a week where we have a break, so in another two weeks when I'm in the middle of test studying again I might feel differently. :-D

One test stands between me and a week of (relative) relaxation

I reconnected with a friend I hadn't spoken to in ages and he said that he'd recently thought about a project he critiqued for me and asked me how it was going. And it isn't going. It is on pause. I miss having a creative outlet sometimes but the trade off has been worth it. I knew going into school that it was going to take priority over hobbies, but that the is nature of higher education not just this field of study.

Hopefully my children are paying attention and they notice how much work higher education can be some days so they can figure out that it is easier to do it when you go straight through... high school -> college -> professional school or whatever they end up doing. I can't even complain about my situation because this is what I am doing full time. I have friends who are working 40 hours a week, dealing with a lot more going on in their lives, and going to school. It would get psychologically exhausting but they keep doing it, they keep working every semester for years.

At least for us we have a finite time frame. We have the three major units of the didactic year (Molecules and Cells, Normal Body, and Body and Disease) which breaks the year up into more manageable chunks, as well as our January Intersession that gives us a taste of rotation. I'm glad that our program starts us out as early as it does with surg path and continues it through the rest of the first year.  It would be strange to have to wait through the entire didactic year to get to start grossing. I have to wonder how other programs handle it, I never thought to ask any of the PAs I worked with before. Any of my readers want to chime in? You can stay anonymous if you want ;-)

I had surg path yesterday afternoon, it always puts me in a good mood! Our group works well together and we managed to finish all of our specimens early, which is helpful in a week where we have two tests. I feel bad for the medical students this week! We only have toxicology (2 lectures) and environmental pathology (3 lectures) while they have those lectures plus 300 antibiotics to memorize and the chemotherapy lectures. Since we didn't have to worry about the antibiotics, etc we've been able to study ahead all week. At least everyone has all of today to study (there was only one class scheduled this morning but it is was a non-mandatory Q&A session) as well as tomorrow morning (the test starts at 11).

I did have a frustrating moment this morning. I've been focusing on my Robbins this week and finally got around to streaming the lectures last night (they were funny! But I am biased and always think the pathology lecturers are the best... although the chemo guy was pretty good too). I normally take my IRA right after I watch my lectures since everything is still fresh in my mind but wanted to do it this morning to kick start my early morning studying. So I took the kids to school, came home, looked over the annotated powerpoints and went to take my IRA about a half hour before it closed at 9 and found out my internet was down :( I've never missed an IRA before, especially not a pathology one! Sad. I thought about driving to campus and taking it in my car but I wasn't sure if I could get wifi in the parking garage and the drive to campus time + the get to somewhere I know I would have wifi time would have pushed me just over the time the IRA was cut off.

New class and social news

So we have an official class list for the class of 2014 and have made our introductions! It is exciting and weird to think that it has only been a year since my class was in their position. We sent out a introductory email and got replies from everyone. We have a couple folks with histotech backgrounds, some with gross and autopsy experience, one forensic photographer, and at least one person that is graduating this summer that also works as a lab tech. It should be an interesting mix!

We had the third Body and Disease test today. The tests start at noon instead of the 9 am starts we had in Molecules and Cells and Normal Body. It gives us the morning to go over more notes before the test, which is helpful. After the test today a couple of us went out for a late lunch and had a really good time. It was a great way to unwind!

Speaking of unwinding, one of our classmates has appointed herself our social director and is coordinating the things we'd like to do during our non-test weekends. We're going to a Tiger Sanctuary! And possibly an airshow on the coast. It is pretty awesome.

Lab Instructor Awesomeness

Normally in lab we have organs to examine and case studies* to go through. We didn't have any organs today so we managed to power through the case studies for the next two weeks. Since we're going to have all this extra lab time our lab instructor asked us if there were any particular disease processes or specimen types that we wanted to see that we hadn't already seen. There were a variety of different requests made so it'll be neat to see what kind of stuff he will be bringing to share.

From wikipedia: An older mitral valve replacement option

Tuesday we got to see a heart that had a Starr-Edwards mitral valve replacement, which is the kind of thing that we still might see on autopsy but that will become progressively less common as replacements are more and more from animals or of cadaveric origins. Apparently it also sounds interesting if you listen to the heart sounds of someone with that style of replacement valve.

I had an open mouth insert foot kind of moment today. It was unexpected... have you ever have one of those instances where you realize that words are coming out of your mouth but at no point did they pass through the discretionary filters of your brain? That was sort of what happened to me... I was speaking without having made any conscious thought to speak. Completely mortifying. Surprisingly well received though.

*The format is usually a few lines with the symptoms they presented with and relevant history. Then we get a gross and microscopic description and have three to five multiple choice questions about their condition. So it might be something like an 83 year old woman, who immigrated from Malaysia five years ago, presents with low grade fever, cough and enlarged lymph nodes. An x-ray reveals multiple 1-5mm nodules disseminated through the liver, lungs, and spleen. What do you think is the primary cause of the disease? What type of co-infection would you most likely expect?

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.