Little HCE and PA school

[tjb15]

I have little HCE, and I'm just wondering how much more difficult PA school will be for me. Any insight?

[acozadd]

Everyone is different... it may vary from not more difficult at all to quite a bit more difficult. Any stereotyped answer likely will not apply to your personal situation.

[cinntsp]

It's all relative but you have to take into consideration that there are schools out there that require no HCE. That tells you that it is believed and has been demonstrated that strong academic performers can still do well in PA school, pass the PANCE, and go on to be successful providers. Will it be harder for you than someone with a couple of years as an EMT or respiratory therapist? Probably.

[FriarMedic]

I recently read a PA student's blog posting that talking about a clinical skills day they had in which they practiced taking vitals, drawing blood, and placing ekg leads. This actually made me really sad because i feel everyone starting PA school should know how to take a blood pressure. Phlebotomy and ekg...ehhh I guess I can see. I will feel very under challenged if were starting out taking blood pressures in PA school. This is why I'm applying to programs that require at least 1k hours, but honestly those are few and far between it seems.

[marilynpac]

I have little HCE, and I'm just wondering how much more difficult PA school will be for me. Any insight?

 

It depends, some people have more knowledge about medicine than they think. What PA school have you been accepted to?

[cinntsp]

I recently read a PA student's blog posting that talking about a clinical skills day they had in which they practiced taking vitals, drawing blood, and placing ekg leads. This actually made me really sad because i feel everyone starting PA school should know how to take a blood pressure. Phlebotomy and ekg...ehhh I guess I can see. I will feel very under challenged if were starting out taking blood pressures in PA school. This is why I'm applying to programs that require at least 1k hours, but honestly those are few and far between it seems.

 

Well I think everyone should go in with a thorough knowledge of phlebotomy and laboratory values. ;) Many people come from health care backgrounds that don't involve taking blood pressures or placing ekg leads. I'm sure you'll see some of them in programs that require HCE but not direct patient care.

 

Besides...can it ever hurt to review the basics?

[Just Steve]

Besides...can it ever hurt to review the basics?

 

I realize this is a digression but right now I'm freaking out how to pay for PA school so this point hit home....

 

I about to hand over close to 70 grand for an education that is to build upon...up on .....aka: to move on from where I am now. If my cash goes to teaching me how to do procedures that are this basic I will be SORELY disappointed. Then again...if they teach it in the middle of the didactic year when my brain is bubbling over with bio chemistry and crazy pharm information, the break back to super basic land may be welcomed.

 

I would much rather get a class in that which begins with "Ok...everyone get a lab sample and an ekg from your partner, then lets run the labs and analyze the values, talking about the findings" Not a class on how to obtain the samples/tests, but a class on reading what you just obtained. i guess time will tell

[EMEDPA]

actually many medics/nurses/resp. techs know how to obtain and interpret ekg's before day 1 of pa school. most of them know common lab values and interpretation as well.

[Joelseff]

would be fun to learn how to collect blood and set up an ekg, but im more worried about interpreting them. i will even go a step further and say that i hope that when i get to go to class, they start off with "ok, we are going to let the MA's collect the blood and obtain an EKG. now we will drum into every bit of information and minutiae that we can on how to interpret the values and treat them". i cant learn those things in nursing school, MA school, paramedic school, undergraduate, or on the job. and look at it this way, the same situation may come up when they start talking about genetics concepts, and....WHOA!.... never took genetics! having holes in background knowlege comes in different flavors.

 

I actually learned how to read 12 lead in 15 minutes from my P-Medic Classmates vs the 4 hour lecture my program gave us...oh yah and Dubin's book! Thanks Guys you know who you are :wink:

[acozadd]

I realize this is a digression but right now I'm freaking out how to pay for PA school so this point hit home....

 

I about to hand over close to 70 grand for an education that is to build upon...up on .....aka: to move on from where I am now. If my cash goes to teaching me how to do procedures that are this basic I will be SORELY disappointed. Then again...if they teach it in the middle of the didactic year when my brain is bubbling over with bio chemistry and crazy pharm information, the break back to super basic land may be welcomed.

 

I would much rather get a class in that which begins with "Ok...everyone get a lab sample and an ekg from your partner, then lets run the labs and analyze the values, talking about the findings" Not a class on how to obtain the samples/tests, but a class on reading what you just obtained. i guess time will tell

 

Everyone will have their strengths and weaknesses entering the class and while you may feel proficient in one area and bored that others do not already know this, I can guarentee the role will be reversed at some point.

 

Learning how to take a BP will consume about 5 minutes of 1 PD lab, you will survive.

[Joelseff]

but medics/nurses/resp techs learn and operate those in the scope of being a medic/nurse/respt tech, and not as PAs. i learned to obtain and interpret ekg's as a CNA and as an undergrad, and obtained them as a CNA...and even in my current role. but i wasnt a PA student. i also know a little bit about lab values, but I'm not superman when it comes to interpreting labs. i will still need to know how they fit into my role as a PA. so ill be sitting forward in my seat and paying attention whenever lab value discussion comes up, because there certainly is more for me to learn.... and it will be even more important for me to understand that knowlege in the context of performing as a PA, and not as a med tech. im not telling everyone that they have to be a trained med tech to be a good PA and understand lab values. if i get into a program that teaches me something i already know, then thats great because its review for me, and news to someone else. according to joelself, reading a 12 lead can be picked up in as little as 15 minutes with the right kind of instruction, which sounds about right. id say that it proably took me about an hour to get the hang of it, but i wouldnt say im really smart.

 

I think you are overplaying the role a PA has when reading EKG's. At least when it comes to PAs vs Medics. I dont think that the medics were reading them in a different context. They look for rate, rhythm, regularity, morphology etc... I dont see how a medic who picks up a 2nd degree Wenckebach on a 12 lead reads it differently as a PA? maybe you can elaborate?

[FriarMedic]

Everyone will have their strengths and weaknesses entering the class and while you may feel proficient in one area and bored that others do not already know this, I can guarentee the role will be reversed at some point.

 

Learning how to take a BP will consume about 5 minutes of 1 PD lab, you will survive.

 

Thinking about it, youre right in that learning the skill to take a bp takes 5 minutes. But i can assume if someone doesnt know how to take a bp, then they dont know appropriate measurements in the context of sick vs not sick. Which means they cant recognize sick vs not sick because it does take some time to recognize and respond appropriately to these signs. Which is why i hold schools requiring hce in higher value.

[LESH]

Everyone will have their strengths and weaknesses entering the class and while you may feel proficient in one area and bored that others do not already know this, I can guarentee the role will be reversed at some point.

Right on!!!:wink:

[EMEDPA]

Thinking about it, youre right in that learning the skill to take a bp takes 5 minutes. But i can assume if someone doesnt know how to take a bp, then they dont know appropriate measurements in the context of sick vs not sick. Which means they cant recognize sick vs not sick because it does take some time to recognize and respond appropriately to these signs. Which is why i hold schools requiring hce in higher value.

exactly!

regardless of background I think there needs to be a list of basic knowledge we hold applicants to....

[acozadd]

Thinking about it, youre right in that learning the skill to take a bp takes 5 minutes. But i can assume if someone doesnt know how to take a bp, then they dont know appropriate measurements in the context of sick vs not sick. Which means they cant recognize sick vs not sick because it does take some time to recognize and respond appropriately to these signs. Which is why i hold schools requiring hce in higher value.

 

Unfortunately for you, you will cover that material in physiology, cardio, ACLS, PD, and many other times...

 

If you hold that attitude while in a PA program, you will not be well liked. As mentioned, everyone will have their strengths and weaknesses and you are there to help eachother, not compare prior experience to see whose balls are bigger. A little humility will go a long way.

 

PS even the schools that do not require prior HCE will probably have an average HCE over 1000... just because something isn't required doesn't mean those that get accepted do not have it.

[Just Steve]

Unfortunately for you, you will cover that material in physiology, cardio, ACLS, PD, and many other times...

 

If you hold that attitude while in a PA program, you will not be well liked. As mentioned, everyone will have their strengths and weaknesses and you are there to help eachother, not compare prior experience to see whose balls are bigger. A little humility will go a long way.

 

PS even the schools that do not require prior HCE will probably have an average HCE over 1000... just because something isn't required doesn't mean those that get accepted do not have it.

 

I truly appreciate your point of view about humility and such and I totally agree. I hope there are others who are far more trained in certain areas than I and I look forward to learning from them, as I hope there is some reciprocity in times that I have something to contribute. However, I think there should be a minimum of how basic our instruction needs to be in PA school. If we go down the road of "re learning the basics is a good thing" road, then how basic do we go? We can make arguments for any level of instruction that we have gathered throughout our education and say "isn't it good to review?" In my opinion, I think coming to PA school with a set of basic skills is beneficial to the learning process.

[EMEDPA]

what constitutes new material, or review material varies from person to person. what may be basic knowlege for one persons background will be different from others, wouldnt it?

not if there were required min skills/abilities.( this is esentially medical asst. or er tech level skills requiring 6 months OR LESS of training to a high school grad)

FOR EXAMPLE:

obtain and interpret all VS including sao2 and obtain/interpret blood sugar readings

basic knowledge/NAME RECOGNITION of common medications(very basic...pcn is an antibiotic, atenolol is for blood pressure, morphine is for pain, dilantin is for seizures, etc)

know how to do basic splinting/bandaging.

know how to give IM/subq injections

know how to give oxygen by cannula and by mask. also how to set up and give nebulizer tx.

know how to use a bvm

know how to obtain an ekg or rhythm strip(basic arryhthmia analysis would be nice as well....)

basic knowledge of sterile technique, how to set up a suture set, etc

perform cpr and apply aed

know how to stop minor/major bleeding

 

the above skills are very helpful for a future in primary care, em, ortho, etc

sooner or later most providers (even in specialty offices) require these basic skills. everyone should know how to manage the above issues in their office setting for the 10-15 min it might take for ems to arrive for the old lady who collapses in the waiting room, the dizzy diabetic, the guy on coumadin who cuts himself with a kitchen knife, the pt stung by a bee right outside your office who is allergic, etc

[acozadd]

I truly appreciate your point of view about humility and such and I totally agree. I hope there are others who are far more trained in certain areas than I and I look forward to learning from them, as I hope there is some reciprocity in times that I have something to contribute. However, I think there should be a minimum of how basic our instruction needs to be in PA school. If we go down the road of "re learning the basics is a good thing" road, then how basic do we go? We can make arguments for any level of instruction that we have gathered throughout our education and say "isn't it good to review?" In my opinion, I think coming to PA school with a set of basic skills is beneficial to the learning process.

 

Well with that said, I believe everyone should be very well versed in the basic sciences like anatomy and physiology... imagine how much more you could accomplish if everyone was already proficient in these areas and we had another 2-3 months of class dedicated to something other than the basic sciences. It's a slippery slope when you start setting minimum guidelines. Plus there are so many topics that schools are required to cover just to be accredited, and I'm sure that ekg interpretation and the others that have been mentioned are certainly on that list. FWIW many of the brightest people I've met in my class didn't have the HCE we are talking about in this thread. These boards provide a VERY skewed level of perspective, so keep this in mind when making your opinions.

[EMEDPA]

FWIW many of the brightest people I've met in my class didn't have the HCE we are talking about in this thread. .

these people have yet to prove themselves in clinicals. believe it or not many of these folks flail when confronted with pts. because they don't act like a "standardized pt" should.

a few yrs ago I had to fail such a student who had a phd in microbio and a 4.0 in didactics....he went on to fail out of pa school when he failed his next rotation as well.

[EMEDPA]

but should admins expand the list beyond just the hands on stuff... maybe add some guaranteed genetics or ochem skills in there so everyone is up to speed on that knowlege before they hit class on day 1?

basic genetics is covered in every 1st yr bio series and all pa programs require at least 1 yr of bio.

if you were going to require a single course before pa school I would require a full yr of a+p with cadaver dissection.

o-chem is fairly worthless clinically and is not represented anywhere on pance or panre. you learn all the biochem you need to know in the context of principles of medical science and clinical medicine courses. many programs neither require it or expect you to understand ochem(including medex, arguably a top 3 program on anyones list). medex is one of the few programs which went from a cert. to ms option without requiring the full monte of medschool prereqs and that is how it should be.

honestly if someone is going to take calc, biochem, o-chem, etc they should just bypass pa school entirely and go md/do. the in depth basic medical sciences are required for medschool as a background to a few specialties which require them. I still believe that an md can practice primary care well without ever having been exposed to o-chem, not so an md/phd who wants to do drug design and trials. biochem has some value and can in fact be taught without o-chem.

o-chem for pre-pa's is just a weeder class. if you don't want to take it, don't. lots of great programs don't require it.

[EMEDPA]

 

 

is not knowing how to...read an EKG really a big enough problem that everyone needs a bootcamp before school?

it's a problem if you can't do it after you graduate from pa school.....in my experience maybe 20% of pa school grads actually have a good undertsanding of reading an ekg and use a method for every ekg every time. I didn't learn that method in pa school, I learned it in medic school. we covered ekg's for maybe 2 hrs in pa school didactics(mostly because it was assumed everyone already knew ekg's). sure, everyone knows the arrhythmias from acls(hopefully) but what % of new grad pa students can tell you which leads corrrespond to which anatomic distributions and can say " see, st depression in 1, avl, v5, and v6. that's lateral ischemia..."
sidebar on ekg's- this is how I teach my students:
rate ( 300, 150, 100 method, 6 sec strip method for irr.)
rhythm(with arrhythmia ID)
blocks( av and vent.)
axis
hypertrophy ( left and right)
ischemia/infarction.
memory device: Rabid Rat Babies Ate Herman's Icy Iguanna.
once they have that down you can talk about effects of potassium, hypothermia, etc and start to address management of abnl ekg's. if you don't know this stuff we will spend a day of your clinicals learning this basic material which could be spent on more advanced topics....and that is true for each thing on my prior list. if you don't know how to make a basic splint for example you will need to learn that before we go over how to reduce a boxers fx, if you can't use a bvm properly we need to learn that before we cover intubation, etc, etc, etc, etc
the more basics I have to teach you on your em rotation the less time we will have for the more adv. topics....

[EMEDPA]

you are right, most of those things i learned in and just after high school.

 

.

 

and those simple things will set you apart from the 50%+ of your classmates who don't have these basic skills and didn't bother taking the time to learn them in prep for their lifelong career....pathetic, isn't it....

[acozadd]

and those simple things will set you apart from the 50%+ of your classmates who don't have these basic skills and didn't bother taking the time to learn them in prep for their lifelong career....pathetic, isn't it....

 

And there will be equally as many things that set those other 50% ahead of you as well... We might as well just ask all PA schools for their entire curriculum and read up on every topic BEFORE going to school so that we can REALLY show them!!! That's what it's all about here, right?

 

pathetic is right

[EMEDPA]

nope, just the basics...it's all about how we define what is basic and what isn't.

let's revisit this discussion when you finish clinicals and you can tell me who their best students are then..and who got jobs right out of school.....I have a feeling it won't be the candy strippers or researchers....

review some posts here about "taking pance for the 5th time","why can't I find a job", etc

the vast majority are written by folks without prior significant experience.

I will admit that there is the occasional student without experience who does well, but wouldn't that same student do even better with a yr of experience under their belt?

[EMEDPA]

And there will be equally as many things that set those other 50% ahead of you as well...

 

sure, but last time I checked being able to diagram the krebs cycle from memory didn't make anyone a better clinician but knowing how to interpret an ekg in your sleep does...