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The residency experience


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#21 Gordon, PA-C

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Posted 05 August 2009 - 01:19 AM

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!


The program at my hospital is similar, except everybody puts in at least 100 hours a week. The ACGME work-hour rules for the academic programs where I've worked are largely ignored. They expect you to lie about your work hours. Its a "dont ask, dont tell" system. If you cant handle the hours, then the old school surgeons will label you unworthy and work to get you out of the system.

As the chief PA on my service, I staff most of the consults that the PGY-1s/PAs get called for. I set the OR schedule in terms of resident/PA coverage. After the residents/PAs do their morning rounds at 4AM, they staff them either with me or the attending, but usually the attending is in on a case already and so they run the patients with me.

#22 mainiac

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Posted 05 August 2009 - 01:41 AM

Doesn't sound like Fun 2 me?!
PA-C !!!! :D

Surgical ONLY!!!! :cool:

#23 klb48

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Posted 05 August 2009 - 10:11 PM

Vachon - thanks for posting your experience as well!! It is really interesting to read about different residencies! Keep us updated!

#24 Iain1028

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Posted 05 August 2009 - 10:18 PM

Wow Vachon congrats, I remember a while back you were looking hard for a job and now look at you, in a residency!! Congrats, I'm jealous, well kind of.....

Lois Lerner for President 2016!!!

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#25 Guest_christina2009_*

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Posted 06 August 2009 - 03:19 PM

Which hospital is your residency program with? Sorry if I missed it somewhere

#26 Jambi

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Posted 06 August 2009 - 05:13 PM

here ya go

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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#27 jthpac

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Posted 07 August 2009 - 01:05 AM

Jambi/ Christina--

True Anomaly, I think is doing his rsidency in Philly. Vachon is doing his post grad in Wisconsin.

Jim

PS Vachon enjoy the Beer, German food, and sharp Cheddar Cheese, :)

#28 mainiac

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Posted 08 August 2009 - 10:26 PM

It's with Childrens Hospital of Wisconsin (#3 in US, Level 1 Trauma Center) and next door is the Adult Hosptial: Froedtert Hospital.

PS I've started a new thread....Look 4 it!
Can we also make it a sticky? Since Anomaly is in ED
& I'm in Surgical Residency,
might be nice to have 2 different sticky threads.....Thx!
PA-C !!!! :D

Surgical ONLY!!!! :cool:

#29 mainiac

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Posted 08 August 2009 - 10:27 PM

Jambi/ Christina--

True Anomaly, I think is doing his rsidency in Philly. Vachon is doing his post grad in Wisconsin.

Jim

PS Vachon enjoy the Beer, German food, and sharp Cheddar Cheese, :)



BTW - Vachon is a Female! :)
PA-C !!!! :D

Surgical ONLY!!!! :cool:

#30 apple810

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Posted 08 August 2009 - 10:59 PM

BTW - Vachon is a Female! :)



Love it! Women in surgery rule!

#31 bchernock

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Posted 09 August 2009 - 01:49 AM

TA....awesome!!! I have been following and researching the program you are in. Although I am just starting clinical year, if I get the opportunity to do a residency I want to be where you are!!! Thanks so much for the posts...keep em coming (time permitting of course). Good luck!

#32 mainiac

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Posted 09 August 2009 - 05:54 PM

Wow Vachon congrats, I remember a while back you were looking hard for a job and now look at you, in a residency!! Congrats, I'm jealous, well kind of.....


Thanks Iain!

Are you doing IR now? [interventional radiology]
I'm still debating on my 2 electives. Let me know if you would recommend it? Why / what you like / hate about it.

Thanks, V2 :)
PA-C !!!! :D

Surgical ONLY!!!! :cool:

#33 jthpac

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Posted 09 August 2009 - 09:16 PM

[quote name='BTW - Vachon is a [B']Female![/B] :)]

V--

Sorry-- I Know never assume,. I may type slow, but my typing, somtimes, is quicker than my thught process.

An Embarrassed Jim :o

#34 True Anomaly

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Posted 07 September 2009 - 09:54 PM

My first full month in the ER is over, and I already miss it. I did a few stretches of 6 days in a row, with three days off in between. It does make for a nice schedule, and with how we rotate hours it keeps it fresh. For instance, I’ll do three noon-midnight shifts, then three 9 AM-7PM shifts, or three 7 PM-5AM shifts in a row. Some days I’m in the “trauma” part of the ER, where we get more emergent patients as well as all the traumas that come in (our trauma bay has three beds). While this is the case, the ER has the policy of “any patient, any bed, any time”- so just because you’re in one of the back areas doesn’t mean you’re gonna miss all the MI’s or respiratory distress cases, which I’ve certainly learned the hard way.

For the most part, everyone has been wonderful to work with- the attendings are all patient with us new interns and most of them enjoy their limited times to teach. The senior residents, while they are adjusting to their new roles of running each area of the ER, are also very understanding of “the kids”, since they were just in our shoes a few years ago. And at no time has anyone looked down on me simply because I’m a PA- I’m seen no differently than the physician interns in regards to what patients I’m allowed to see. At some times I’ve been in the right spot at the right time, which has enabled me to place a couple central lines and do a couple LP’s on my patients. With our extensive use of bedside ultrasound in our ER, I’m getting some good looks at looking for viable intrauterine pregnancies, cholecystitis/cholelithiasis, free fluid in the abdomen based on FAST exams, and learning ultrasound-guided IV placement. The only hard-and-fast rule in regards to procedures in our ER is that the second-year residents always do the airway, and the third-year residents run any traumas that come in.

Because of the extensive support, I feel I’m able to forge ahead and try to manage as many patients as possible- right now I feel that 5 is definitely pushing the limit of what I’m capable of at the moment. I’m certainly hoping that by the time I’m finished here, managing 6 patients at once will seem like a breeze.

Oh yeah...and with the characters that come into this ER, I'm keeping a private journal that maybe, years from now, will make for some hilarious reading. :D

Right now I’m two weeks into my first off-service rotation in general surgery. To keep this a mostly positive post, I’ll just say that my experience has not been what I expected, and we’re struggling a little to find the best way to integrate me into the surgical team. That, coupled with the chaotic nature of the surgery service, makes me long for the “ordered chaos” of the ER. (As a side note, I just don’t know how some of y’all in surgery deal with surgeons….). This isn’t to say that I’m not learning; just by watching their reactions to what those of us in the ER determine is a surgical admission is enough of a lesson in what NOT to do. In a couple weeks I begin rotation on the telemetry service, which should be a bit more uniform.

So overall….two and a half months into this thing, and I’m definitely glad I’m here. The sights and sounds of Philly are keeping me well entertained, as well as the people I’ve met here. It does get a bit lonely at times, but there’s always a reminder of something to read or do.
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Gig 'Em Aggies

#35 Hemegroup

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Posted 07 September 2009 - 11:32 PM

It does get a bit lonely at times, but there’s always a reminder of something to read or do.


Roadtrip! Dude, serious, I was going to say let's head to the coast and grab some sun and surf until I just checked the weather and see that rain will be here just about every day until my rotation starts in a couple weeks :( But hey isn't it my turn for dinner on your side? (first thing he says to me, "ohh, you're old!!" grrreat, thaaanks, nice to meet you too!)

#36 True Anomaly

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Posted 07 September 2009 - 11:54 PM

Roadtrip! Dude, serious, I was going to say let's head to the coast and grab some sun and surf until I just checked the weather and see that rain will be here just about every day until my rotation starts in a couple weeks :( But hey isn't it my turn for dinner on your side? (first thing he says to me, "ohh, you're old!!" grrreat, thaaanks, nice to meet you too!)


Actually, I was referring more to female companionship... ;)

Yeah, it's about due for dinner again; I just have to get out of this surgery rotation alive. Hopefully you'll still be alive yourself, since you're so old and all :D
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#37 Hemegroup

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Posted 08 September 2009 - 12:05 AM

Actually, I was referring more to female companionship... ;)


Well, excuuse me! Seriously, c'mon now, surely you have a few lady nurses in your black book (pda) by now?

Hopefully you'll still be alive yourself, since you're so old and all :D


har har ... just wait till you hit 38, young whipper-snapper!

#38 EMEDPA

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Posted 08 September 2009 - 12:50 AM

(first thing he says to me, "ohh, you're old!!" grrreat, thaaanks, nice to meet you too!)


I'm older than you and he didn't tell me I looked old when we met at sempa in tuscon last yr. you really must look like crap!:eek::p;):D

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#39 istat2

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Posted 08 September 2009 - 07:29 AM

I'm older than you and he didn't tell me I looked old when we met at sempa in tuscon last yr. you really must look like crap!:eek::p;):D


Dude,
They aren't talking years :eek:

They be talking MILAGE :D
Just an old broke down medic living in Anchorage-which is only 20 minutes from Alaska :D

#40 mainiac

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Posted 12 September 2009 - 02:22 AM

[quote name='jthpac'][quote name='BTW - Vachon is a [B']Female![/b] :)][/quote][quote name='BTW - Vachon is a [B']

V--

Sorry-- I Know never assume,. I may type slow, but my typing, somtimes, is quicker than my thught process.

An Embarrassed Jim :o[/quote]

No worries Jim!
PA-C !!!! :D

Surgical ONLY!!!! :cool:




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