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The residency experience


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#1 True Anomaly

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Posted 28 June 2009 - 07:38 PM

Since some folks expressed interest in me doing some sort of journal of my foray into the residency world, I thought I'd keep a running post on this board as opposed to doing some sort of blog- mostly because it's easier to just post here than to maintain some separate website. I'm all about efficiency and convenience :D

If there were a hundred different blogs about PA's in residency, I wouldn't even think of doing one. Since there isn't even one, and I know there are some of y'all out there weighing the pros and cons of such a program (like I spent the last 3 years doing), I'll try my best to be your tour guide (or something equally cheesy)

So, enough of that crap....

The first week of our emergency medicine residency is over, and already this is a rather humbling experience. Myself and two other PA's are currently going through orientation with 12 physician interns- they make no distinction between us. Orientation is a month long, where we will be spending most of the days in a conference room doing lectures; so far it's only been ER-specific legal issues, but we will soon cover some broad-based topics that help introduce us to emergency medicine. This will cover not only systems-based problems like pelvic pain, altered mental status and acid/base disorders, but also logistical issues like how the local EMS system works and ER chart review and quality assurance lectures. There are days set aside for PALS, ATLS and ACLS, as well as bedside ultrasound training and advanced airway techniques. And this ALL occurs before we even start our formal rotations in a month.

What makes this humbling is that we've already got the sense that this is one big powerhouse of emergency medicine training, with not only the great expanse of pathology that is seen, but also with who is doing the training. The attendings here are at the very forefront of shaping emergency medical care in this country (Drs Levitan and Jaslow, who are both experts at advanced airways and EMS, respectfully, are both attendings here). It really feels like I "backdoor'd" into a top physician residency program...but I'm okay with that :)

Even though formal shifts don't start until late July, we do have some "ED-lite" shifts every so often this month, where we may work an occasional 6-hour shift during the week or a 12-hour shift on the weekends. The idea of course is that we get our feet wet without being thrown into the deep end. This is unlike the other departments in the hospital, where they immediately start their interns on shifts as soon as possible. Both the PA's and the physician interns are doing the exact same thing this month.

Even though this is the very first time they've had PA interns join the physicians during the same orientation (we're the second class of PA's to start here), everyone has immediately been very open-armed with us and has been a pleasure to deal with. We're all gelling pretty well, and it's nice to hear the new docs talk about their positive experiences with PA's when they were going through med school rotations. I like to think that our mere presence helps reinforce the idea that PA's work hand-in-hand with the docs, and will be something they'll never forget no matter where they end up as attendings.

There is, of course, a MOUND of reading to do, but having very few shifts to do this month enables me to spend as much time as I want to review stuff while also picking up detailed facts that weren't covered in PA school. The books we've been given are exactly what you want: Rosen's, Roberts and Hedges Clinical Procedures in Emergency Medicine, An Introduction to Clinical Emergency Medicine, Levitan's The Airway Cam, and Guide to Intubation and Practical Emergency Airway Management; plus the necessary materials for PALS, ATLS and ACLS.

Friday was the graduation of the senior residents, plus the intern's white coat ceremony. Despite my opinion on the white coat which I've expressed before on the board, it was a rather proud moment to get a long white coat with "True Anomaly PA-C, MPAS" on the front- like hell, I actually accomplished something! I'm also damn glad this coat is MUCH thinner than my PA school coat, so less overheating! Later on this month, we'll be getting six sets of scrubs with our name and stuff embroidered on it- hopefully before my first ED-lite shift in another week!

Other than getting more detailed, that's about all for now! I plan to keep these rather broad, and can post further entries at whatever interval suits me :) If one of the moderators wants to make this a sticky, that's cool. And if any of y'all have specific questions about stuff I post here, feel free to PM me.
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#2 eze8923

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Posted 28 June 2009 - 08:15 PM

many thanks for spending the time to fill us in. an EM residency is something that i'm potentially interested in doing in the future, so it's great to read about your experiences thus far. please keep them coming! =)

MPA, PA-C, EM-CAQ
"Perfection means not perfect actions in a perfect world, but appropriate actions in an imperfect one." (R.H. Blyth)


#3 EMEDPA

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Posted 28 June 2009 - 08:19 PM

Consider it stuck....
did I mention I am incredibly jealous of this great opportunity you are getting?:D
make us proud!

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#4 kimq26

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Posted 28 June 2009 - 08:36 PM

Sounds awesome! I look forward to reading your posts and thanks for taking the time to post about it!
PA-C :D

#5 Guest_Nitty_*

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Posted 29 June 2009 - 03:14 AM

more, more, more! please :)

#6 maldo

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Posted 29 June 2009 - 05:54 PM

Oh my goodness
This could be the best post I have read! I appreciate the feedback so much and want to know every detail
I'm also very jealous!
Keep it coming......btw....which program is this?

#7 istat2

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Posted 29 June 2009 - 06:01 PM

OUTSTANDING1 I'm a refuge from the now defunct LA County General Hospital EMPA residency. It was one of the painful and rewarding things that I've ever taken on. And it was worth every minute. Drive on my man. And have the time of you life!!!!!!!!!
Just an old broke down medic living in Anchorage-which is only 20 minutes from Alaska :D

#8 Piper

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Posted 29 June 2009 - 07:20 PM

Very, very cool! Thanks for doing this so the rest of us can live vicariously through your......learning/torture/awesome experience.

#9 Brotherman

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Posted 29 June 2009 - 08:12 PM

TA, looking forward to hearing of your journey. We are wrapping up our EM block and can't wait for the real thing!

#10 klb48

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Posted 03 July 2009 - 02:03 AM

Thanks for doing this! Since I am seriously considering doing a residency when I finish school, I really appreciate you posting your experience! Can't wait to hear more!

#11 pawag

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Posted 03 July 2009 - 04:37 AM

Your program sounds just like mine with the Air Force associated with Wright Patt AFB and Wright State University Emergency Medicine Residency. This was a great time and a lot of hard work. Good luck your going to love it!

#12 Guest_Cieara08_*

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Posted 04 July 2009 - 10:52 PM

What is a PA residency? Are you still a PA when you are done with it or what?
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#13 EMEDPA

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Posted 04 July 2009 - 11:58 PM

What is a PA residency? Are you still a PA when you are done with it or what?

after you finish pa school you can do an optional residency.
see www.appap.org
you are still a pa when done, just a smarter and more marketable one who can demand a higher salary and greater degree of autonomy.

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#14 Devildog

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Posted 05 July 2009 - 03:36 AM

Sounds awsome! Where are you training?
Bon Chance!!

#15 EMEDPA

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Posted 05 July 2009 - 03:59 AM

Sounds awsome! Where are you training?
Bon Chance!!

He's at albert einstein in philadelphia. the place is a major knife and gun club.
he will come out of there an em stud!

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#16 kbinvt7

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Posted 13 July 2009 - 01:19 PM

Hey True Anomaly;
Have you met Thomas Marchiondo, DO, FACOEP? He came and spoke to us at Drexel about Respiratory EMED. Fun he called that place the N. Philly Guns and Knife club. Can't wait to view the experience through your eyes.

Kev
PA-S Drexel 2010

#17 True Anomaly

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Posted 27 July 2009 - 07:36 PM

The month of orientation is now over. There had to been just a LITTLE jealously among interns on other services when they see we were only working once a week and otherwise were taking classes during the day, but this has really helped in transition into the culture here. Now we're free to fall flat on our faces :D

As I mentioned before, we were also going to be put through ATLS, ACLS, PALS, an ultrasound course as well as an advanced airway introduction. The airway course was taught by Dr. Levitan, and it was basically a truncated version of the course he puts on in Baltimore with the cadavers; he let us play with all his airway toys and demonstrate how they're REALLY supposed to work (that Airway Cam is nice when used properly!). Getting a crash course in ER ultrasound showed us how to do a FAST exam, diagnosing IUP's, looking for a pneumothorax and how to place US-guided central lines; it was even cool to see how you can differentiate cellulitis from an abscess on ultrasound. ACLS was a nice review, but the added bonus is they're gonna allow us to get our ACLS instructor if we so desire. ATLS was a little strange- it wasn't quite clear how we were going to be certified (which I know quite a few of you here have had some difficulty with), but we went through the course and got to practice all the skills, which I didn't have a chance to practice in PA school. I recall during ATLS thinking how we were being granted "access" to some super-secret knowledge base that only the ACS knows...which just makes them look silly compared to the AHA giving ACLS/PALS to everybody.

The handful of shifts this month have been....well, they've been ER shifts, and most of you know how that goes. There's definitely been some exposure to that "knife and gun club"; my very first patient there was someone with an open mandibular fracture who was just "bending down to tie my shoes, and the guy just came up and hit me". But there has been no pressure to "move the meat", as they constantly stress- they want us to work through things as much as we can and ask any questions we need to. I know that if this was a job, they would've been cracking the whip from the start. I was surprised that we do our own splinting, since as an ER tech in the past that fell under my scope, but it's been good to get that down pat- plus we're free to do our own IV's, blood draws and other basic procedures if we want to (and hey, I was only an EMT, so I didn't have all the practice with IV access in the past).

Having time to explore the city has been the other big benefit of this month, and we've done our best to take advantage of it. Not just checking out what's in town, but getting to see some of the outer regions (took a nice trek through the Delaware Water Gap last weekend), and even a night down in Atlantic City :D. Transitioning to the city has been a breeze.

Thankfully I'm starting right in the ER; next month though I'm going to the surgery service, something I'm not quite looking forward to- but at least I'll get it out of the way. At least it'll be a better experience than what I had during PA school. Other rotations this year are in Tele, Anesthesia, Rads, OB and Trauma. Peds and rotations like that will come in the last 6 months of the residency.

Overall, this is turning out exactly how I hoped it would. But once the hours really start to ramp up, we'll see how I feel then :D
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#18 klb48

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Posted 27 July 2009 - 10:26 PM

Thanks for posting an update! Sounds pretty awesome so far and definitely what I'm looking for in an EM residency if I end up doing one! Keep us posted on how things are going for you!

#19 primadonna22274

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Posted 28 July 2009 - 12:48 AM

This is so awesome that you're sharing this with us TA. You may know that we at MCG lost funding this year for our EM residency which is a huge bummer. I may have some students who want to come up your way. Nice to be able to tell them about your experiences! Keep it coming.....
L.
"It is only with the heart that one can see rightly. What is essential is invisible to the eye."
--Antoine de Saint-Exupery

#20 mainiac

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Posted 04 August 2009 - 02:02 PM

Hi Everyone,

1st: Congrats TA on the EM residency; I hope you enjoy it! BTW u r working with 1 of my fellow PA's from PA school!

2nd: I'm in a Surgical Residency Program in WI, they only take 2 PA's / year. Just thought I might throw some of my experiences in here as well. As I know this was a tough decision for me to make, to attend a residency program.

I also moved across country to WI; I do not have any ties here & have never been here before I interviewed. I did get a loft apartment within 1 mile of the hospital in a great little town, with underground parking! :rolleyes:

This residency program is affiliated with the Medical School of WI and has 2 very large hospitals: The Childrens hospital is rated #3 in the US and is a Level 1 Trauma Center. At our disposal is online access of the Library with numerous textbooks, videos, Up-2-date, MD Consult. etc; we can access from home.

The residency PA's come in Mid June for 2 weeks of orientation; Specifics on Post Grad. PA orientation: we reviewed high yielding topics for surgery: Antibiotics in Surgery, Complications in Surgery, Blood products, IV fluids, TPN, Wound Healing, Chest Tubes, Surgical Lab Interpretation, Pre-op, Post Op, Billing, ABG's, Vents, DM, RF, Radiological Studies, etc. We were also required to take online exams on most topics at home. We are given 2 Long, White Coats, [-] the ceremony! Throughout the year we meet about 1 time / month to have specialized lectures: burns, etc. also with online exam.

Next, we had 2 days of ATLS with the PGY1's and became certified. Then we started Curriculum with the PGY1's. Curriculum is 4 days of lecture / reading / hands on labs / etc. with exams at the beginning and the end. We are also treated like the PGY1s except that they do have us distinguish ourselves, since were are already professionals with a license and are here to get an additional year of specialized training. We are paid equal to PGY1's. Curriculum meets about every other month throughout the year, for 4 days, covering different topics / labs.

After the orientation and curriculum week, we all broke into our assigned services. The PGY1's do 4 weeks [1 month] rotations, on each service, however we are doing mostly 6 weeks on each service. I think this is mostly do to the fact that the PGY1s go to other facilities / hospitals and we [Post-Grad PA's] do not.

I started my 1st rotation on Peds surgery & trauma with 4 med. students, 3 other PGY1's, a Fellow, a PGY4, 5 faculty PA's & 9 Surgeons.

A Day in the LIFE: We meet most mornings at 5:30a to sign out, then round, write notes then round with the attending and team. Then we do discharges, go to the OR for our assigned cases, answer nursing / pt questions. Then at 5:30p we sign out to the night Post Grad PA/ PGY1 then day people leave. This service is very busy and we do not have much down time. Also 1 Post Grad PA / PGY1, each week for 1 week during the day, carries the "consult / HOT" pager. This means that they are paged for all new consults from the ED - floor - outside hosp/direct admit. They return the call, then go to [for ex] the ED, see the patient, do a H&P, devise an "assessment & plan" contact the "senior" and verbally present the pt, 'senior' sees the pt and then a plan is finalized. May do a consent if surgery in needed, put in orders, admit pt. etc. Two days a week we come in at 5am because we have grand rounds, M&M and conference.

TRAUMA: We respond to Trauma calls to the ED: we are "doctor Right" during the trauma. I've been on 2 so far, a level 2 and Level 1. The level 1 was most similar to what I would say you can see on "Trauma Life in the ER" show on Discovery Health channel -- intense!

THE OR: My 2nd OR experience: 1st Assistant, 1st with this Surgeon: a simple enough procedure: I&D of Abscess. However after the positioning / draping / etc. The surgeon tells the scrub tech: "Scalpel to "me" "I was like "what"? did I hear that correctly? Yes, I did! :D I got to do the majority of the case! How sweet! Never did I anticipate that! The surgeons here are very willing, have patience and are interested in teaching. Nothing that I had experienced, as a PA student, in a surgical rotation! That alone has convinced me that I've made the correct decision; knowing I will continue to gain invaluable experiences over this next year. So very happy that I decided to do this! :cool:

CALL: So we take over night in house call. During the week we have 1 person assigned to overnight call, they start Sun 5:30am and leave Mon. 6am. Then work T-W-Th overnight. They carry the "HOT" pager & do all consults, answer all home calls, nursing calls etc. They are supported by a senior, in house. Weekend Call: is only different in the fact that person comes in 5:30a Fri, Sat or Sun gets sign out, rounds, and stays all day and overnight until the next 5:30am, then goes home: post call; always supported by a 'senior' in house.

Okay, reality check: :rolleyes: it is very hard, long hours: ~80+ / week with day to overnight shifts of 30 hours! We are held to the same hours & expectations of the PGY1's. However I don't think I would have gained this same experience from jumping into a surgical job right out of PA school!

Please feel free to PM me with any questions. I will also try to post as time allows. I hope those of you who are interested in a surgical residency program find this useful!

Good Luck!
-V [post grad surgical PA]

PS. Not sure if you want make this a separate Sticky? for Surgical Residency?
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