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Just Steve

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Just Steve last won the day on November 10 2013

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  1. I used the Kaplan question bank as my primary study tool to pass the PANCE. It's my only experience with the question you are asking.
  2. Just Steve

    Issues in PA education

    Problems with education today? The belief that a person with no experience can enter a program and then graduate with enough competence to hit the ground running and not require a residency or prolonged OJT period. This talk of early integration into patient care while in school... here is an idea..how about integration into patient care before they ever start school? There should not be a former Navy Corpsman, Airforce/Army medic, a paramedic, a nurse, a respiratory therapist that does not have at least one or two schools calling them every few months to get them into a program. That health care professional should not have to wonder "where I am going with my career"... ever. Instead, programs cater to the buzz over PANCE rates, admitting super smart and clinically naive students to ensure that PANCE rate doesn't wobble... No one seems to have an issue with it but then at the same time we see a rapid development of PA residency programs and specialty exams... we see fresh grads struggling to find a job...we see a big dip in preceptorship spots. We stand around and scratch our head thinking "why are things getting more complicated for PA education" but they don't stop to admit that perhaps it's the related to the lack of HCE. Perhaps docs and senior PAs have tired of dealing with students who don't know which way to point a bevel when they are in their clinical year. Perhaps employers are tired of hiring, then being forced to train over several months, a new grad who has only truly held a needle driver for less than a 100 sutures? Or never felt what CPR is really like..or talked with real parents about real issues regarding their really sick kids....have developed a bedside manner that allows for rapid rapport development... Non experienced students simply do not have the medical knowledge entering school to come out the other end as a reliable practitioner within a relative short amount of time. We have already supported this statement with the explosion of residency programs and employers endorse this statement with the growing requirement for experience and/or specialty exams....of which you can't sit for without experience or a residency. We can either change the 2 year training model and expand it to build in a residency, or change the type of student being admitted. I know I am probably burning a couple of bridges or at least crawling under peoples' skin with my rhetoric but I am done apologizing. I came into the PA profession after spending 22 years in the trenches. I worked side by side with an untold number of "para professionals" or "allied health employee" who can run clinical circles around some of these PAs who are graduating. Sure, they can't diagram the Kreb cycle in their sleep or they may struggle with standardized tests but they sure as heck can tell the difference between a snotty kid who has a cold and a snotty kid who is about to run out of steam and crash in front of you.
  3. Every time I don't listen to my gut, I regret it.
  4. http://www.togct.com/downloads/TOG_Articles/ortho-ob-dss-ultrasound-in-ortho.pdf I hear a lot about the assumed vs. true accuracy of joint injections. We use US guidance quite a bit.. almost exclusively, in my current practice for steroid injections. Yes, the reimbursement rate is nice however what is also nice is being able show proof that the injection was delivered to the appropriate structure instead of using "best guess". The enclosed link is to a collection of data comparing guided vs non guided injections performed by skilled experts. If I was going to let someone drive a needle into my joint and pump me full of steroid, I sure would appreciate them using an US to help ensure they were in the right spot.
  5. Just Steve

    Time Saving Tips

    Looks like I touched a sore spot. I share my experience and opinion and it's labeled overgeneralization. I call it anecdotal. It's not all doom and gloom. It's not all backbreaking work. It's not total immersion. It's not that difficult if you come into the program with a solid understanding of what you're getting into. It's just like any other project in life. Previous experience will aid in future endeavors. It allows your brain to sort through "I have seen this, it's already filed, move on" and "This is new, pay attention, dedicate some time to this". If it's all new, you will be overwhelmed. The more direct and diverse your previous experience is, the more room your brain has to sort the new stuff, thus not feeling overwhelmed and overloaded. I have digressed and made a fool of myself enough for today. I will agree to disagree about the current path of PA education and it's efficacy. Have a wonderful day.
  6. Just Steve

    Time Saving Tips

    Class would get out between 4-5 pm. I'd goof off until 8 or so. Study until 10-11 pm. Bed until 7-8 am, lather, rinse, repeat. Home every weekend without my books through my didactic year (I attended about 3 hours away from my kids). I would return early afternoon on Sundays as they loved giving tests on Mondays. Bit of a refresh of material Sunday afternoon/evening. Stayed on the Deans list through the program. That's a benefit of having significant previous health care experience. It allowed me to absorb relevant information so much easier. My point is the fear of drowning is over exaggeration if you have followed the classic PA model... building upon previous HCE. Walking into class with no clue of what medicine is or how it's applied would a nightmare. Good luck
  7. Just Steve

    RN to PA

    Had three in my class of 25 students
  8. Such a subjective question. So many variables. My first thought was "what's your background experience?" I ask because if PA school is the first time you have had to apply critical thinking skills regarding patient care and you are depending on those 24-27 months of school to prep you for super sick patients or a LARGE daily case load or both, then inpatient may be a bit much to chomp off on your first bite. Sure it's fun to be challenged and all that but if that institution is lacking in their training methodology you may get left in the breeze trying to train yourself at the expense of your personal life and sanity. However, if you have been around this medical thing for awhile and not riding your first rodeo, then cowboy up and dig in. Hospitalists have a greater chance to do pretty cool procedures (chest tubes, intubations, central lines etc) than most PA jobs (even ER/Urgent Care). Plus you are gaining GOBS of patient management education with drips, complex med regiments, multi tasking...holy cow you can be up to your rafters in fun in no time. Just don't oversell yourself. Jumping into a potentially very complex job as a new grad/employee is about 4.7 million light years different than the relative safety of being in student mode. Good luck
  9. Just Steve

    Medical espirit de corps

    My old medic partner is my best friend. I helped him roof his place this morning. I get to hear the stories of the old job, he gets a knowing ear that he can download and de stress to. Personally, I know PTSD runs deep in EMS and we're not allowed to talk about it for fear of losing the trust of our partners and employers. Now that I am out of the business, I talk about it openly with my friends who still work in it, and give them a safe place to come talk and unwind. Imagine the darkest days as a medic... can't tell your family as that stuff is too dark for a civilian to be exposed to.. can't tell your workmates as they will just do the game of "one upmanship" or lose their trust. Can't go to the boss, they'll treat you funny after. Employee Assistance Programs are not always that helpful. There are days that I miss it. But when those days start to run too close together, I set up a fishing trip, or a backyard cookout, or a night on the town with my buddies and we talk shop. They appreciate having a safe place to vent with a person who knows exactly where they are coming from and I get a reminder that the good old days were not that good. If they want to hear about some suggestions regarding medical decision making and such, I offer it up. I attended a PA program where there was a lot of discussion about role transition. You're moving past the technician level now. When you're done with PA school, contact your old squad about getting into the training and education model. Perhaps your resource as a former medic, and your expanded medical knowledge via school, can really ignite their training program and bring some folks up to the next level. Personally...I find great joy in talking folks to go back to school and further their education... tickles me to no end when they send me a facebook notice letting me know they got into PA school.
  10. Just Steve

    First Job-Drowning in water

    Oh I know I am going to get flamed for this but... OP, you posted that you failed the PANCE is Feb of 2013. Here we are in November of 2013 and you're diving into a job of Surgical ICU. Holy Cow...what is going on? What sort of perspective do you have on your skill set? Why are you applying for a job that is rigorous with a high potential of killing a patient (as they are pretty fragile in the surgical ICU)? Why are you not building up your base knowledge in a lower risk arena such as family practice (No offense to FP, don't get super excited, those patients will die too..just not as fast) I can appreciate wanting to have a solid job with good pay and all that jazz but you're putting yourself at risk (you're about to get sacked from your first job, employers may already be scratching your head of why the long time between graduation and first job. Now they are going to wonder why you didn't last at your first job very long). I really hope you find a way to swallow the pride and dial back the ambition a bit. The emphasis you shared in reporting your request for training at the interview makes it sound like you were hoping more for a training residency. I get the fact that you have bills to pay and all that but you may want to really consider some sort of residency. You'll still get a bit of a paycheck and will get a great boost to both your abilities and your resume'. That resume' is going to need some damage control after this go around. There is no shame in primary care. It's a great place to get a great education.
  11. Got into PA school without a Bachelors, graduated Aug 22, 2013. Took my PANCE Sept 16. Started first job Sept 17. Sure glad I passed so I got to keep my job. My point is this....if you prepare yourself in a manner of which the school is seeking, you don't need to sweat all the details. Read the website, make sure you meet that school's requirements, and move forward. Your degree should reflect your passion, not just be a check mark on a PA application
  12. I gave up skim reading.... Sorry if this has been asked... How are you treating your ADHD? If you are not treating it, why not?
  13. What level of the spine we talking? C 3-4 with some Botox?
  14. PA school... The most expensive self study course you will ever do.
  15. Just Steve

    PA with no HCE

    While you have no health care experience, you have at least 15 years experience working in a high stress environment with a focus in small team management, critical thinking, de-escalation tactics, situational awareness, personnel management, and overall life experience. These attributes will benefit your cause in your pursuit by letting the various AdComs that you have faced the real world, survived, and determined to improve your quality of life. Get some experience, but don't kill yourself for a couple of years waiting for the perfect job.
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