This week in frozens

This is my third week at Duke North on this rotation, which means I'm doing triage/frozens.

Pinned specimen from this site

Triage varies by specimen, but almost everything gets weighed, measured, or both. Margins may be taken, specimens may be inked for orientation, and opened up or bread loafed (sectioned but not cut all the way through) to allow better formalin fixation. Some specimens may be pinned out on cork boards so they fix in the shape they are pinned into (useful for things like an esophagogastrectomy). And everything gets put into adequate formalin. Larger specimens are held until the next day for grossing, which is nice when you're a student picking out the cases you'd like to do for the next day.

Where I worked before didn't do that much with triage. Sometimes we would open the colon specimens, and sometimes we would ink mastectomies for orientation and bread loaf them. Colons and breasts were held until the next day, but everything else was grossed the day we got it. Most of our specimens were received in formalin, but larger things like spleen and liver were usually not. And being in formalin isn't the same thing as being received in enough formalin! Sometimes there was so much specimen crammed into a container that there was just a splash of fixative on it and most of the tissue was still unfixed. So I can appreciate that the PAs or residents doing triage at Duke are the ones ensuring there is enough fixative, and that there is enough flexibility on the the turn around time that things can be held for a day.

Frozen sections are interesting. We go with the staff PA or resident to the operating room and are handed the tissue of interest to take back to the gross room. Then we triage the specimen and whatever section(s) we need are taken and given to the techs. The techs section the tissue and stain the slides. The staff PA works with the tissue bank/research folks to provide needed tissues at that time as well if they can. The pathologist reading frozens that day may see the specimen or ask for additional sections, but once they are done the specimen is put into formalin and accessioned.

It has been nicely steady and I've gotten to work with one of the staff PAs that I haven't worked with before. Plus, I've worked with several residents which isn't something that happens often when we're at Duke North. It is good to get to learn from so many different people.

In other news, today is my dad's birthday! We had a small family celebration at home. 

An atypical day in the life...

It started at 8 with an interesting talk on genetic analysis using microarrays, mostly I took away how you can tell when when someone is the result of consanguineous breeding (this bit is normal!).

Then we milled around a bit and some of us retook our official school photos.... I'm wondering if I should have left well enough alone but what's done is done. After that we were officially introduced to the incoming class and chatted a bit with them, possibly giving useful advice (one hopes anyway!).

Then back upstairs to mill some more. Members of our class began planning efficient student tours for tomorrow and more events were added to the social calender one of my classmates had put together. I added two events, a cheese class at Reliable Cheese (I haven't been there in a month! But I'm poor until student loans are dispersed again, so I'll have to wait.) and a drag show at a local bar (where my classmates might actually get to meet some of my non-classmate Durham friends). The milling didn't last long because the first years kept being efficiently processed through various things at Duke, and we joined them for lunch from Foster's Market. More chatting ensued and we tried our best to answer questions/remember what was useful when we were starting out.

Lunch ended and I headed across the street to the VA with the other student on that rotation this week. We knew there were large specimens waiting on us since we'd triaged them the day before. Slide sign out was pretty brief and we started grossing around 2:30.... We finished four long hours later. That includes our resident taking over the third station to knock out the smalls and triage a large specimen for tomorrow. We realized that if tomorrow goes as long as today did, we'll still be at the VA grossing when the official welcome party for the first years starts.

The worst part is when we were walking back to the parking garage and realized that neither one of us had loaded the decal specimens on the processor... So back to the VA we went to correct that mistake. Moral was not the highest after that, but thankfully I'm on rotation with someone with a good sense of humor and we were still laughing at the end of the day!

It is amazing though, to be the person grossing the large specimens. We'll be faster once we've had more experience.

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.

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!

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

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.

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!

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.

As intersession ends.

Last year's class apparently did really, really well on the neuroanatomy quiz which means that this years quiz got significantly harder. We had it this morning and it was rough! And long! It just kept going and going. It was scheduled from 9-10 am, but I didn't finish until after 10:30 and only about half the class had finished by that point.

I will say that the text assigned for it has been the most readable textbook ever. There were even moments of humor it, and like a James Patterson novel the chapters are only a page or two long which makes it a fairly quick read. It also has lots of diagrams, interesting case studies, and a bunch of practice questions in the back.

Last Friday the med students had their big final for Brain and Behavior (their intersession class). When talking to some of them about it I realized just how much I am enjoying our intersession and how I don't want it to end. But it must! Next week we start up again with the medical students for Body and Disease. It should be interesting... I am withholding judgement on the TBL format and am trying to be cautiously optimistic. There have been extremely mixed reviews from the Brain and Behavior format from the medical students and apparently working in small groups negatively impacts the intelligence of the people in the group.

Wednesday afternoons the med students have their practice course, and since we don't have to learn how to interact with patients we get to use that time for clinical rotations. Actually, this whole week they are practicing their patient interview skills. Meanwhile we're going to have a four and a half day weekend. I don't have anything fun planned but it will still be nice to have a break!

Last weekend was actually pretty good. Friday was strange. I really wanted to go out but my classmates were opting to stay in and be studious, so I went to hang out with some medical students. My husband was visiting so he went too. It was surprisingly fun to do something different. Saturday, my class went to the Duke lemur enclosure (the second largest population of lemurs in the world) and we got to see lemurs! And slow lorises and bush babies! I want to go back in the warmer months when you can walk through the areas where the lemurs are running free (in the winter they have indoor spaces). I'm glad my husband got to come since for the most part he comes on the weekends when I have tests and don't go out.

There were autopsies on Saturday that we could have gone in to see. I kept going back and forth about whether I should go or not, and finally decided not to go. The kids have basketball games on Saturdays and the autopsy staff don't have the luxury of time to do a lot of teaching on the weekends. And my group has been able to see autopsies almost every day that we've been on call over the past few weeks, so I already feel a bit ahead of the curve.

Day in the life: Rotations

Appendix of the testis slide from webpathology.com

Yesterday morning my group went to a conference with one of the staff PAs and the second years where the second years presented interesting cases they've had recently and gave background information on the disease associated with the specimen. It was very interesting and we learned some things we wouldn't have learned otherwise (I can't be the only person surprised to learn about the appendix testis, right?). And while we didn't have an autopsy we saw a case signed out, and one of the autopsy PAs let us see the organs from the case from the day before which had some interesting findings.

Today we had brain sign out, medical terminology and rotations. Surgical pathology is fun and honestly learning the format for dictations here at Duke is the hardest part of doing smalls so far. For some reason I'm trying to say one word (like quote) and another one pops out of my mouth (colon). No idea why, but it is driving me batty! At least we're picking up speed and getting to do a wide variety of small specimens.

Derms are done in a way completely different from what I am used to, which means that so far the only advantages gained from three and a half years of grossing are 1. I can pronounce the word nevus correctly without thinking about it and 2. I know when to call something a macule and when to call it a papule. In the future I may also demonstrate some decent knife handling skills, but for right now this is what I've got :-)

Rotations, Autopsies, and a bit of a social life.

January has been such a fantastic month so far! Rotations continue to be great, and I'm looking forward to another day of surgical grossing at Duke North. I am getting used to their format for dictations but more practice is always welcome!

Last week we finally got to see some autopsies, including one where we got to see a second year student do the evisceration. That is what I'll be doing this time next year, so exciting! We also got to see the autopsy technicians (dieners) do some evisceration and it is impressive how quickly they get everything done.

I mentioned before that Duke does a modified Letulle autopsy, removing the colon and then doing the rest of the organs en masse. I am used to Virchow autopsies, which is all done one organ at a time and doesn't require the prosector to visualize body placement/orientation. The en bloc method makes it much easier to examine the entire organ system at once and minimizes the time the body is open and exposed. I like being able to see the different styles.

Grave Digger at Monster Jam! Photo credit to April :)

In other news, we had a three day weekend for MLK and it was so relaxing! My class (and my husband!) went to Greensboro for Monster Jam! And since we were there, I finally got to take advantage of a friend's generosity and treated everyone to sushi courtesy of him. It was a really fun time.

Sunday I went to visit my favorite med students and one of my classmates and I took over their apartment and everyone made Filipino food together. Then we took a break where I went home and cooked American food for my family, and then I went to the movies with a couple friends (War Horse, which was okay but not as good as the company).

Yesterday was my dad's birthday, so the kids and I got him a card, some money, made his favorite dinner and baked a cake while I studied off and on for my autopsy procedure quiz and ignored the giant pile of laundry I didn't fold this weekend (I will do it tonight... probably).

Intersession Week 1

Tabs from our binder--awesome topics to cover this month!

It all started on Monday with getting to see all of my classmates again and play catch up on everyone's holiday break. We had an orientation to the schedule for the month and received the not unsubstantial binder containing lecture materials.

We had classes on neuroanatomy, medical ethics, lab safety, medical terminology (which is more fun than it sounds), autopsy and surgical pathology at Duke, as well as neuroanatomy lab. And, as I mentioned a bit in my last post we've been split into two groups for autopsy and surgical pathology rotations. It is fine, because our class is pretty close as a whole there have been no complaints about who is in which group. And being split up makes it fun to come back together and hear about what the other group got to do that day.

I really cannot being to say how excited/happy/jubilant I am about the rotations? Sadly there wasn't an autopsy Thursday afternoon (the one time my group has been on that particular rotation) but I'm holding out hope for tomorrow afternoon (and if we don't have one then it is extra time to read the neuroanatomy text, which is useful too). I am really interested to see an autopsy here because they do a modified Letulle (en mass organ removal) for their evisceration, while my experiences up until this point have been with Virchow (organ by organ removal).

Trimming knives

The surgical pathology rotations are pretty great so far. It is fun to be grossing (even just a little bit!) again! I tried to be good on Friday and use the scalpel instead of the trimming knife so I can be more proficient with using it. 95% of the time I've used the type of scalpel I posted in the last blog entry. Occasionally I used a regular scalpel with a #22 blade, so I have to get used to handling a regular scalpel with a much longer cutting surface than that. Trimming knives are fantastic and sharp but it would be ridiculous to try to cut up a little skin shave with one or bisect a little GI biopsy. I am sure that by the end of the month I will be much more comfortable using the tools available to me here, it is (like most things!) a matter of practice.

Also, if I can add another thing about how Duke is different from my previous experience? There is just so much more going on in the surg path department! Frozen sections are happening all the time; there are PAs, PA students, and pathology residents doing fixed tissues; and there are techs moving around through all of this as well. It is definitely a bustling environment! At my last job there were three of us in a brand new facility (built around the middle of my time there) with yards of open space between the grossing tables. It is fascinating to be somewhere where the pacing is so different and every where you look someone is doing something interesting.

Studying for exams has eclipsed the rest of life

I haven't seen my kids in any meaningful way since Tuesday some time (and even then I was home but studying, so I'm not even sure that counts). I studied last night and tonight in the PA room until 9:15ish, which is well past their bedtime. I'm going home right after gross anatomy tomorrow and will stay home to study this weekend, so I'll see them off and on. I'll be holed up in my studying room in the apartment but I like to come out from time to time for hug breaks. My kids like hugging.

My dad has been in charge of feeding and tending the kids. He doesn't seem to be going crazy and they're still alive so that's a good sign.

Meanwhile, I'm so tired of studying but that's fine. It is only for another eight days, then it is a fabulous two and a half week break followed by January intersession. I'm so excited about January! We start with autopsy and surgical pathology rotations. But first I have to survive exams.

Everyone has to survive exams first. Med students are posting all over facebook with predictions of gloom and doom. Cumulative exams are horrific since after a couple months all you retain are concepts, not the level of detail you need for tests. There are a lot more lectures to study for this test.

I will write a real blog entry after exams.

My day was cooler than yours

I don't want to come off as weird or morbid or gruesome, but I had the coolest day ever today at school. I got to cut our cadaver's head off! It was amazing. It just isn't one of those things that happens very often and I'm glad that I got to do it. Would I want to do it a lot? No, probably not, but it was still really cool to get to do it once (The dens is really hard to cut through, by the way.). I got to stick my finger through the foramen magnum while we were checking our position and it was just so neat to trace the path of the spinal accessory nerves, the spinal arteries, etc. It is not an experience that most people will ever get to have and I feel lucky to have done it. I will never again have the opportunity to dissect a body so thoroughly. And for everyone who didn't come to gross anatomy (I'll talk about this in a separate blog entry) they missed out on that. It is completely their loss because that has been the best gross anatomy lab so far.

Quick, name all the structures!

This week is strange. We're not having a lot more new information presented but we're having clinical case information given to us and by taking patient history we're supposed to be able to go through the differential diagnosis process to decide what to test them for. They are mandatory for med students (well, mandatory-ish, since they aren't taking attendance) but optionally mandatory for us. The one today did go over some of the material and we will probably remember that course material better than the things we didn't have in symposium, but for the time it took it wasn't high yield study time. Oh, and when you ask a bunch of PA students what tests to run on someone with abnormal uterine bleeding you get answers like "Let's do an endometrial biopsy!" in addition to the blood tests you're probably after.

It looks to be a fairly light week, which is good because everybody is in a state of semi-panic over the upcoming exams. It is a terrifying amount of information to be tested on in just one week. It should be doable. I keep telling myself that it is doable. I am hopeful, oh so hopeful... and yet so very scared at the same time. I spent this past weekend studying, I'll study tonight after I finish writing this, I'll study for two hours tomorrow morning before class starts, an hour over lunch, and all tomorrow night.

My kids started basketball week, but my dad is taking my oldest for practice tomorrow and my husband and my dad will take both kids to their separate practices on Saturday. I'm still trying to decide if I'm going to study on campus or holed up in my study room with headphones in at home.

Eyes, Brains, Fertilization

I was right, our brain wasn't well fixed. My classmate that's had the most autopsy experience did a really good job of getting it out though. It involved four sets of hands and a bucket to catch the runoff, but it came out in one piece. We put it in fixative for a few days, but when we checked it today it was still mush. I didn't have high hopes, but we figured it couldn't hurt to try to fix it and it did firm up the parts that were less liquified. Oh well, there were a lot of really nicely fixed brains around so we were able to see all the nerves in person and I don't feel like I missed out on much.

Today we did eyes. One was left in place but the skull was dissected above it so we could see the superior muscles and the other one was taken anteriorly, which exposed all of the inferior muscles. The ear was optional but we didn't get to it today. I've done ear enucleation specimens in the gross room before but only from animals, so I do want to be able to see a human one to be able to compare them. I might be able to get to it on Friday, we're scheduled to do the neck but I can be in the skull while other people are working elsewhere.

Colorful, fuzzy brain worms.

One of our classmates took our bone box replica skull and marked the various foramens and canals with labeled pipe cleaners. I have to share a picture of it because it is fantastic.

Meanwhile, I'm up for notesgroup notes tomorrow for a lecture on fertilization. Luckily we are done with classes at noon tomorrow, so I am going to throw something together for the family to eat for dinner tomorrow and plan to stay until 8ish. It will give me a chance to do my notesgroup notes as well as go back over the lectures from Monday and Tuesday. Friday goes until 5, with both a microanatomy and a gross anatomy lab so I know I won't be in the mood to stay late then. I am planning to spend the weekend studying in the library or the PA room though since there are only two weekends left before final exams.

Normal Body

So this second unit is called Normal Body.

I like the names of the units at Duke, they sound so innocuous, so very not stressful at all.

Unlike the first unit (Molecules and Cells) Normal Body is subdivided into Physiology, Microanatomy, Gross Anatomy (<3!!) and Embryology.

For testing purposes the embryology subject material is on the gross anatomy tests and microanatomy is on the physiology tests; although microanatomy and gross anatomy have practicals in addition to written tests.

Some weeks have had more gross anatomy lectures and others (like last week) skew more towards physiology. But it all tries to tie in together, like we dissected the hearts when we were studying electrocardiology and hemodynamics.

This unit is so much more fun than Molecules and Cells. I know I've already gushed about how much I love Gross Anatomy, but I do! And the course director is very enthusiastic about his subject which helps immensely.

We still have TBLs, but the individual portion is done at home/open book and the group exercise is done in class and usually incorporates multiple topics. There are also GA TBLs which are at the end of the lab sessions and are closed notes but open cadaver.

Unlike Molecules and Cells where we had a test every 2 weeks on everything we've been taught in the previous 2 weeks, Normal Body had a 3 week stretch without a test, followed by something every Monday for the next month. It sounds bad and it does kill your social life, but it isn't as horrible as it could be since each week is a different subject (next week is the microanatomy practical, but happily we just had to study the MA lectures for the physiology midterm we had today so that should all be fresh in our minds. And frees up some study time so I can spend the next two weeks studying the heck out of our GA and embryology materials since that's the Monday after next).

My husband came up this weekend so I had to strike a little bit of a study/life balance and go out on a date with him. It was good to spend a few hours not thinking about anything more complex than what to order for dinner. He was pretty awesome and took the kids for a hike while I sequestered myself in my study room. I hope if I study ahead enough that I can give him more time when he comes up again Halloween weekend (can I mention how it is my absolute favorite holiday ever and I'm really sad at the idea of not getting to make costumes this year?? But I left my sewing machine at home for a reason. It is only one year afterall).

I'll make a separate entry about how I'm doing personally, but I've been meaning to put this one out there for a while. I think the course set up is very interesting and this set up with having the different units is unique (at least in my academic experience). Overall I think it works well.

Class Schedule AKA There is no typical day in the life of a PA student!

The first six weeks of PA School at Duke (and to be technical, a first year medical student at Duke) are spent in a class called "Molecules and Cells." The first five weeks have included courses with names such as: Pathways of Signal Transduction, Chromosomes and Cytogenetics, and Action Potential Generation. We have a test every two weeks and a TBL session on the weeks we don't have tests.

Days can run from 8:30 to 4:30 with an occasional delightfully short day when the med students have something in the afternoon that we aren't required to go to. Most of our days are filled solely with lecture but a few times a week we also have histology lab which is usually on a structure we've studied in class. We can have one to five different lecturers on a given day. Sometimes the day's lectures are distinct topics, but you can also get two part lessons as well. We did have that one week that covered metabolism in depth (I cannot stress how much it helped to have the doctor we had teaching it teaching it. *He was fantastic!), but that's been the only time we've had something that distinctly inter-related over that long a time period.

There are one to two clinical correlations a week. The format is pretty similar--a physician comes in and gives a presentation on a given disease, followed by a patient who is generous enough with their time to come in and discuss their condition. The clinical correlations are really interesting and hopefully give the future physicians some perspective into the patient's point of view. 

There are two half hour Q&A sessions each week which are pretty free-form, some days have more questions than others. Last year's med students voted to discontinue them but this year's still seem to be utilizing them. Attendance is not mandatory and they start before the normal class time so it doesn't hurt to have them.

We usually have an hour for lunch and 10 minute breaks between classes. Since we stay in the same amphitheater and it is right by the food court and restrooms the 10 minutes is usually more than enough. The labs, which are also where we have tests, are up on the forth story in a different part of the building (not that far as long as you don't get lost, and I don't get lost nearly as much anymore!).

Our parking garage is a ten or fifteen minute walk (depending on how fast you walk) from the amphitheater. Sometimes in the morning I will take the bus if it is there when I arrive, but since the time waiting for the bus plus the time it takes to go through its route is longer than the time it takes to walk waiting for it doesn't make sense. In the afternoons we usually tend to walk back to the parking garage in a large group chatting and socializing.

Then I get to go home, feed the family, do the dishes, make an effort to keep the laundry levels under control and study enough to keep from having to cram before tests. This weekend is the first time I'm ever having to play catch up, so I'll have to see how much time that takes.

It is busy, the days are full, and every time we have a clinical correlation I have to wear business casual clothes but I really do love it.  I'm happy. Every other weekend I am intensely stressed out about the upcoming test, but every week that passes is another week closer to grossing again.

Now that my overview is finished, and my husband has made it into town (3.5 hour drive for him) I have to go get ready so we can go out to Chapel Hill with some of the med students and some of the other PA students (two of our number are out of town, and one's wife is running a half marathon starting early tomorrow). Hope you guys have a good weekend! I'm going to go off and enjoy maintaining my life/school balance for a few hours ;-)