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gbrothers98 last won the day on June 24 2015

gbrothers98 had the most liked content!

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About gbrothers98

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  1. Bullying needs confrontation at the first instance. If not, behavior persists on the part of both parties. Immediate feedback to the bullying party at the time of is necessary. If this is well known behavior, then a trip to HR with well documented dates, times, witnesses and recall of the action should occur. If there is no action, then the canary is being ignored, time to surface. Good luck. George
  2. If concerned this is a NCCPA money grad, then have your employer pay the tab. Now all you have to do is prepare which is a worthwhile endeavor and likely what you are doing anyway. While one may perceive the CAQ as not necessary for current position, will the current position be the only gig till retire? A few hundred to set up future self is a small price to pay. As for recruiters, not particularly surprised that they do not know about the minutiae of our profession, they are more interested in finding a body that meets criteria for position and moving on to filling the next assignment. BTW, my group of EMPAs is having the CAQ be a goal of every new hire and would be preferential for those already holding the status. George
  3. Do the Levitan course, money well spent. I will be taking it for the 2nd time this fall, well worth the time and the experience boosts confidence immensely. George
  4. PANRE is a numbers game and the numbers are in your favor. Bar set is very low with score of 400 to pass. Percent failing on a yearly basis is less than 10%. https://prodcmsstoragesa.blob.core.windows.net/uploads/files/PANREPassRates.pdf Very good odds. To improve the odds, work in FM, IM, EM. If in specialty, then revisit your knowledge base regularly. Cognitive science studies list several learning strategies leading to success, Retrieval Practice and Spaced Practice being the most worthwhile. http://www.learningscientists.org/downloadable-materials/ Purchase a test bank and use regularly, eg Rosh Review, Kaplan, etc. (retrieval practice) Purchase Primary Care RAP and complete monthly, https://www.hippoed.com/pc/rap/ (spaced practice) (I receive no benefit from anyone subscribing to either of these products.) Spaced practice tip: Set up google account. Go to google calendar. Enter in a daily tip or pearl one month from now as an event or reminder. Set up either text or email as a reminder. Tip or pearl then shows up a month later, can repeat on a monthly basis for however you choose. Multi day review courses are worthwhile if that is your thing. I would not follow the advice from the courses about taking close to exam but rather several months prior to exam and then use resources provided as materials for both retrieval and spaced practice. Head up, shoulders back when you sit down in that cubicle. Fear is a mindkiller. Good luck George
  5. QUOTE: Sometimes if you want to do a rotation in a specific location (i.e "back home") you do have to find your own. Schools may provide sites but if you want a specific location or specialty, you're on your own - and I can't imagine that violates any standards. From ARC-PA standards: A1.11 The sponsoring institution must support the program in securing clinical sites and preceptors in sufficient numbers for program-required clinical practice experiences. A3.03 Students must not be required to provide or solicit clinical sites or preceptors. The program must coordinate clinical sites and preceptors for program required rotations. ANNOTATION: Coordinating clinical practice experiences involves identifying, contacting and evaluating sites and preceptors for suitability as a required or elective rotation experience. Students may make suggestions to principal faculty for sites and preceptors but are not required to do so. Student suggested sites and preceptors are to be reviewed, evaluated and approved for educational suitability by the program. From anecdotal experience, when a student is cold calling sites 'back home' for a rotation, this is interpreted by ARC-PA as requiring the students to solicit sites. It also creates quite a bit of work for the program in establishing one time sites and does not take in consideration local, regional and state conflicts such as other students of various medical professions, liability insurance and workman's compensation insurance. From a student's perspective, arranging one's own rotations appears to be a matter of a preceptor agreeing. In reality, it is much more complicated. A tremendous amount of time and stress can go into 'suggesting' potential sites, precious commodities for PA students during the didactic year. 'Suggesting' and arranging sites during the clinical year is too late, sites don't work that way, they plan anywhere from 6-12 months ahead. The enforcement of the standards and the review of compliance by both application and site visit leads many programs to take the placement of clinical sites out of the student's hands completely in order to meet the expectations of the standards. Last, traveling and relocating to far flung sites is expensive and time consuming, another financial layer to a costly endeavor as is. Final thought, it is your time and money to expend as you wish, wisely or not. George
  6. You are not supposed to solicit preceptors and sites for clinical rotations. That is the program and sponsoring institution’s responsibility. If your program is requiring students to obtain clinical rotations, they are violating ARC-PA standards. If you are doing this on your own, you are likely wasting precious time and energy that your tuition dollars are being spent for. George
  7. Pimping does not work unless the intent is to intimidate the pimpee. Unfortunately, pimping continues due to it's prevalence in days past and new preceptors only have their own prior experiences to direct future interactions. Pimping is nothing more than a skewed game of medical trivial pursuit, the pimper holds all the cards with the answers. Questions are specific bits of knowledge dependent upon recall, a lower learner function, instead of enabling a student to create and apply clinical reasoning. Sounds like the OP did not get his money worth from that rotation and may have been set back a step or two in the clinical phase process. Unfortunate given the amount of money being spent and the compressed timeline for obtaining skills, knowledge and attitude to enable transition to PA practice. Likely there is a feedback mechanism to clinical faculty concerning the preceptors and experience. One of these questions should be 'did the preceptor enable acquisition of knowledge in the specialty?'. Pimpers should get a resounding no to this question. https://journals.lww.com/academicmedicine/Fulltext/2015/01000/Socrates_Was_Not_a_Pimp___Changing_the_Paradigm_of.11.aspx Good luck. George
  8. Cathy Best thing to do rather than be concerned about test bank performance is to review your PANCE report. Should have a clear delineation of how you did in specific topics and task areas. Major contributors are cardiovascular, pulmonology, GI, Women's health, EENT and musculoskeletal. Most likely diagnosis, H&P, diagnostic testing and pharmacology are the most important task areas. If you did poorly in those areas, focus questions and reading/studying in those areas. While test banks are good, none are specifically going to touch on every topic and task area. If they did, the test bank would contain several thousand questions, most run about 1500 to 2000 questions. So there is much left untouched. The only way to ensure you are prepared is to fill in the gaps the questions don't hit. Good luck. George
  9. Speaking from the perspective of precepting students in an ED, initially not paid, now paid plus 2.5 yrs experience as clinical faculty placing students in the rotations. Pay for sites is a tsunami across the PA education landscape. Realize that savvy programs and sponsoring institutions have been anticipating this for years. Those outright refusing to pay for rotations are not embracing reality. Plus the truth is that someone, somewhere is getting some sort of reimbursement indirectly or directly for having a student. The biggest change is with the individual preceptor that the students spend time with requiring payment. Clinics and facilities have been getting paid in some way or form, they don't have the disruption a student brings to the business of medicine get in the way of revenue stream. Clinicians that realize that a student takes a lot of time and effort done right and places a burden onto their already burdensome day, ask for recognition of this. Some want $, others some other tangible reward. Programs that do not recognize and get in front of this are placing their rotations in jeopardy. With a significant amount of new programs coming online, many without existing relationships with medical education networks, the preceptors that they are reaching out to are more likely going to request/require a stipend. There is realization that PA programs are a significant source of revenue for the sponsoring institution, not only in actual student tuition but the draw to the undergraduate population particularly if there is a 'pipeline' in place for enrolled undergrads to transition to program attendance. Given that preceptors bear the bulk of the instructing during clinical year as compared to faculty of the program during didactic year, having an expectation for compensation in some form seems matter of fact rather than the exception. What compensating preceptors does enable is expectations the students get attention, instruction, direction and worthwhile assessment when on site. The moment money is accepted, the expectation of a service rendered is established. That means preceptors are implicit in the satisfactory outcomes for the student rather than just paying it forward. Programs can establish standards to be met and use that to justify stipends and also ensure accreditation needs are being satisfied. George
  10. If you are using a tracking board where comments can be entered, likely you can enter the same comment field and erase the DISPO comment. But that is counter passive aggressive. Avoiding jousting matches such as this enables career longevity. My personal practice is to stay on the move and update nurses on what I am doing for the patients, what my plans are, get their feedback, what I am waiting for, etc. Verbal communication beats the trackerboard every time. This kind of behavior also invites reflection. While the nursing staff may be passive aggressive, there is also the potential that you are not as organized nor as attentive as you think you may be. Or you may just be over sensitive in a fast paced environment that emphasizes action higher than contemplation? There is much in the ED that we can let bother. The staff member we may not like working with much, the attending that pimps you like you were on your first clinical rotation, the chronic ED patient who you see more than their own PCP. To make the ED a marathon rather than a sprint, best to pay attention to what really matters vs the minutiae and mundane. Good luck. George
  11. To clarify how faculty determine if a quiz or test question should be dropped or counted. The biserial correlation is determined, a common statistical measure. Exam software and learning management systems (eg. Canvas) may do this automatically for faculty to review. A simple explanation of biserial correlation is that a good question is one that high scoring students got correct and low scoring students got incorrect. A poor question is one where that correlation is absent, meaning both high and low scoring students either got the question incorrect or correct. There is also poor correlation when all students get a question correct. That could be a weakness of the biserial correlation because why would there not be some questions that all students could answer correctly as a confirmation of general medical knowledge? George
  12. Not going to directly refute the above suggestions. But HR and other parties that do hiring will ask the candidate what they are looking for concerning compensation based upon several reasons. 1. They use your expectation to determine if you are a serious hire for them. No sense pursuing you if your expectations vary widely from what they are prepared to provide. 2. They themselves have no idea what to pay because there is no precedent and you may establish that for them. 3. They already know what they will pay up to but are counting on the fact that most candidates will not be savvy enough to have a number that recognizes worth and your expectation is lower than they would pay, they are happy to pay you $75/ hr when prepared to pay $100 / hr. This is all negotiation 101. Any answer to their question places them in the driver's seat and control of the process rather than where the control should lie, with the party that has the skills, knowledge and attitude needed to directly provide the service. Since you are asking on this forum, you don't know what your worth is to this place other than you know that the injections are lucrative. The potential profit from these injections accounts for a competent provider to provide the injections. The employer is smart to hire a PA or NP to do this procedure vs paying a physician, who would eclipse the salary range in mind. A general internist median salary is about $200k, about $111/ hr based upon a 1800 hr work year. A 30% adjustment to this hourly rate due to no benefits brings that rate to nearly a $150. Savvy physicians would start far north of this number, because as pointed out above, time is valuable and median is only at the 50% measure with 50% or more to go. If there is competition from others to provide this service, engagement in this negotiation will be short since there are more candidates to consider. Alternatively, if these people are pressing up against a timeline and needed someone yesterday, they may say yes to a number that exceeds 100% of expectations. That said, everyone has a number they will think is worth it based upon their needs for the money. What is worthwhile to one person may be a waste of time for another. Best to counter their question with this reply: (smile, make eye contact) What do I expect for pay? (wait several beats, smile more) I don't know what the compensation should be for this position. What is the range that has been determined? When I have that information, I can determine if the salary is commensurate with the travel, time and responsibilities associated with the position so that I don't agree to something I cannot deliver. (stop talking) If you get an answer then, you may be able to quickly close or decline. If they cannot, ask for a firm deadline with an answer. If they cannot get back to you within a reasonable time frame, they are disrespecting your time and abilities. Do you want to work for someone that does that? Good luck George
  13. Asking for a raise by email will get you nowhere. Face to face, know the players, know the landscape, have your numbers in mind, high and low and what you will settle for. A suggestion concerning preparation: Never split the difference: Negotiating as if your life depended on it Even if you aren't negotiating a salary, this is a good read on just interacting with people, particularly patients, whom I seem to be negotiating with in some form or other in nearly every encounter. Good luck George
  14. The OP asks questions that are difficult to answer and what others do is not always applicable to an individual situation. Stock and bond allocation has to take into account not only personal risk determination but also forward return expectations. While stocks have a long track record of inflation beating returns over a long time horizon, there have been plenty of instances during such a horizon that stocks were a sideways or even losing proposition. A better question to ask is what is a realistic expectation for the next 10 years when considering stock and bond returns? Can one wait out under performance in an asset for an extended period of time? How much value of an initial or ongoing investment can be lost to market gyrations in the short term? For those sure that the market will come back, there were plenty who thought the world was ending in the Great Recession, that America was swirling the financial toilet in the 70s and that the entire country was one large Dustbowl filled with vagrants and economic refugees during the Great Depression. Investments improved after these trials but staying the course during was not a given when the end of the story has not been written. So how much can you lose of that initial investment, if any? Just like gaining medical knowledge, financial knowledge is a constant study, insights shift and become more complex, what appeared straightforward has dips, valleys and other obstacles to skirt. The OP has taken the first step which is to save, which can be a daunting effort given our consumptive culture. But savings should occur in the greater context of the overall plan with outlined goals aligned with personal considerations. For example, all well and good to provide your child with 100s of thousands for education....until your own retirement is at risk of being underfunded or little Jimmy goes to trade school at a fraction of the cost vs navigating a BS followed by an MS .... to a PhD? You may dump all of your monies into VTSAX on monday but 3 years from now when you need it for a downpayment on housing, you find the return would have been better in a ladder of bank CDs due to a market hiccup that removes 30% of value. The answer here is to sit with spouse/partner and get up to speed if there is a lack of financial knowledge and then start applying in a stepwise fashion based upon priorities. Good luck. George
  15. Deadline for the pilot is coming up, so no way to compare until questions start getting delivered to those participants. I assume those participating will be asked to not share knowledge of the questions. For those who have taken the test prior, that would have to be one sharp recall in order to provide comparison. The pilot is for the PANRE only, not the PANCE. The PANCE remains the same, go to testing center. The pilot is only for those recerting in 2019 and 2020. There is no guarantee that those recerting in 2021 will be able to participate or if the pilot will become the new reality. Depends on the outcome of the pilot and if the response from the PA world is robust enough to warrant the alternative pathway. George
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