akdEM

Albany Med EM Fellowship Blog, Part Deux

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Hi Everyone...

About 2 years ago, Matt and Jordan, 2 of the EM fellows at Albany Med, started a blog detailing their time in the Albany Med EM Fellowship. It got me interested in learning more about residencies, and was a major reason why I eventually decided to take the plunge myself. I ended up applying to a couple of different programs, but after interviewing at Albany Med, I knew I had found the right place. I was fortunate enough to be offered a spot and took it without a second thought. I wanted to do something similar to what they did, and try to share some of my experiences along the way. Whether or not to do a residency/fellowship is a big decision, and it really helped me to hear peoples' personal experiences. I'll try to post every few weeks, but I can't make any promises. Feel free to post any questions and I'll do my best to answer them... I'm still new to all of this, so maybe some of the more seasoned resident graduates could also chime in.

My wife and I moved up to Albany last week, and have really enjoyed it so far. This year there are 4 fellows, an increase from previous years when there were only 2 spots. The two other fellows started in mid-August so that we could be staggered going through rotations. It also allowed us to each receive some one on one mentoring from the outgoing fellows. Our first few shifts in the ED are scheduled such that one of the outgoing fellows will be there, basically shadowing us and helping us learn the ins and outs of the department. She won't be picking up any patients, and will basically just function as a guide as we get used to being "real PAs." I think it will be a great way to get our feet wet. The first week of October, we are scheduled to have a 2 week ultrasound rotation. This will include some classroom time for a few hours each day, and some hands-on time, just walking around the department doing as many scans as possible. The guys who started in August said they got close to 200 scans each last time I talked to them. Should be a great experience!

Well that's all for now. Feel free to post questions, and I'll also try to check in every few weeks with a quick update.

-Andy

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Time for a quick update...

 

The last 2 months have been a whirlwind of learning a new hospital, a new EMR system, and trying to become a better EM provider  not to kill any patients. The first few weeks of the fellowship we spent just getting used to the department. Our first 7 or 8 shifts were scheduled with one of the outgoing fellows, and she was there just to help us learn the ins and outs of the how things work at Albany Med. It was SO helpful having her there and having her show us the ropes for the first 2 weeks. We would have been lost without her. After 2 weeks, the training wheels start to come off, and we began working shifts on our own. There is usually one of the other fellows in the department, and there are is always plenty of backup from the attendings. I've never felt like I was in over my head, because I know that there are lots of people around who are willing to help and answer questions.

 

In October, we completed a 2 week ultrasound rotation. It consisted of 1 week of classes and hands-on training and 1 week roaming around the ED practicing ultrasounds on any willing patients. During that time, we racked up around 250 ultrasound scans each. We mostly focused on FAST, renal, gallbladder, and cardiac, but we also did some OB and ultrasound guided IV too. It was a great experience. Dr. Cadigan, who teaches the classes, is fantastic and really knows her stuff.

 

The rest of October consisted of just working our regular 4-5 10 hour ED shifts per week. We mostly work evenings, because that's when the action tends to happen. The schedule varies, but we're never really scheduled to stay any later than 2am, which is nice. That said, I'm usually there about 30-45 minutes extra finishing up charting and tying up loose ends.

 

Last week, 3 of us went to Syracuse to get ATLS certified. It was a fun trip, we all passed, and the classes were actually pretty useful. Unlike some of the other certifications, they really like to make sure you are competent before they pass you... That test is no joke.

 

For 2 weeks in November, I have been doing my ophthalmology rotation. The first week is spent upstairs in the clinic. At first it was mainly just shadowing, but by the end of the week, I was starting to see some patients on my own and getting a lot more comfortable with eye exams. The second week, which I'm just now starting, consists of taking call with the ophtho resident. I'm scheduled for fewer ED shifts, and instead will just be going in for eye emergencies several days this week. It's a nice change of pace, and it is really a great way to learn how to manage eye patients. It's a real luxury to be able to sit and pick the brain of the ophthalmologists, finding out what things we should be consulting them for and what we shouldn't. I still have a lot to learn about ophtho, but this was a great start. I can at least feel fairly competent with a slit limp exam, and I have a pretty good idea of when I need to call in the specialists. I think I may go back at the end and try to do another ophtho rotation... we'll see.

 

Well, that's all I've got for now. They keep us busy, but it's totally manageable. It's been a fantastic experience so far. I'll try to keep the updates coming and get some of the other fellows on here to share their thoughts, too

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Do you mind elaborating a little bit on what your daily schedule has been ? And how many days a week are you working?

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We're scheduled to work 4 days one week and 5 the next. Plus there are things like Wednesday morning conference we attend. Our shifts are 10 hours long. The usual shifts are 11-9p, 12-10p, 2-midnight, 4-2am, and the occasional 9-6pm or something like that. On conference day we usually work 6 or 8 hour shifts. So it comes to probably 50-55 hours a week on average I would say. When you're doing off-service rotations, the scheduling just depends on how busy that service is. For example SICU is more hours than ophtho.

I'll just say that going into it, hours and being worked to death were one of my biggest concerns. I knew that it would be more hours than a regular job, but that's how you get experience. I haven't felt overworked. Adam and Sara, the directors, are very flexible with scheduling understand that we have lives outside of emergency medicine.

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Hey Andy,

 

If you don't mind, could you discuss some your stats when you applied? (GPA, experience...).

 

Thanks.

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As far as GPA and experience goes... I don't think either is a major factor in admission. A GPA below 3 might be a dealbreaker, but I think what they really look at is potential and desire to work in EM. I would guess that all of us had GPAs in the neighborhood of 3.5 or maybe a little higher, but don't put too much stock in that.

 

I was an EMT for a couple of years before PA school, and that may have helped some. But I know that there have been several fellows in the past and present classes who went straight through from undergrad to PA to fellowship. So the short answer is, there really isn't a formula that they're looking for. The biggest thing is just to have some good EM rotations and demonstrate that you are passionate about this specialty.

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Do you recommend to apply to many of the EM residences in hopes of landing one? Sounds like steep competition being only 4 slots available. 

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If you are absolutely set on doing a residency, then, yes, I would suggest applying to several. They are pretty competitive, but if you're a good candidate you won't need to apply to 12 programs to get in. The Arrowhead program, for example, takes I think 12-14 people each year. Residencies are definitely getting more competitive, but there are also more and more programs being added each year.

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For 2 weeks in November, I have been doing my ophthalmology rotation. The first week is spent upstairs in the clinic. At first it was mainly just shadowing, but by the end of the week, I was starting to see some patients on my own and getting a lot more comfortable with eye exams. The second week, which I'm just now starting, consists of taking call with the ophtho resident. I'm scheduled for fewer ED shifts, and instead will just be going in for eye emergencies several days this week. It's a nice change of pace, and it is really a great way to learn how to manage eye patients. It's a real luxury to be able to sit and pick the brain of the ophthalmologists, finding out what things we should be consulting them for and what we shouldn't. I still have a lot to learn about ophtho, but this was a great start. I can at least feel fairly competent with a slit limp exam, and I have a pretty good idea of when I need to call in the specialists. I think I may go back at the end and try to do another ophtho rotation... we'll see.

 

 

This is gold.

Something that I am still uncomfortable with is the eye, even with working closely with ophthalmologists and having them walk through slit lamp exams.

As an AMC PA grad, I wish that this residency was available way back when. What a great opportunity. Make the best of it and thanks for the updates.

G Brothers PA-C

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Hi everyone,

 

My name is Matt, I'm one of the other fellows, along with Andy, doing the fellowship at Albany Med. I was fortunate enough to start back in August and wow has time flown by. It is unbelievable to think that I am almost half way done with this 12 month fellowship. I know I have come a long way as a PA over these past 6 months and I can't wait to see where I am when its all over. A little update, so far I have completed a 2 week ultrasound course and am continually honing my skills during my everyday practice. Toxicology - time on call seeing patients in the ED/hospital for consults along with formal lectures, and we have been fortunate to go to two toxicology conferences one in NYC and one in Syracuse. This time was nice as well because we had less shifts in the ED during these weeks because we are on call. Further the Toxicology Attendings we have here at AMC are all wonderful and great teachers. Currently I am doing my airway rotation with anesthesia down in the OR for the week. It's so beneficial getting comfortable with airways in a nice controlled environment before putting these skills to use in the hectic ED. Further, its nice because we can practice using lots of alternative devices like LMAs, ILMAs, Glidescope, Bougies, etc. Other rotations I have completed to this point include time in the pediatrics ED, ophthalmology (Excellent!), radiology - reading mostly cxr and other plain films, and all four of us passed ATLS, on the first time!! Looking at the schedule, next month (February) I'll be spending some time in the CCU (Cardiac Care Unit), which is all cardiac ICU patients often following MI's etc. One other nice feature to Albany Med is our visinity to great skiing. A bunch of us are heading up to Mt. Snow for a weekend in February. Should be a nice time for some R&R.

 

For anyone out there thinking about fellowships/residencies, I highly recommend it. I think the opportunities afforded during these programs are invaluable. For those of you considering EM fellowships/residencies I highly recommend considering the fellowship here at Albany Med. The most important things I was looking for in programs was the demands of the program and the opportunities afforded. I knew a fellowship was going to be demanding however, I did not want to be part of a program simply pushing you to see more and more patients. There is absolutely none of that here. The program directors Sara and Adam are absolutely wonderful and are constantly looking for ways to improve the program and extend opportunities to us. Further, they completely understand we have lives outside of the ED. There is not doubt, in my mind, the fellowship experience here at AMC is one of the best out there.

 

Anyways enough for this rant...for anyone out there with any questions regarding fellowships/AMC etc please feel free to post or send a message to myself or Andy. I'll be back once I have some more updates...hopefully it will be a little warmer!

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Hi Andy and Matt, 

 

Thank you both so much for taking to time to write these updates! It's been so valuable getting this kind of insight and definitely furthered my decision to apply here! Just sent in my application yesterday! :)

 

If you don't mind... what advice do you have for those of us hoping to start an ED fellowship? Are there certain things you wish you'd learned or focused on prior to starting? Thanks!

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Good luck! Maybe we'll get to meet you when you come up for an interview.

I kind of wish I had focused more on my internal medicine and pharmacology skills. As PAs, it's our bread and butter, but it's easy to lose sight of just how important all that "family medicine" stuff is in the ED. We all know the line between EM and family medicine is blurring, but I think I was still a little naive coming in. Other than that, just get a nice broad foundation. Learn as much as you can in each specialty rotation, because it will ALL come in handy eventually in the ED. 

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For anyone out there thinking about fellowships/residencies, I highly recommend it. I think the opportunities afforded during these programs are invaluable. For those of you considering EM fellowships/residencies I highly recommend considering the fellowship here at Albany Med. The most important things I was looking for in programs was the demands of the program and the opportunities afforded. I knew a fellowship was going to be demanding however, I did not want to be part of a program simply pushing you to see more and more patients. There is absolutely none of that here. The program directors Sara and Adam are absolutely wonderful and are constantly looking for ways to improve the program and extend opportunities to us. Further, they completely understand we have lives outside of the ED. There is not doubt, in my mind, the fellowship experience here at AMC is one of the best out there.

 

 

 

 

well said

and why they should be mandatory

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Hey there! My name is Jenelle and I am another one of the four current PA fellows here at AMC doing the ED fellowship. I know Matt and Andy have already talked extensively about their experience but I just wanted to add to that. I am currently doing my airway/anesthesia rotation where we spend 1 week in the OR doing just intubations…it has been awesome so far! So far I’ve been able to get 26 airways, mostly ET tubes but also a few LMAs and 2 glidescopes, in 4 days. Tomorrow is my last day on this rotation so I’m hoping for at least 5 more or maybe 7 more so I can beat Eric’s record! ;) As Matt said, I really can’t believe I’m almost finished with my 5th month…it’s been a crazy awesome experience. Yes, we put a lot of hours in (approximately 50-60 per week), however, I head into work every day so thankful for this amazing opportunity, never dreading a day.

 

So far the rotations that I’ve completed are ultrasound, toxicology, ophthalmology, radiology, pediatric ED, and airway, with a bunch of ED time mixed in there. I still have CCU, EMS, SICU, trauma, and 2 electives coming up. Ultrasound was SO beneficial. Dr Cadigan, our ED ultrasound specialist is amazing to work with. I was able to get over 220 scans within 2 weeks, which Jenna (fellow from last year’s class) tells us was SUPER marketable during job interviews. Also, I can’t say how impressed I am with our toxicology specialists here; they are all amazingly brilliant and I have learned so much from working with them during our tox rotation and in the ED. This rotation was really great because I personally didn’t get much, if any, toxicology background in PA school, which is pretty common and very important stuff to know in the ED. Another rotation that has been immensely beneficial to me was ophthalmology. Again, I definitely did not get much clinical experience with eyes in PA school, which again is critical for ED practice. I certainly did not feel comfortable seeing patients with eye complaints prior to doing this rotation; I didn’t feel confident at all in my eye exam skills (had never even used a slit lamp before) or my assessment of eye complaints. However, after the experience gained from the ophtho rotation, I now feel much more comfortable and confident with these patients. I feel like some of the other residents and mid-levels in the department tend to come to us fellows with ophtho and ultrasound questions given the great experience we’ve gained from these rotations, which I think says a lot.

 

As far as ED time goes, we pretty much function the same as the ED physician residents, which I think is pretty cool. We do all of the same things they do, except some of them are assigned to traumas and we aren’t, except for during our trauma rotation or overnight shifts. However, many of the residents will let you pick up and manage their trauma patients if you ask them to. We attend the same weekly conference as them, the same monthly journal club, and most of the same rotations.

 

Again, as Matt already said, I really can’t say enough about how great this program has been so far and how fantastic our directors are. They truly care about getting us the best learning experiences and are always looking for feedback from us on how to better the program and to ensure that we’re getting the best fellowship experience we possibly can. I personally was most impressed and still am highly impressed with the quantity and the quality of off service rotations offered by this program. I looked into a lot of other Fellowships/Residencies and couldn’t find a program that I was more impressed with in that regard, and my opinion hasn’t changed!

 

I apologize for the length of this post, but there’s just so much to say! I will try to post another update after a few more rotations. My next rotations coming up soon are CCU (cardiac critical care) and EMS, where we get to ride along in the LifeNet helicopter and in ambulances, which should be pretty neat. Oh yeah, and all of us fellows and Adam are also going to the ACEP/SEMPA EM Academy conference in Las Vegas for a week in April which should be a ton of fun!! Please feel free to ask me any questions you might have; I am more than happy to answer! Feel free to email me at romigj@mail.amc.edu if you have any questions that you don’t feel comfortable posting on the blog. 

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Hey everyone! My name is Eric and I am one of the 4 fellows at Albany Medical Center ER currently. I felt now was a great time to comment on my experience so far because I am about half way through the fellowship. So far in addition to all my ER shifts I have completeted rotations in: ultrasound, toxicology, ophthalmology, pediatrics, anesthesia, radiology. I still have yet to do a rotation in CCU, SICU, EMS, trauma. and my elective month.

 

I started my fellowship with 2 weeks of ultrasound training which was beyond amazing to learn. When we were not doing class or hands on with our attending, myself and another one of the fellows were out in the ER ultrasounding every person we could find which was amazing because patient's were very receptive to letting us practice and learn and just by explaining to the patient what we were looking at and for, helped educate the patient and us reinforce the skills and knowledge exponentially. Matt and I even took it a little further and started learning how to apply ultrasound to many other things (i.e. Ophthalmology, peritonsillar abscesses, etc.). After hearing from previous fellows how marketable ultrasound training was when applying to jobs, I made it a point to keep up with my ultrasound skills and get as much exerperience as I possibly could. So far I have about 560 ultrasounds logged of various kinds. Dr. Cadigan who is our ultrasound ER guru is exceptionally amazing to work with and will take free time to go out of her way and explain something to you if you have any questions.

 

As Jenelle has previously mentioned, I too feel that I did not have the confidence I should with seeing patients with eye complaints. We unfortunately did not have a great deal of Ophthalmology training in school. I will even admit that when I saw patient's initially in the ER at the beginning of my fellowship I was intimidated by doing a good and thorough slit-lamp examination or even knowing who needs to be consulted and who can be sent home with follow-up. Well after my Ophthalmology rotation with various amazing Ophtho residents and attendings at AMC, I was a rockstar! I learned so much and just learning how to perform a good and thorough slit-lamp examination alone is a huge help. I now see patient's and do things without even needing to consult Ophto residents to do. I remove foreign bodies from people's corneas. I even performed a laceration repair of a lid margin using 7-0 chromic gut sutures, which impressed the Ophthalmology resident that is something that normally requires a skilled Ophthalmologist to handle. So needless to say, I have now have a huge passion for Ophthalmology and find that other PAs, residents, and sometimes attendings have asked me questions about using the slit-lamp or with handling certain Ophtho complaints, which is a huge confidence booster.

 

Toxicology was beyond amazing. I never how much existed regarding tox until doing this rotation. Albany Medical Center ER is extremely fortunate that we have 3 amazing board certified Toxicologists! Between the lectures and tox cases that I had, I gained a huge amount of knowledge that I would have never learned otherwise. We learned not just drugs/medications, but how to recognize and treat certain exposures to chemicals (i.e. from patient's place of employment), plants, etc. Now when we get overdoses or exposure to random chemicals, I jump right on it and feel confident seeing those patient's and knowing how to treat them accordingly.

 

Anesthesia was an amazing experience. I don't know how many intubations some people may have done while in school, but after talking to some of my friends who have completed a year of ER as a PA, they have done ZERO. With that said, I did 32 intubations in 1 week alone! Talk about a great experience, after that week I felt like I could walk into any situation and intubate without any hesitation.

 

Pediatrics was a great rotation because let's face it, kids can be very intimidating to treat. Unless you have that background in Pediatrics, there are a lot of differences in working up a kid or newborn baby. We have some absolutely amazing Pediatric ER certified attendings and they just made the experience amazing. I loved every minute of it, and within 1 week alone I was picking up ICU level peds patient's.

 

All in all, my experience over the past 6 months has been beyond amazing and far exceeded my expectations prior to starting the program. It is also great because I have 3 other amazing PA fellows that I work with, and we enjoy sharing our experiences with one another because we all want to learn and help each other come out of this program with the most knowledge that we can possibly gain over this year. Everyone else in the ER has been great from nurses to the other PAs, residents, and attending physicians. I find that no matter how busy it may be sometimes, there is always someone is willing to help if I have a question or feel like I need to bounce some ideas off of them. If anyone has any questions at all about my experience or the program itself feel free to contact me williae1@mail.amc.edu.

 

I will definitely keep updating this blog with any latest experiences or news.

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Hey Everyone,

 

Its about that time of year...interview season! Looking forward to meeting all the great candidates for next years class. Interviews are right around the corner! Feel free to message me or the other fellows with any questions about the AMC ED fellowship, interviews at AMC or in general, or Albany itself.

 

As far as updates...I'm currently in the Surgical/Neurosciences ICU at AMC for the month of March. I'm loving every minute of it! Lots of acuity, lots of procedures, and lots of learning. The hours can be demanding during the month but it is an opportunity I would not pass up and I know its going to be make me a stronger provider when I return to the ED. After this month, I'll be 8 months done with the fellowship, and it's flying by. I still have a lot to learn and work on when I get back to the ED next month which I'm looking forward to.

 

Last month, I had my 6 month evaluation. It was much more formal then I was expecting but extremely beneficial. I had an  meeting with the directors Sara/Adam and had the opportunity to provide feedback to them on my experience and rotations so far. This is important because I know they take the fellowship very seriously and are constantly looking to improve the experience and make changes. Furthermore, the 6 month eval i received was extremely beneficial in talking about how I've been doing, what to work on, and future plans. It was great to see the constructive feedback I received from the ED and our off service rotations. It gives me great insight into how I'm doing and things I want to try and work on/improve over the next 6 months. Overall, I was really amazed at the constructive feedback the ED attendings provided during my review. It shows they really care and have my professional growth as a provider in mind.

 

With regards to the never-ending winter, in April we are heading out to Las Vegas!!! cant come soon enough. We will all be attending EM Academy sponsored by SEMPA/ACEP. Should be a great conference! Anyone else going to be out there? Let me know.

 

To those that have interviews coming up good luck and Trust me..you're making the right decision!!

Matt

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Well it has been a while since any of us have posted, so I thought I'd give everyone an update.... We're closing in on the last couple months of the program. Matt and Eric actually finish up next week. Jenelle and I have until the end of September.

 

Since the last update, we've all had the chance to spend a month in the Surgical ICU. I think I speak for all of us when I say that was a pretty great experience. Definitely a change of pace from the ED. Days start around 6am but usually end around 5 or 6pm, so that's kinda nice. For the most part it was 5 days a week. Very manageable. The morning was spent pre-rounding and then rounding with attendings and the rest of the clinical team. Each day you'd have 3-4 patients you were responsible for. Do a daily note, update medications, maybe a procedure or two... In the afternoon, admissions would start to roll in, which usually meant lots of procedures (mostly intubations, chest tubes, and central lines). All in all, it was cool to see what happens to our critically ill patients after they leave the ED.

 

We've also had the chance to get into the simulation lab a few times in the last couple months. Basically, we pair off into teams of 2 and each of us takes turns running some kind of critical care scenario. I got lucky enough to have the seizing infant/respiratory distress case... Aside from using the wrong end of the Braslow tape and probably overdosing the child with ativan, I think it went fairly well...! Our program directors, 2 ED attendings, several ED nurses, and one of the former PA fellows volunteer their time to help put the simulations together. It can be nerve wracking, but everyone is always so supportive and patient. We're lucky to have such a cool facility. I know that they're hoping to incorporate it into the the curriculum more heavily next year, too.

 

For the last 6 weeks, I've been working nights. We each do a stint of overnights in the A Zone (mostly trauma and critically ill patients with a sprinkling of psych patients). I was nervous about it. I wasn't sure if I was ready to handle the patient loads or the acuity level. I've got to say, though, that it has really been one of my favorite rotations. There have been some rough nights, no doubt. There have been times where I was counting the minutes until the AM team arrived... But my ability to carry lots of patients, sort out the sick from the not sick, and get people where they need to be has increased exponentially these last few weeks. When it's just you and one other resident carrying half of the department, you realize that getting stressed out doesn't change a thing. All you can do is keep seeing patients. We've had a fair amount of a stabbings, shootings, MVCs, etc... Working nights feels like much more of a "team sport" than days. It's been a lot of fun. Tomorrow is my last night. I'll miss it, but I'm also ready to have a normal sleep schedule again!

 

I got to fly with the LifeNet helicopter crew a few weeks ago, too. We only transported one patient during my two days, but we did get several calls and would hover around the scene of the MVC before being told to stand down. It was a cool experience. I have a new found respect for the medics and flight nurses who do that for a living. They are some of the sharpest medical providers I've come across and they all seemed to love their jobs. I can see why... I want to look into what kind of opportunities exist for PAs...

 

Other than that, it's been just a lot of regular ED shifts for the 4 of us. We've finished all of our off-service rotations. Jenelle and I are doing "electives" for the last month. For me, that means a few days seeing nothing but ortho cases, a few days of lacerations and plastics cases, a few days of bedside ultrasound, and a few days of fast track. Ironically, "fast track" patients are still one of the areas that I feel like I need more experience in. Learning to see lots of patients efficiently but safely is a skill that comes with time, and it's one that I want to start working on. I know in the "real world" there will definitely be a lot more pressure to move the meat.

 

Well that's all I've got for now. I'll check in one more time a few weeks from now. That will be right as I'm finishing up the fellowship program. Please feel free to PM or post any questions in the mean time....

 

-Andy

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sound like great experiences! Prob more excited to pursue a residency after graduation now.. I'm a few months away from my program rotations, so I have about a year left of school.

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Hey everyone,

    It has been almost 6-7 months since my last update on here. At the time i was about halfway through the fellowship and I actually finished a little over a month ago. I just wanted to give a little bit more information about the remainder of my experience. In the springtime I did a little over a month of shifts in the trauma zone with primary emphasis on being involved in and/or running a trauma. It was a great experience and I was able to get exposure to all kinds of traumas and also racked up a bunch more procedures. I also was given the option to do some EMS shifts and work out in the field with the medics and EMTs. As much experience as I had prior to PA school I unfortunately never had any EMS experience so this was amazing. I would respond with the medics to the scene of anything from dyspnea to cardiac arrest and traumas. I had the option to do some time up at Malta Med (a newly built, amazing urgent care) which is roughly 30 min away from Albany. I chose to do some time there because I wanted to see what it was like in a different setting, seeing patients with more straight forward problems. This was great because it allowed me to really work on my speed. It seems a lot of ER and urgent care places today emphasize seeing X number of patient's per hour, so it is helpful to have a good sense of how many patients you can handle seeing (it definitely helps on job interviews because that is something places either asked, or they would ask if I felt comfortable seeing X number of patients an hour).

 

Towards the end of the fellowship everyone has 1 month of elective time which you can use any way you want (you can split it up and into 4 different 1 week rotations or you can do all 4 weeks in the same rotation). I loved all my off service rotations so it was a hard choice to make but I ended up doing some more time with trauma and I also went back to rotate in the SICU. I personally thought SICU was absolutely amazing. I found that it challenged me in new ways and expanded my knowledge on many things that I was weak in when I would be working in the ER. Since this was my second time back, a lot of the residents, fellows, and attendings remembered who I was so whenever a procedure needed to be done (i.e. central line, intubation, a-line), they were more than fine with me doing it on my own. My favorite thing to tell people was how when the new second year resident would have to go do a central line or a-line, the attending physicians would tell them to bring me and to have me teach them. There is no greater feeling that having the respect of attendings that trust you and recognize your skills to the point that they let you (a first year PA) go and teach a second year resident how to do a complex procedure. It was great because most of the residents would compliment me and tell me how they never really knew what a PA did and when they saw my level of knowledge and skill they were flat out impressed.

 

That pretty much sums up the bulk of my experience although i'm sure I could go on forever about all the awesome things I did and saw. When I finished I had a number of job offers which was tough because they were all fantastic options. Every person I interviewed with was blown away at my CV and what I did in the fellowship and every job I applied for I was offered the position and that was made clear during my interview. So I think it speaks volumes when you can apply for jobs and let them see what you accomplished in 1 year. Just to throw out some numbers to give people an idea of some of the procedures I did and how many within a 1 year period (not counting the ones I assisted other people on when I taught them): Ultrasounds 822, Central lines 24, Arterial lines 14, Intubations 78, Chest tubes 29, Lumbar puncture 10, Procedural sedations 7. I even helped put in Swans and transvenous pacemakers. In the SICU they let me do an entire bronchoscopy (with biopsy sampling and all) by myself (of course an attending was present for this to make sure I did it right. These are just some of the many procedures I accomplished, but hopefully that gives people some idea of how far ahead an ER fellowship puts a new grad PA in comparison to others (even compared to the residents in some aspects).

 

It has been a great year and I was really sad to have it end but on the other hand I decided to stay at Albany Med working overnights (in the trauma zone, still getting procedures) as well as doing what I can to help teach the new PA fellows. Best of luck to everyone in whatever they decide and please do not hesitate to contact me with any questions williae1@mail.amc.edu.

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I just discovered this thread today and it's been a really great read. I'm matriculating to AMC for its PA program in January - really excited, but also very, very nervous. I've spent the last few years working as an EMT and in the ER of a level 2 trauma hospital as an ER tech. I don't know if emergency medicine is where I want to end up yet, but it's definitely something I've considered because of my pre-PA experiences. If I decided to do emergency medicine, I figured I'd probably have to either do a fellowship or work in a less saturated location where I might have a shot at getting a job in a hospital ER or urgent care center for a few years' experience. 

 

You and the other residents seem to have had a great experience living in Albany and working with the AMC faculty, clinicians, and staff, which is reassuring. It sounds like a very supportive and organized atmosphere, which is what I'm hoping for in the AMC PA program. I'm from a rural/suburban area so I'm still a little iffy with moving to a city but I've had many positive experiences meeting and talking with Albany residents. But I'll admit, the thought of street parking or parallel parking in a city is significantly more terrifying to me than getting the chance to learn and practice a central line. Do you generally feel safe in Albany and in the capital district region - assuming one has common sense and knows to avoid certain areas after dark, etc.? How's the traffic there and dealing with the snow? 

 

If someone was seriously considering emergency medicine as a specialty, what do you recommend they do for elective rotations besides different ER settings? Something in the ICU, cardiology, pediatrics or surgery? 

 

Thank you for sharing your experiences!! Congratulations on making it through!

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Hello all,

 

It has been a long time since I have posted anything, but I just wanted to do one last update. A bit of an epilogue... My fellow PA fellows and I all finished our program about 3 months ago. I found that, having done a fellowship, the whole job-search was pretty easy. A lot of recruiters and medical directors hadn't heard of these types of programs, so I did have to do a fair amount of educating. Those that were aware of what a fellowship has to offer were instantly more interested in making an offer. Ultimately, I ended up moving back to my hometown in metro Atlanta and taking a job at the hospital 10 minutes from my childhood home. My scope of practice out in the community setting is definitely not what it was at Albany Med, but that is to be expected.

 

When you're in the midst of it, it's really hard to grasp how much you've learned or how much your confidence level has changed. But my first week on the new job, it really began to set in. I have so much left to learn and by no means do I consider myself an expert PA. But when it's just you and one other resident on night shift and you have 5 critical patients with multiple stab wounds roll through the door, or when you spend 4 weeks working side by side with 3rd and 4th year residents in the ICU, or when you just spend a year dealing with the day to day controlled chaos that is an urban level 1 trauma center, it makes a lot of other things seem a whole lot easier and considerably less scary. You can debate whether doing a fellowship will make you more money in the end (I'm not sure it does, but it certainly lets you be picky about what job you take), but you simply cannot replicate or replace the kind of intense, hands-on experience I got from this fellowship program. It would take years to accumulate the kind of experiences that I've had in the last year. I still have years and years of learning to do, but I wouldn't trade my fellowship experience for anything. For anyone out there who is on the fence, I'll just echo what so many others have said: If you go into it with the right reasons in mind, you will not regret it. It was the most intense, challenging, and rewarding year of my life.

 

Feel free to ask any questions... I'll try to be better about logging in more frequently!

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Any particular reason you didn't seek out a job with a bigger scope? Any plans to in the future?

 

My wife and I wanted to be near family and I didn't want a long commute. Basically, the pay and location are so perfect that I was willing to compromise a little bit on scope of practice. Scope is probably the most fluid of the 3 variables (pay, location, and scope). There are plans for PAs to become more involved in critical care, and the medical director hired me specifically for that purpose given my training. I certainly don't feel under-utilized, but there is some room for growth.

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Hey everybody!

 

My name is Jamie and I'm one of the current Albany Med ED PA fellows for the 2015-2016 class! I've been wanting to introduce myself and give you guys some updates ever since starting in October so I apologize for not getting on here sooner. It's crazy how time is absolutely flying..!

 

A little background information about myself: I worked as a medical scribe in the emergency department for 2.5 years while obtaining my biology degree at the University of South Florida. Then I moved to Ohio where I did PA school at the University of Mount Union. 

 

Before I go into some details about this year, I just want to reiterate everything that all the past PA fellows have said. After going through the whole application process and reading all these threads prior to interviewing, then getting accepted and actually starting this program, I just want to say they were 100% truthful and accurate in everything they said!!! The experiences I have been afforded in the last 3.5 months are things that I NEVER thought I would be doing this soon after being a new grad!

So this year there are 5 PA fellows (increased from 4 last year!) and we all started at the same time in October. We spent 2 days doing hospital orientation, and then 2 weeks paired one-on-one with one of the previous PA fellows from last year’s class to help us get oriented to the department, learn the charting system, help us transition into the “I’m not a PA student anymore” mind-frame, and basically just have a support system in a brand new place! This was the first year that our co-directors Adam and Sara also designed a 3-day specialized emergency medicine orientation just for us PA fellows. There were multiple lectures all day by different ED attendings and other practicing ED PAs on various types of patients that we would be encountering, such as the “abdominal pain emergency” or the “psych patient”. One of the afternoons we spent in the simulation center where we got personalized feedback about a specific case that we ran through (kind of like an OSCE). Another afternoon we all got time in the cadaver lab!! Who knew that after my first week of ED fellowship, I already would’ve performed an intubation, placed a chest tube, placed an IO, placed a central line, and done a cricothyrotomy on a cadaver!

My first rotation after working a few ED shifts was toxicology. This rotation is one month. Currently we have 4 board-certified medical toxicologists who are ED attendings and they run a toxicology service at the hospital. I had 10 days of being on-call for any tox consults and in between then, there were toxicology lectures with just me, one other resident, and the attending. I also worked a few scattered shifts in the ED. My tox month was absolutely AMAZING and kinda crazy!!!! We had a code disaster where a bunch of local firemen were exposed to Hydrofluoric Acid!! I won’t go on too long of a rant about this, but let’s just say I’ve never seen so much calcium available in multiple different forms in my life!! I think I dropped like 9-10 consults that night. I also took care of 2 serotonin syndrome cases as well as one patient with classic anticholinergic syndrome! It was pretty crazy!! :D Plus your typical cases of acetaminophen overdose, benzos overdose, plenty of K2, etc…  Let’s just say I feel much more comfortable now picking up any patient coming in for overdose or taking a bunch of pills! I also went to New York City for a special toxicology conference for the day, and then I headed to Syracuse with the other fellows for an annual toxicology conference! It was awesome!

Since then I also completed one week of ophthalmology, two weeks of ultrasound training, became ATLS certified, and I’m currently in my second week of pediatrics. I could say so much about all of these amazing experiences but I’ll have to save that for a later post! But real quickly, I do want to mention that I also had the wonderful opportunity of becoming a Sexual Assault Forensic Examiner recently. I’m not sure if any of the other previous posts have mentioned this, but Albany Med has a wonderful sexual assault forensic program and you have the option of becoming a certified examiner. This involves obtaining a very thorough documented history, performing a detailed physical exam, photographing injuries, and collecting evidence such as oral swabs, clothing, and genital swabs for the forensic kit. This is completely optional and not a mandatory part of the fellowship, but it does offer an opportunity for extra side cash while learning another useful skill that you can apply in any emergency department!  

Alrighty well I think that’s enough for one post! I’ll end by saying: for those of you who are considering applying to this program, you truly cannot go wrong. I cannot imagine getting this kind of experience anywhere else, and when I talk with other classmates who graduated with me a few months ago, they cannot believe the kind of experience I am getting. I hope to update you guys with another post in the near future, but feel free to ask any questions that haven’t already been answered. You can also email me at hodesj1@mail.amc.edu.

Thanks for reading! J

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I know this residency starts in October - do they accommodate for graduation dates, say starting in June/July?

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ewillPAC, my goodness your numbers are absurd!  "Ultrasounds 822, Central lines 24, Arterial lines 14, Intubations 78, Chest tubes 29, Lumbar puncture 10."  That is extraordinary.  You honestly probably have more numbers than some of the physician residents at my program (and they go for 4 years!).  Jeez, and you guys have a cadaver lab too!!  Sounds like a really incredible program!!  Thank you all for writing your experiences here; they are great to read.  

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Thanks for sharing your experiences with the EM fellowship ! I'v heard many great things about the fellowship and the PA program in general.  I'm from the area originally and was also born at AMC  ;) Definitely considering applying to the PA school in the near future !

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In the past they accommodated some fellows starting in August while others started in October. I am unsure how our program directors are feeling about that for this upcoming year; however, usually if there's a way, they try to make it happen!

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Hard to believe it has been almost a year since graduating the program. I still get a lot of messages regarding Albany Med and PA residencies in general. It makes me very happy to see the level of interest out there and to see all the awesome new programs popping up across the country. Just wanted to re-extend the invitation that, if anyone has any questions about residency programs, feel free to PM me. 

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Hi All!

 

My name is Amanda and I just graduated from the AMC ED PA Fellowship this October. My apologies for not blogging sooner!

 

Well first of all to summarize, I had an absolutely great year at Albany Medical Center and I would highly recommend it to anyone. I just started my new job last week and it is amazing how comfortable and confident I feel compared to last year just getting out of school. The things I learned this year definitely gave me a leg up and gave me the advanced knowledge to excel in the emergency medicine environment. Also, it definitely made a difference on the job search. Places I interviewed told me they wouldn't have even considered me 1 year out of school without doing a fellowship/residency, however now instead they were giving me job offers. Pretty cool.

 

Regarding the details of the fellowship, I think a lot of previous posts touched on our rotations etc which is also listed online, so I will just tell you what I liked about them. Ophthalmology was one of our first rotations and it was extremely helpful. I had never learned how to use a slit lamp before and now I feel pretty comfortable. I also felt I knew NOTHING about eyes after PA school and, though the rotation was only one week, I felt I had enough knowledge to know what was bad and what I can handle. I think the important thing with optho is to know what you can handle and when you need to call a specialist. This rotation really gave me a good handle on that. I also learned how to detect retinal detachment with an ultrasound which was pretty cool :)

 

The next rotation was ultrasound. It is a 2 week rotation which is great. Lecture style, hands on style and lot's of practicing in the department. It is good to learn this in the beginning because you can keep practicing all year. At the end, you will get a certificate saying how many scans you did which helps for credentialing purposes at your next job. It also is a very useful skill to have. One thing that is incredibly useful to learn here is how to perform US guided IVs. When nobody can get IV access and you can, it is a pretty great feeling. Also, AMC has an ultrasound fellowship so there are a lot of people passionate about ultrasound around.

 

Next was airway and anesthesia. This was one of my favorites because I found it so useful (I also chose to go back during my elective time). By the end of the year I had performed 54 advanced airways, most of them in the OR. After many intubations in the OR, I had my first intubation in the ED. I was told I looked very relaxed the whole time even though the situation we were in was getting pretty crazy. I attest that to the anesthesiologists and nurse anesthetist who taught me their zen ways of the OR.

 

Toxicology came after which was another very useful rotation. It is a month spent with 4 dual-board certified toxicologists/ED attendings. It is spent doing lectures, having on-call time mixed in with ED shifts. I learned a lot this month and found it very useful.

 

We also do 2 weeks in CCU and 1 month in SICU. SICU may be the most challenging rotation but it is well worth it.

 

We do a trauma month which means we do a lot of overnights in the summer and therefore are managing a lot of traumas. I did 4 chest tubes this month. Enough said.

 

We also spend a total of 4 weeks in the pediatric section and 4 weeks in the E-zone (fast track area) split into 2 week blocks. I know no one does a fellowship to spend time in the fast track however I believe it is a very important rotation. It is where you see the bread and butter of emergency medicine which you don't always get in the main ED. The second week of fast track is done at the very end of the fellowship and gives you an opportunity to start working independently and improving your efficiency before going out into the real world which I found helpful. 

 

Other cool things I got to do was fly in a helicopter with LifeNet for a day, co-author a chapter in a PA emergency medicine book/journal, and go to San Diego for a conference for a week while staying at a house on the beach (that was mostly paid for with CME money). I can't finish this post without attesting to our program directors. They are such nice people who truly care about helping us excel. They understand you have a life out of work and are very accommodating.  There is no pressure to have you stay at Albany when you are finished, though they would really like if you did. They truly made this fellowship what it is. They listen to feedback and really try to make it the best experience possible.

 

Oh, one last thing. The attendings and other PAs there are very receptive to teaching which is nice. The medical residents and us get along pretty well too. We do a lot of things they do like Wednesday morning conference, etc so we get to know each other pretty well. I think with anything, as long as you are a team player with them, they will be the same for you. I only mention this because when I was deciding if I wanted to do a fellowship I wasn't sure if the residents wouldn't want us there or if they would feel we were stepping on their toes. This is definitely not the case in my experience.

 

Anyway, I hope that answers some questions! In the end, if you are deciding to do a fellowship/residency, I wouldn't hesitate. It was the best decision I could have made and don't regret it for a second. The knowledge you learn here you can take with you throughout your whole career and gives you a great platform to build upon. I can't attest to other programs as I didn't go there, but the Albany Medical Center ED PA Fellowship is where it's at!

 

Good Luck!

 

-Amanda

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Hey everyone, just wanted to give another update. If you have already read my previous posts, then you probably know I am a graduate of the Albany Medical Center ER PA fellowship from 2015 so I finished about 1.5 years ago. Since finishing my fellowship, I actually stayed at Albany Med and took a job working overnights in the ER. One of the greatest aspects about working my overnight shift is that there are very few residents and I (being the only PA on during the night time) work solely in the trauma section of the ER. I have to say that without a doubt it would be difficult to handle such an intense area of the ER. I don't think that I would be able to function so well if it had not been for my fellowship training. Additionally, having done a fellowship and having the skills and knowledge I acquired, the attending physicians love how autonomous I am. Since it is only myself and 1 resident in the trauma zone, when we have multiple trauma's or sick patient's simultaneously, I can manage them confidently, and the attending physicians love it. I continue to have the ability to perform all the procedures that I did during fellowship, which yet again would be a huge challenge if I did not have so much prior experience. Often, I go off by myself without anyone in the room and perform invasive procedures (i.e. chest tubes, central lines, etc). I have done so many at this point, that I even teach and let PA students do some of these procedures. It is also not uncommon that the attending physician will have me even teach some of the residents how to do these procedures, since I have done more than many of them.

 

Another area that I have now become more involved in is the academic side of things. I love getting to work with the current PA fellows and passing my knowledge to them, in addition to giving away procedures to them that I may have (which they greatly appreciate) because I want to help contribute to trying to make the program be the best experience possible for anyone that goes through it. Since I have so much ultrasound experience, I was even asked to be the point person that trains all the PA's on ultrasound. I feel very honored to still be a relatively new PA, yet because of how good I am at ultrasound, I am now in charge of training a large group of physician assistants (with many more years of experience than me). I have also become involved with SIM center training and myself and another PA have worked hard to try and make SIM training better than ever. I absolutely love my job, and I love all the emails I receive from everyone who has interest in a fellowship. If i've said it before, i'll say it again, hands down the best thing I ever could have done out of school. So for those that are interested, please do not hesitate to contact me as I am always happy to answer any questions that people may have. Williae1@mail.amc.edu

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Hey Everyone, 

 

My name is Katie and I am a current fellow ('16-'17) here at AMC. I just posted in the other group but thought I would add on here as well. I just wanted to reach out as I don't think you have heard from anyone in my current fellow class. As everyone has noted previously this has been an amazing experience. I am about 6-7 months in and have completed rotations in Ultrasound, Ophthalmology, Toxicology, Pediatrics, CCU, and community medicine. Currently I am on my airway rotation. Today we started interviews for the next class of fellows and one of the popular questions was "What is your favorite rotation so far?" For me that is difficult to answer because I really have enjoyed all of them, and learned so much on each and every one. I will say that following each rotation I return to the Emergency Department with more confidence in treating patients with those specific conditions. I still have a lot to accomplish and a couple more rotations left however I have learned so much over the past couple of months. As many people have mentioned before the procedural experience has been amazing. From what I have heard from prior fellows, when they look for jobs potential employers are always astounded at the amount of procedures we have under our belt (I will keep you posted on that one--I am just starting that process.) I also want to speak about the acuity of the patients that we see here at AMC. Many are very sick, therefore you are able to get exposure to a wide variety of pathology. I know that in comparing the patients that I see in a day to some of the patients my classmates from PA school care for is eye opening. At the same time the attendings that I work with have been really amazing. If you need help or guidance they have your back. They are also very open to teaching--and really pro-PAs (which unfortunately isn't always the case elsewhere). Our program directors are also amazing. They are always open for feedback and interested in making this the best experience possible. Every year they make subtle changes to ensure that we are getting the most out of our experience. I think the prior fellows in this blog have gone over the curriculum and process really well. If any of you have further questions or want to hear more about the process feel free to reach out to me. I am here to answer any questions you may have. Thanks. -K

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Hey everyone, 

      Graduate of the program here. This is a long overdue post. Have been meaning to put this on the forum for some time unfortunately life and work have gotten in the way. I want to offer a perspective of someone who has completed the program and since moved on to an entirely different location and non academic hospital system. For starters I want to echo the previous posters comments on the quality of this program. The program directors are excellent. Its a demanding year but I have to say that Adam will do everything he can to accommodate you during the process. The focus of this program is education. Yes you will pull many shifts per month and be required to attend many lectures conferences etc but 100% this program is about making you better. At no point did I feel as though this program was a waste of time nor did I feel I was being utilized as cheap labor. You are essentially completing intern year at an MD residency with great Attendings fellow residents rotations etc. Not all programs are created equal and though it may be difficult it will be up to you to ensure it is not the "residency" or "fellowship" that sticks you in triage or fast track paying you resident salary without appropriate learning opportunities. I have talked with graduates of such programs and several of my friends have regrettably attended such programs. As is mentioned previously in these posts there are a great deal of critical care opportunities and procedures. I didn't get quite the numbers that Eric pulled but I wasn't too far behind. Many people in these forums are asking the real value in such a program. I have heard many of my colleagues in school state that they would rather "learn on the job" or do a few years in urgent care and transfer over to EM to be proficient. These options are fine for the person that wants to stay in triage/fast track but lets not kid ourselves as there is no comparison in the work being done. The person seeing URI and sprained ankles for years will never get the hands on experience managing the actual sick patients. Several have also asked the question what is the point of learning how to operate at such a level if you're not going to be able to perform such work at your next job. The short of it is that you will be able to replicate the environment at Albany. When I was looking for jobs there was no difficulty finding positions. I currently have two jobs. The first one I obtained out of the program wasn't hiring however was familiar with the program and made a position for me. I was offered a sign on bonus and an hourly rate fitting for the experience I have acquired. At this point in my career I have worked RME/triage a total of 2 times. Both of my jobs are main ED coverage. I pick up charts alongside the docs interchangeably. I am credentialed at both hospitals for intubations central lines chest tubes etc. No one blinks an eye when I pick up the crashing patients. I can also say that having completed this program and being able to operate at a higher level in these ERs I have gained a great deal of respect from my SPs. I still study daily. Many hours spent with Mel and Billy. There is much for me to learn however this experience has given me a base for which to operate proficiently in a main ED environment. If youre serious about learning real emergency medicine and are fortunate enough to be offered a spot in this program I personally wouldn't hesitate to take the position. 

Thanks for the read

CB

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Awesome prospective CB. 

 

Currently plugging away in a residency now and it's good to hear perspective from "the other side." Even if I'm not in the same residency, mine correlates well. 

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