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Little HCE and PA school


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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...

 

Believe it or not there are docs out there that cannot interpret an EKG. Could it be that maybe many of the skills you listed as basics aren't even used in all specialties? There is life outside of the ER, believe it or not. While your 35 year old married with children medic might do great on your rotation with you, he may struggle in others as he has no experience with that specialty. And while that former surgical tech may struggle in the ER, they may rock in surgery.

 

Could it be that no one position prepares you for all specialties in medicine? And that being proficient in certain skills will vary heavily from 1 field to the next?

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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?

 

An interesting point to note is that, while the type of student you listed may be the one that struggles with the PANCE, they made it to the point of being able to take the PANCE. If you looked at the demographics of those that failed out of the first semester of PA school during the basic science portion (aka the individuals who didn't even make it to sit for the PANCE), it is probably the older, more clinically experienced individual.

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interpreting vitals and blood sugar isn't relevant to every field?

name recognition of common meds?

sterile technique? (even internists occasionally do punch biopsies in their office)

you think knowing cpr is a bad thing?

(surg techs tend to rock in the er as well)

 

I'm not saying hce is the be all and end all. folks still need basic prereq knowledge with a reasonable level of understanding( say 3.2 gpa) but what is wrong with looking at the whole package in applicants?

prior hce+grades+community experience, etc

why is it ok to accept someone with no experience but not someone with a gpa of 3.1?

a well rounded applicant makes for a better class across the board and these folks tend to migrate to positions that serve their communities as well as their pocketbooks. I wonder how many folks would go to pa school if the only practice options after graduation were fp, im, peds, ob, general surgery, and em(essentially primary care and primary care subspecialties)?

what? I can't do plastics or cosmetic derm m-th 10-4 for 150k? I'm outta here....

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interpreting vitals and blood sugar isn't relevant to every field?

name recognition of common meds?

sterile technique? (even internists occasionally do punch biopsies in their office)

you think knowing cpr is a bad thing?

(surg techs tend to rock in the er as well)

 

I'm not saying hce is the be all and end all. folks still need basic prereq knowledge with a reasonable level of understanding( say 3.2 gpa) but what is wrong with looking at the whole package in applicants?

prior hce+grades+community experience, etc

why is it ok to accept someone with no experience but not someone with a gpa of 3.1?

a well rounded applicant makes for a better class across the board and these folks tend to migrate to positions that serve their communities as well as their pocketbooks. I wonder how many folks would go to pa school if the only practice options after graduation were fp, im, peds, ob, general surgery, and em?

what? I can't do plastics or cosmetic derm m-th 10-4 for 150k? I'm outta here....

 

 

I've never once argued for no prior experience being acceptable ;)

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fair enough. and you won't see me arguing to admit someone with a 2.0 who was the best medic on earth. believe it or not I'm kind of an academic nerd myself( 2 bs degrees, a masters, a postmasters cert, several grad certificates and currently applying for a doctorate).

we can argue about what the prior experience should teach you but at least neither of us would accept a "4.0, daddy was a dr and I want to work in his office handing him stuff, no health care experience" applicant.

I'm guessing you wouldn't be a big fan of non-clinical researchers and medical receptionists either.

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Is there any useful advice for a student about to enter his/her first year in regards to reviewing/"learning the basics." In particular I'd like to review reading an EKG, setting up a suture set and subcutaneous/IM injections. I'm not asking to be criticized for my lack of experience. I'm asking for good references to review.

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fair enough. and you won't see me arguing to admit someone with a 2.0 who was the best medic on earth. believe it or not I'm kind of an academic nerd myself( 2 bs degrees, a masters, a postmasters cert, several grad certificates and currently applying for a doctorate).

we can argue about what the prior experience should teach you but at least neither of us would accept a "4.0, daddy was a dr and I want to work in his office handing him stuff, no health care experience" applicant.

I'm guessing you wouldn't be a big fan of non-clinical researchers and medical receptionists either.

 

I'm all for getting your hands dirty and learning some humility before going to pa school. There is a lot to be learned as a lowly assistant regarding the patients... you are able to spend much more time with patients and tend to get an earful as to what they like/dislike about any given provider. You learn how to interact with patients and their families, to lay your hands on a patient (can be a bit foreign at first...), how to react to difficult scenarios, and of course any skills that are required for your job along the way.

 

Someone that has never worked with patients/never worked in a medical facility probably wouldn't even be sure if medicine is for them.

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tjb15-for ekg's memorize dubin's rapid interpretation of ekg's cover to cover. it's a very easy, interactive read. you can do it in an hr or 2.

the best way to learn hands on clinical skills is to have someone demo them for you so talk to a nurse or tech that you know and they can teach all 3 of these things in about 15 min. and have them watch you do them. I usually let my students stick me for blood draws, iv's, etc but if they prefer an orange or straws that works too.

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Is there any useful advice for a student about to enter his/her first year in regards to reviewing/"learning the basics." In particular I'd like to review reading an EKG, setting up a suture set and subcutaneous/IM injections. I'm not asking to be criticized for my lack of experience. I'm asking for good references to review.

 

IM/subQ injections will be learned in PA school and probably wont even be something that you do often/ever so waiting until PA school to learn this would be fine. There are many texts available for EKG interpretation... amazon is your friend. Start with the basics and work your way up to 12 leads. It really isn't all that complicated with a little practice. Suturing again will be learned in PA school, if you want to do a little research look up simple interrupted, inverted interupted, running subcuticular, veritcal + horizontal matress, etc. and how to tie and surgeons and a square knot. Again not very complicated, just takes some practice and getting used to.

 

The thing that was most helpful to me prior to starting PA school was an old step 2 study guide (I'd probably recommend a pance review guide now). Basically a run down of each disease in 0.5-1 page. It will introduce you to many terms and different pathology. If you have some time and are looking for something to fill it with, this isn't a bad idea.

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Something else to go along with the experience argument. What if you shell out over $100k and two years of your life and find out you don't like working in medicine? Not always, but mostly you will be hands on with the sick and or injured. I once worked with a FP Resident. Very intelligent but hated patient contact. She even admitted she didn't like to touch or be around "sick" people.

 

Any kind of patient contact helps a person determine if this is something they want to do. You don't get that from academia. All senses come to the forefront. People smell, vomit, bleed, pee, pooh and express pus when you least expect it.

 

The good part about being a PA is we have some lateral mobility to a different field. Personally, I'd rather flip burgers than work in pediatrics all the time. It is like being a veterinarian. I don't care how many clowns or lollipops are on my lapel, a two year old starts screaming as soon as I walk in the door. A 15 month old is like an Alzheimer's patient with a better prognosis, don't trust them. If you examine a male babies abdomen you better have a towel over his groin. If not sooner or later you are going to get a shower.

 

I still love it though.

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IM/subQ injections will be learned in PA school and probably wont even be something that you do often/ever so waiting until PA school to learn this would be fine.

peds/fp:vaccinations, depo provera injections, vit b-12 shots, insulin

ortho/rheum/IM: need to know these before you can do joint injections or trigger point injections

psych: long acting antipsychotic meds come as depo injections(haldol, etc)

em: goes without saying- I do multiple IM/subq injections daily(some nurses can't give insulin, narcs, etc)

neuro: botox as migraine prophylaxis

IR: all about needles

derm: lots of injections

 

sure, you can learn this in school but it's a less than a 1 hr skill to pick up and master so why not learn it now?

you will notice suturing was not on my list. neither was iv starts(harder than you might think).

my previous version of this list in a similar thread included venipuncture but I removed it(under protest).

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The thing that was most helpful to me prior to starting PA school was an old step 2 study guide (I'd probably recommend a pance review guide now). Basically a run down of each disease in 0.5-1 page. It will introduce you to many terms and different pathology. If you have some time and are looking for something to fill it with, this isn't a bad idea.

"primary care secrets" is also a good review text with 1 page entries on general medical topics like anemia, heart failure, etc

great for boards too.

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dm123-

agree about infants. I like peds procedures and fixing sick kids. what I don't like is the 3 hr workup of febrile babies I know aren't sick from the doorway but have to work up to prove that to the parents....septic workups, hate them.

at my per diem job we sign up for sections of the er. I always do adult, never peds.

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I think this was a great thread-- as it morphed through several themes, there were some good arguments in there. For me, I sum it up as:

 

We need to learn a LOT of material in 12 months to prepare us for clinicals, which can hopefully land us our first job out. I see this as the end goal for PA school to start that next chapter of my life. To get there, I'm shelling out around 100k plus opportunity costs and I damn well don't want to miss out on some of the advanced things we lose to basic material because of time constraints. A room full of 1K+ HCE'ers can breeze through some of the clinical assessment and procedural stuff faster than a room full of medically green folk. I multi-disciplined cohort can feed off of each other and yes, humility for what I excel in will go a long way-- i'm certainly no egotistical hot shot-- i just want my money's worth and dont' want to feel let down by my learning experience. Hopefully there will be those that excel in the sciences to balance a give and take to assist with the chem acid-base balance and genetics material that I'll struggle in.

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Phrases such as "have some humility" or "on a soapbox" tend to have a negative tone. "What we have here is...(say it with me...) a failure to communicate." (my apologies to Paul Newman and to those who have no idea where that movie quote came from)

 

I don't think anyone here is some gunner trying to top out by stepping on or putting down their classmates/peers. We have a few different opinions about what is needed in, during, and after PA school and those opinions are all ok. We are all entitled in our opinions and by virtue of partaking in a message board forum, we consent to being subjected to each others. We will each find our path. We have seasoned vets who have been working in the field for years, we have current students in different phases of their education, and pre pas hoping to toss their hat in the ring...all different points of view based on their own experiences. Around 140 programs in the nation and even the higher ups who make the curriculum can't agree what creates the ideal PA. Thankfully, we get to shop around and find what school works best for each of us.

 

I am from the camp that believes if I am spending this much money, attending a program that prides itself in its students having significant health care experience, with the current matriculated class having over 6 years of experience/person on average, I really hope I get challenged by my classmates. It is not from a lack of humility, it is from a desire to be challenged. Genetics, molecular chemistry, advanced pharmacology, infectious disease, courses that have words that this native English speaker can't pronounce scare the heck out of me and I'll be looking around the room for a study buddy who can help me out. But at the same time, I surely prefer to have more class time discussing the courses that scare me than spending time covering material that is taught in the first week of CNA/MA/LPN/EMT schools. That is my opinion and it's ok to have one. It doesn't make me a schmuck...it makes me human.

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  • 6 months later...

Yes I know I am digging up an old one...

 

I can't help think that schools are not simply shunning those with 10,000 medic hours for the sake of a .1 difference in GPA. It is very difficult for me to think of this whole issue without thinking that the reason why schools are not "requiring" such high standards for HCE is because there just aren't enough applicants out there that could meet both standards of super high quality HCE hours AND being academically strong enough to meet the rigors of the program. So for the sake of producing enough PA's to meet the need of society, standards must be adjusted. If there are a ton of medics out there with strong 3.6 - 4.0 GPA's academic backgrounds that were applying to PA school, I am sure they are getting picked first. I don't think anybody would deny that. The shift is merely an opening of the bottom end to prop up the numbers, and realizing that 1000 hours as a patient care tech is often sufficient to produce a high quality PA. I don't think anybody would deny the value of extra experience. I couldn't come up with a figure for what the minimum should be. Often times the value of an applicant is not as black and white as a hardfast set of numbers. I am sure there is a paramedic out there with a 2.5 GPA that would make a great PA... as well as a 4.0 student with no experience that could as well. But short of picking those out of the hay stack... there are typical numbers that tend to predict the success of a potential PA that fall somewhere between those extremes. But if the expectation were to be 10,000 hours as a medic and a 4.0 GPA, there wouldn't be much of a profession to even have this debate about. I think many of us can admit that the academic discipline needed to maintain a 3.0 vs. a 3.9 is GALAXIES apart; as well as the kind of experience that a 10 year medic would bring to the table vs a 6 month CNA. Is there room for a 10 year medic with a 3.1, yes. Should there also be room for the 6 month CNA with a 3.9, yes. But I guarantee that the 10 year medic with a 3.9 is going to get picked first... as he/she should. But after all those applicants are picked, who's there to fill in the rest of the 28 spots in the program? A bunch of average numbers that have question marks everywhere...

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  • 3 weeks later...

Im sorry but you guys really seem to be oversimplifying medicine.

 

Sure you can take a BP - but PA school will explain to you why/how this BP is high/low, differentials, and how to treat it.

Sure you can do phlebotomy, and deliver blood to a lab, and get back values, but PA school will explain to you what that hypocalcemia, or hyperkalemia might be caused by, and how that might show on an EKG.

And i'm sorry - but if you really really think you learned how to "read" an EKG in 60 minutes, you're all crazy. ED doctors practice EKGs constantly. it takes time, skill, and patients to master the EKG. sure a-fib is pretty easy to catch, but what about a pulmonary embolism on ekg.

 

And learning HOW to obtain things, is really important. An ABG can easily be ruined if not obtained correctly. And I've seen them ruined by medical students and PA students who didn't pay attention in class because they thought it was boring. a catheter in a uterus is very different than a catheter in the bladder, and is done a lot by students who didn't pay attention. and a incorrectly placed intubation can kill a patient. so dont belittle the classes that teach you how to do things. and no school is every going to fail to teach you how to interpret the information you have. Other wise you'll never pass the boards.

 

 

Pa school will give you the knowledge to pass the PANCE and get you a job. but you will have so much to learn for years and years to come. I know I do.

 

And while HCE does help, it helps in the sense that you will grasp some things easier than others. but everyone will have their strengths and weaknesses. My background was stricktly surgical, in ENT, plastics, opthamology, and orthopedics. it helped a ton. but not in neurology, not in psych, not in cardiology, and more. those classes were brand new information for my brain to process. Don't be intimidated by not having a ton of HCE. you will learn and experience things in PA school that you will only learn and experience in PA school. everything before PA school might help, but it wont make you a PA.

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This ^^ by the way was in response to mostly the first page of PA students/prePA...

 

and with further reading - it almost seems like a lot of you expect yourselves and your classmates to know how to be PA's before PA school even starts. I'm not saying knowledge before hand isnt helpful, but seriously, if you expect yourselves and your entire class to know everything about medicine before hand, why even bother being a PA? I mean, if as a medic or an EMT you do all the same stuff, whats the point. the paycheck?

I became a PA to grow in medicine, and learn more than I could in the career i was in. And the things I learned blew me away - it kept school engaging, and interesting. who wants to sit through 40+ hours of lectures a week on things you already know? with these kind of expectations to pre-req for PA school..i dunno it just seems counter productive. trust me - school will weed out those who can't hack it. and HCE isn't everything. We had a 10 year EMT in my class with a great GPA who couldn't and he failed out fairly quickly. On the other hand our valedictorian did go right from highschool to BS to PA school, spending only her summers volunteering and shadowing, and she did so well on rotations she got offered jobs by most of them.

HCE absolutely helps, but if you go in with an attitude that you already know all this, and lets skip on to the "more important stuff" (btw - its ALL important), you won't just have to worry about your classmates not liking you. The professors won't care for that kind of attitude either. No matter how much you know - there is always more to learn.

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  • 2 weeks later...

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