True Anomaly

The residency experience

83 posts in this topic

Since some folks expressed interest in me doing some sort of journal of my foray into the residency world, I thought I'd keep a running post on this board as opposed to doing some sort of blog- mostly because it's easier to just post here than to maintain some separate website. I'm all about efficiency and convenience :D

 

If there were a hundred different blogs about PA's in residency, I wouldn't even think of doing one. Since there isn't even one, and I know there are some of y'all out there weighing the pros and cons of such a program (like I spent the last 3 years doing), I'll try my best to be your tour guide (or something equally cheesy)

 

So, enough of that crap....

 

The first week of our emergency medicine residency is over, and already this is a rather humbling experience. Myself and two other PA's are currently going through orientation with 12 physician interns- they make no distinction between us. Orientation is a month long, where we will be spending most of the days in a conference room doing lectures; so far it's only been ER-specific legal issues, but we will soon cover some broad-based topics that help introduce us to emergency medicine. This will cover not only systems-based problems like pelvic pain, altered mental status and acid/base disorders, but also logistical issues like how the local EMS system works and ER chart review and quality assurance lectures. There are days set aside for PALS, ATLS and ACLS, as well as bedside ultrasound training and advanced airway techniques. And this ALL occurs before we even start our formal rotations in a month.

 

What makes this humbling is that we've already got the sense that this is one big powerhouse of emergency medicine training, with not only the great expanse of pathology that is seen, but also with who is doing the training. The attendings here are at the very forefront of shaping emergency medical care in this country (Drs Levitan and Jaslow, who are both experts at advanced airways and EMS, respectfully, are both attendings here). It really feels like I "backdoor'd" into a top physician residency program...but I'm okay with that :)

 

Even though formal shifts don't start until late July, we do have some "ED-lite" shifts every so often this month, where we may work an occasional 6-hour shift during the week or a 12-hour shift on the weekends. The idea of course is that we get our feet wet without being thrown into the deep end. This is unlike the other departments in the hospital, where they immediately start their interns on shifts as soon as possible. Both the PA's and the physician interns are doing the exact same thing this month.

 

Even though this is the very first time they've had PA interns join the physicians during the same orientation (we're the second class of PA's to start here), everyone has immediately been very open-armed with us and has been a pleasure to deal with. We're all gelling pretty well, and it's nice to hear the new docs talk about their positive experiences with PA's when they were going through med school rotations. I like to think that our mere presence helps reinforce the idea that PA's work hand-in-hand with the docs, and will be something they'll never forget no matter where they end up as attendings.

 

There is, of course, a MOUND of reading to do, but having very few shifts to do this month enables me to spend as much time as I want to review stuff while also picking up detailed facts that weren't covered in PA school. The books we've been given are exactly what you want: Rosen's, Roberts and Hedges Clinical Procedures in Emergency Medicine, An Introduction to Clinical Emergency Medicine, Levitan's The Airway Cam, and Guide to Intubation and Practical Emergency Airway Management; plus the necessary materials for PALS, ATLS and ACLS.

 

Friday was the graduation of the senior residents, plus the intern's white coat ceremony. Despite my opinion on the white coat which I've expressed before on the board, it was a rather proud moment to get a long white coat with "True Anomaly PA-C, MPAS" on the front- like hell, I actually accomplished something! I'm also damn glad this coat is MUCH thinner than my PA school coat, so less overheating! Later on this month, we'll be getting six sets of scrubs with our name and stuff embroidered on it- hopefully before my first ED-lite shift in another week!

 

Other than getting more detailed, that's about all for now! I plan to keep these rather broad, and can post further entries at whatever interval suits me :) If one of the moderators wants to make this a sticky, that's cool. And if any of y'all have specific questions about stuff I post here, feel free to PM me.

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many thanks for spending the time to fill us in. an EM residency is something that i'm potentially interested in doing in the future, so it's great to read about your experiences thus far. please keep them coming! =)

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Consider it stuck....

did I mention I am incredibly jealous of this great opportunity you are getting?:D

make us proud!

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Sounds awesome! I look forward to reading your posts and thanks for taking the time to post about it!

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Oh my goodness

This could be the best post I have read! I appreciate the feedback so much and want to know every detail

I'm also very jealous!

Keep it coming......btw....which program is this?

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OUTSTANDING1 I'm a refuge from the now defunct LA County General Hospital EMPA residency. It was one of the painful and rewarding things that I've ever taken on. And it was worth every minute. Drive on my man. And have the time of you life!!!!!!!!!

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Very, very cool! Thanks for doing this so the rest of us can live vicariously through your......learning/torture/awesome experience.

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Thanks for doing this! Since I am seriously considering doing a residency when I finish school, I really appreciate you posting your experience! Can't wait to hear more!

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Your program sounds just like mine with the Air Force associated with Wright Patt AFB and Wright State University Emergency Medicine Residency. This was a great time and a lot of hard work. Good luck your going to love it!

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What is a PA residency? Are you still a PA when you are done with it or what?

after you finish pa school you can do an optional residency.

see www.appap.org

you are still a pa when done, just a smarter and more marketable one who can demand a higher salary and greater degree of autonomy.

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Sounds awsome! Where are you training?

Bon Chance!!

He's at albert einstein in philadelphia. the place is a major knife and gun club.

he will come out of there an em stud!

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Hey True Anomaly;

Have you met Thomas Marchiondo, DO, FACOEP? He came and spoke to us at Drexel about Respiratory EMED. Fun he called that place the N. Philly Guns and Knife club. Can't wait to view the experience through your eyes.

 

Kev

PA-S Drexel 2010

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The month of orientation is now over. There had to been just a LITTLE jealously among interns on other services when they see we were only working once a week and otherwise were taking classes during the day, but this has really helped in transition into the culture here. Now we're free to fall flat on our faces :D

 

As I mentioned before, we were also going to be put through ATLS, ACLS, PALS, an ultrasound course as well as an advanced airway introduction. The airway course was taught by Dr. Levitan, and it was basically a truncated version of the course he puts on in Baltimore with the cadavers; he let us play with all his airway toys and demonstrate how they're REALLY supposed to work (that Airway Cam is nice when used properly!). Getting a crash course in ER ultrasound showed us how to do a FAST exam, diagnosing IUP's, looking for a pneumothorax and how to place US-guided central lines; it was even cool to see how you can differentiate cellulitis from an abscess on ultrasound. ACLS was a nice review, but the added bonus is they're gonna allow us to get our ACLS instructor if we so desire. ATLS was a little strange- it wasn't quite clear how we were going to be certified (which I know quite a few of you here have had some difficulty with), but we went through the course and got to practice all the skills, which I didn't have a chance to practice in PA school. I recall during ATLS thinking how we were being granted "access" to some super-secret knowledge base that only the ACS knows...which just makes them look silly compared to the AHA giving ACLS/PALS to everybody.

 

The handful of shifts this month have been....well, they've been ER shifts, and most of you know how that goes. There's definitely been some exposure to that "knife and gun club"; my very first patient there was someone with an open mandibular fracture who was just "bending down to tie my shoes, and the guy just came up and hit me". But there has been no pressure to "move the meat", as they constantly stress- they want us to work through things as much as we can and ask any questions we need to. I know that if this was a job, they would've been cracking the whip from the start. I was surprised that we do our own splinting, since as an ER tech in the past that fell under my scope, but it's been good to get that down pat- plus we're free to do our own IV's, blood draws and other basic procedures if we want to (and hey, I was only an EMT, so I didn't have all the practice with IV access in the past).

 

Having time to explore the city has been the other big benefit of this month, and we've done our best to take advantage of it. Not just checking out what's in town, but getting to see some of the outer regions (took a nice trek through the Delaware Water Gap last weekend), and even a night down in Atlantic City :D. Transitioning to the city has been a breeze.

 

Thankfully I'm starting right in the ER; next month though I'm going to the surgery service, something I'm not quite looking forward to- but at least I'll get it out of the way. At least it'll be a better experience than what I had during PA school. Other rotations this year are in Tele, Anesthesia, Rads, OB and Trauma. Peds and rotations like that will come in the last 6 months of the residency.

 

Overall, this is turning out exactly how I hoped it would. But once the hours really start to ramp up, we'll see how I feel then :D

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Thanks for posting an update! Sounds pretty awesome so far and definitely what I'm looking for in an EM residency if I end up doing one! Keep us posted on how things are going for you!

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This is so awesome that you're sharing this with us TA. You may know that we at MCG lost funding this year for our EM residency which is a huge bummer. I may have some students who want to come up your way. Nice to be able to tell them about your experiences! Keep it coming.....

L.

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Hi Everyone,

 

1st: Congrats TA on the EM residency; I hope you enjoy it! BTW u r working with 1 of my fellow PA's from PA school!

 

2nd: I'm in a Surgical Residency Program in WI, they only take 2 PA's / year. Just thought I might throw some of my experiences in here as well. As I know this was a tough decision for me to make, to attend a residency program.

 

I also moved across country to WI; I do not have any ties here & have never been here before I interviewed. I did get a loft apartment within 1 mile of the hospital in a great little town, with underground parking! :rolleyes:

 

This residency program is affiliated with the Medical School of WI and has 2 very large hospitals: The Childrens hospital is rated #3 in the US and is a Level 1 Trauma Center. At our disposal is online access of the Library with numerous textbooks, videos, Up-2-date, MD Consult. etc; we can access from home.

 

The residency PA's come in Mid June for 2 weeks of orientation; Specifics on Post Grad. PA orientation: we reviewed high yielding topics for surgery: Antibiotics in Surgery, Complications in Surgery, Blood products, IV fluids, TPN, Wound Healing, Chest Tubes, Surgical Lab Interpretation, Pre-op, Post Op, Billing, ABG's, Vents, DM, RF, Radiological Studies, etc. We were also required to take online exams on most topics at home. We are given 2 Long, White Coats, [-] the ceremony! Throughout the year we meet about 1 time / month to have specialized lectures: burns, etc. also with online exam.

 

Next, we had 2 days of ATLS with the PGY1's and became certified. Then we started Curriculum with the PGY1's. Curriculum is 4 days of lecture / reading / hands on labs / etc. with exams at the beginning and the end. We are also treated like the PGY1s except that they do have us distinguish ourselves, since were are already professionals with a license and are here to get an additional year of specialized training. We are paid equal to PGY1's. Curriculum meets about every other month throughout the year, for 4 days, covering different topics / labs.

 

After the orientation and curriculum week, we all broke into our assigned services. The PGY1's do 4 weeks [1 month] rotations, on each service, however we are doing mostly 6 weeks on each service. I think this is mostly do to the fact that the PGY1s go to other facilities / hospitals and we [Post-Grad PA's] do not.

 

I started my 1st rotation on Peds surgery & trauma with 4 med. students, 3 other PGY1's, a Fellow, a PGY4, 5 faculty PA's & 9 Surgeons.

 

A Day in the LIFE: We meet most mornings at 5:30a to sign out, then round, write notes then round with the attending and team. Then we do discharges, go to the OR for our assigned cases, answer nursing / pt questions. Then at 5:30p we sign out to the night Post Grad PA/ PGY1 then day people leave. This service is very busy and we do not have much down time. Also 1 Post Grad PA / PGY1, each week for 1 week during the day, carries the "consult / HOT" pager. This means that they are paged for all new consults from the ED - floor - outside hosp/direct admit. They return the call, then go to [for ex] the ED, see the patient, do a H&P, devise an "assessment & plan" contact the "senior" and verbally present the pt, 'senior' sees the pt and then a plan is finalized. May do a consent if surgery in needed, put in orders, admit pt. etc. Two days a week we come in at 5am because we have grand rounds, M&M and conference.

 

TRAUMA: We respond to Trauma calls to the ED: we are "doctor Right" during the trauma. I've been on 2 so far, a level 2 and Level 1. The level 1 was most similar to what I would say you can see on "Trauma Life in the ER" show on Discovery Health channel -- intense!

 

THE OR: My 2nd OR experience: 1st Assistant, 1st with this Surgeon: a simple enough procedure: I&D of Abscess. However after the positioning / draping / etc. The surgeon tells the scrub tech: "Scalpel to "me" "I was like "what"? did I hear that correctly? Yes, I did! :D I got to do the majority of the case! How sweet! Never did I anticipate that! The surgeons here are very willing, have patience and are interested in teaching. Nothing that I had experienced, as a PA student, in a surgical rotation! That alone has convinced me that I've made the correct decision; knowing I will continue to gain invaluable experiences over this next year. So very happy that I decided to do this! :cool:

 

CALL: So we take over night in house call. During the week we have 1 person assigned to overnight call, they start Sun 5:30am and leave Mon. 6am. Then work T-W-Th overnight. They carry the "HOT" pager & do all consults, answer all home calls, nursing calls etc. They are supported by a senior, in house. Weekend Call: is only different in the fact that person comes in 5:30a Fri, Sat or Sun gets sign out, rounds, and stays all day and overnight until the next 5:30am, then goes home: post call; always supported by a 'senior' in house.

 

Okay, reality check: :rolleyes: it is very hard, long hours: ~80+ / week with day to overnight shifts of 30 hours! We are held to the same hours & expectations of the PGY1's. However I don't think I would have gained this same experience from jumping into a surgical job right out of PA school!

 

Please feel free to PM me with any questions. I will also try to post as time allows. I hope those of you who are interested in a surgical residency program find this useful!

 

Good Luck!

-V

 

PS. Not sure if you want make this a separate Sticky? for Surgical Residency?

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A Day in the LIFE: We meet most mornings at 5:30a to sign out, then round, write notes then round with the attending and team. Then we do discharges, go to the OR for our assigned cases, answer nursing / pt questions. Then at 5:30p we sign out to the night Post Grad PA/ PGY1 then day people leave. This service is very busy and we do not have much down time. Also 1 Post Grad PA / PGY1, each week for 1 week during the day, carries the "consult / HOT" pager. This means that they are paged for all new consults from the ED - floor - outside hosp/direct admit. They return the call, then go to [for ex] the ED, see the patient, do a H&P, devise an "assessment & plan" contact the "senior" and verbally present the pt, 'senior' sees the pt and then a plan is finalized. May do a consent if surgery in needed, put in orders, admit pt. etc. Two days a week we come in at 5am because we have grand rounds, M&M and conference.

 

TRAUMA: We respond to Trauma calls to the ED: we are "doctor Right" during the trauma. I've been on 2 so far, a level 2 and Level 1. The level 1 was most similar to what I would say you can see on "Trauma Life in the ER" show on Discovery Health channel -- intense!

 

THE OR: My 2nd OR experience: 1st Assistant, 1st with this Surgeon: a simple enough procedure: I&D of Abscess. However after the positioning / draping / etc. The surgeon tells the scrub tech: "Scalpel to "me" "I was like "what"? did I hear that correctly? Yes, I did! :D I got to do the majority of the case! How sweet! Never did I anticipate that! The surgeons here are very willing, have patience and are interested in teaching. Nothing that I had experienced, as a PA student, in a surgical rotation! That alone has convinced me that I've made the correct decision; knowing I will continue to gain invaluable experiences over this next year. So very happy that I decided to do this! :cool:

 

CALL: So we take over night in house call. During the week we have 1 person assigned to overnight call, they start Sun 5:30am and leave Mon. 6am. Then work T-W-Th overnight. They carry the "HOT" pager & do all consults, answer all home calls, nursing calls etc. They are supported by a senior, in house. Weekend Call: is only different in the fact that person comes in 5:30a Fri, Sat or Sun gets sign out, rounds, and stays all day and overnight until the next 5:30am, then goes home: post call; always supported by a 'senior' in house.

 

Okay, reality check: :rolleyes: it is very hard, long hours: ~80+ / week with day to overnight shifts of 30 hours! We are held to the same hours & expectations of the PGY1's. However I don't think I would have gained this same experience from jumping into a surgical job right out of PA school!

 

The program at my hospital is similar, except everybody puts in at least 100 hours a week. The ACGME work-hour rules for the academic programs where I've worked are largely ignored. They expect you to lie about your work hours. Its a "dont ask, dont tell" system. If you cant handle the hours, then the old school surgeons will label you unworthy and work to get you out of the system.

 

As the chief PA on my service, I staff most of the consults that the PGY-1s/PAs get called for. I set the OR schedule in terms of resident/PA coverage. After the residents/PAs do their morning rounds at 4AM, they staff them either with me or the attending, but usually the attending is in on a case already and so they run the patients with me.

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Vachon - thanks for posting your experience as well!! It is really interesting to read about different residencies! Keep us updated!

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Wow Vachon congrats, I remember a while back you were looking hard for a job and now look at you, in a residency!! Congrats, I'm jealous, well kind of.....

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here ya go

 

He's at albert einstein in philadelphia. the place is a major knife and gun club.

he will come out of there an em stud!

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Jambi/ Christina--

True Anomaly, I think is doing his rsidency in Philly. Vachon is doing his post grad in Wisconsin.

 

Jim

 

PS Vachon enjoy the Beer, German food, and sharp Cheddar Cheese, :)

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It's with Childrens Hospital of Wisconsin (#3 in US, Level 1 Trauma Center) and next door is the Adult Hosptial: Froedtert Hospital.

 

PS I've started a new thread....Look 4 it!

Can we also make it a sticky? Since Anomaly is in ED

& I'm in Surgical Residency,

might be nice to have 2 different sticky threads.....Thx!

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Jambi/ Christina--

 

True Anomaly, I think is doing his rsidency in Philly. Vachon is doing his post grad in Wisconsin.

 

Jim

 

PS Vachon enjoy the Beer, German food, and sharp Cheddar Cheese, :)

 

 

BTW - Vachon is a Female! :)

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TA....awesome!!! I have been following and researching the program you are in. Although I am just starting clinical year, if I get the opportunity to do a residency I want to be where you are!!! Thanks so much for the posts...keep em coming (time permitting of course). Good luck!

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Wow Vachon congrats, I remember a while back you were looking hard for a job and now look at you, in a residency!! Congrats, I'm jealous, well kind of.....

 

Thanks Iain!

 

Are you doing IR now? [interventional radiology]

I'm still debating on my 2 electives. Let me know if you would recommend it? Why / what you like / hate about it.

 

Thanks, V2 :)

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Female![/b] :)]

V--

Sorry-- I Know never assume,. I may type slow, but my typing, somtimes, is quicker than my thught process.

An Embarrassed Jim :o

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My first full month in the ER is over, and I already miss it. I did a few stretches of 6 days in a row, with three days off in between. It does make for a nice schedule, and with how we rotate hours it keeps it fresh. For instance, I’ll do three noon-midnight shifts, then three 9 AM-7PM shifts, or three 7 PM-5AM shifts in a row. Some days I’m in the “trauma” part of the ER, where we get more emergent patients as well as all the traumas that come in (our trauma bay has three beds). While this is the case, the ER has the policy of “any patient, any bed, any time”- so just because you’re in one of the back areas doesn’t mean you’re gonna miss all the MI’s or respiratory distress cases, which I’ve certainly learned the hard way.

 

For the most part, everyone has been wonderful to work with- the attendings are all patient with us new interns and most of them enjoy their limited times to teach. The senior residents, while they are adjusting to their new roles of running each area of the ER, are also very understanding of “the kids”, since they were just in our shoes a few years ago. And at no time has anyone looked down on me simply because I’m a PA- I’m seen no differently than the physician interns in regards to what patients I’m allowed to see. At some times I’ve been in the right spot at the right time, which has enabled me to place a couple central lines and do a couple LP’s on my patients. With our extensive use of bedside ultrasound in our ER, I’m getting some good looks at looking for viable intrauterine pregnancies, cholecystitis/cholelithiasis, free fluid in the abdomen based on FAST exams, and learning ultrasound-guided IV placement. The only hard-and-fast rule in regards to procedures in our ER is that the second-year residents always do the airway, and the third-year residents run any traumas that come in.

 

Because of the extensive support, I feel I’m able to forge ahead and try to manage as many patients as possible- right now I feel that 5 is definitely pushing the limit of what I’m capable of at the moment. I’m certainly hoping that by the time I’m finished here, managing 6 patients at once will seem like a breeze.

 

Oh yeah...and with the characters that come into this ER, I'm keeping a private journal that maybe, years from now, will make for some hilarious reading. :D

 

Right now I’m two weeks into my first off-service rotation in general surgery. To keep this a mostly positive post, I’ll just say that my experience has not been what I expected, and we’re struggling a little to find the best way to integrate me into the surgical team. That, coupled with the chaotic nature of the surgery service, makes me long for the “ordered chaos” of the ER. (As a side note, I just don’t know how some of y’all in surgery deal with surgeons….). This isn’t to say that I’m not learning; just by watching their reactions to what those of us in the ER determine is a surgical admission is enough of a lesson in what NOT to do. In a couple weeks I begin rotation on the telemetry service, which should be a bit more uniform.

 

So overall….two and a half months into this thing, and I’m definitely glad I’m here. The sights and sounds of Philly are keeping me well entertained, as well as the people I’ve met here. It does get a bit lonely at times, but there’s always a reminder of something to read or do.

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It does get a bit lonely at times, but there’s always a reminder of something to read or do.

 

Roadtrip! Dude, serious, I was going to say let's head to the coast and grab some sun and surf until I just checked the weather and see that rain will be here just about every day until my rotation starts in a couple weeks :( But hey isn't it my turn for dinner on your side? (first thing he says to me, "ohh, you're old!!" grrreat, thaaanks, nice to meet you too!)

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Roadtrip! Dude, serious, I was going to say let's head to the coast and grab some sun and surf until I just checked the weather and see that rain will be here just about every day until my rotation starts in a couple weeks :( But hey isn't it my turn for dinner on your side? (first thing he says to me, "ohh, you're old!!" grrreat, thaaanks, nice to meet you too!)

 

Actually, I was referring more to female companionship... ;)

 

Yeah, it's about due for dinner again; I just have to get out of this surgery rotation alive. Hopefully you'll still be alive yourself, since you're so old and all :D

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Actually, I was referring more to female companionship... ;)

 

Well, excuuse me! Seriously, c'mon now, surely you have a few lady nurses in your black book (pda) by now?

 

Hopefully you'll still be alive yourself, since you're so old and all :D

 

har har ... just wait till you hit 38, young whipper-snapper!

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(first thing he says to me, "ohh, you're old!!" grrreat, thaaanks, nice to meet you too!)

 

I'm older than you and he didn't tell me I looked old when we met at sempa in tuscon last yr. you really must look like crap!:eek::p;):D

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I'm older than you and he didn't tell me I looked old when we met at sempa in tuscon last yr. you really must look like crap!:eek::p;):D

 

Dude,

They aren't talking years :eek:

 

They be talking MILAGE :D

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Female![/b] :)]

 

V--

 

Sorry-- I Know never assume,. I may type slow, but my typing, somtimes, is quicker than my thught process.

 

An Embarrassed Jim :o

 

No worries Jim!

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Time for an update!

 

I’m now four months into my training; after my first rotation in the ER, I’ve done one rotation in general surgery, followed by another in telemetry. Now I’m back in the ER where I belong, and while it’s really kicking my *** with H1N1 in full effect, it’s still better than being elsewhere in the hospital.

 

 

Here’s what I learned first and foremost about my experience on general surgery- it’s very rough to be the very first person to do something- and I had the lucky honor of being the first-ever PA resident to join the surgery team. Please understand, in no way am I trying to compare myself to those PA’s in the past who had to really struggle with trying to establish their foothold in the medical world- but I certainly do appreciate their situation more! There were quite a few kinks to work out, but I tried to make the experience as meaningful as I could- lots of reading on the side about how these surgery cases correlated with what would come into the ER; trying to see as many consults in the ER as I could for the surgery team; taking the time to learn how a surgeon reads a CT scan…or for that matter, having the radiologist show me how they also read emergent surgical CT scans. The nice thing about my struggles in surgery is that there was a change made for the better for my fellow PA resident, who is now on a different surgery team and is having a significantly better experience.

 

The next month was telemetry- a much different setting and pace from surgery. The difference in teaching between the two services was night and day- whereas little if any teaching went on during surgery, there was ample time and effort made to educate about the world of cardiology. While the attendings in surgery couldn’t be bothered with dealing with an off-service intern, the cardiology attendings were very approachable and enjoyed teaching. There was time to explore every little detail of EKG’s; every other thing that caused a troponin elevation; when a persantine-sestamibi study was actually needed along with a cardiac cath; and probably the most important lesson of all- the small amount of confidence I gained with being able to send a chest pain patient home. During the first couple of weeks on the service I wasn’t able to go down to the ER to admit patients, but was finally allowed to do so after proving myself on the team. I had some big shoes to fill after my other fellow PA resident, who is much sharper at the inpatient side of things than I am and who completed the rotation before me.

 

The off-service rotations provided several opportunities to educate about what a PA resident really is. More often than not I got the question, “So when you’re done with this, you’re a doctor?” There’s also been other logistical issues raised, but it all comes with educating other people in the hospital about just what our role is.

 

As I mentioned above, I’m now back in the ED for my second full month, and it really felt like a homecoming- but oh wait, here’s H1N1 to spoil the party! Our ER has been inundated enough to set up our very own “Flu Tent” outside to steer the masses there who clearly need some TLC at home for their illness (the truly sick complications from H1N1 will still get routed through the main ED). The journey through the two off-service rotations has again helped me give just a little bit of confidence when it comes to dealing with those particular types of patients, whether surgery or cardiac (not even the ED physician residents get to do a telemetry rotation- they just do a standard internal medicine inpatient rotation). I’m finally starting to feel confident on the relatively easy stuff, while at the same time being more brave with how far I can go on the more complicated patients. It’s amazing to me how dealing with the nursing home patient who can’t speak no longer brings this overwhelming tide of insecurity through me like it did before. And I’m squeezing myself into enough traumas that I’m trying to get to run either the primary or secondary surveys on the patients (on the minor stuff….but hey, you gotta start somewhere).

 

In short…..so far, so good. I don’t think I’d be this far along in confidence and ability had I made a go of this on my own without the program.

 

Next rotation...anesthesia! Nothing but intubating all month long!

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Next rotation...anesthesia! Nothing but intubating all month long!

 

MAKE SURE YOU GET ENOUGH "REAL INTUBATIONS"(AS OPPOSED TO LMA'S) AS LAZY ANESTHESIOLOGISTS REALLY LIKE LMA'S FOR SHORT CASES. I'M NOT A BIG FAN OF THE LMA IN EMERGENT PTS AS IT DOESN'T ACTUALLY PROTECT THE AIRWAY...

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Does anyone have a general idea of the salary a PA would make after a residency such as EM?

>100k to start in the right setting.

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Does anyone have a general idea of the salary a PA would make after a residency such as EM?

 

First year out of EM residency at a large hospital in Miami, my friend started at 120k. More and more, I see the benefits of aresidency. As many have said in other posts, your responsibilities and autonomy is greater (i.e the procedures you can do) and it seems the starting out money is worth the year of lost pay as a resident.

 

I really enjoy this thread TA. Thanks and keep it coming!

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When I started this thing, I had anticipated not posting regularly, but at least I had envisioned a post at least once a month. I’ve just been busy enjoying not only my residency but also the life I now find myself in. So I’ll spend this post catching y’all up on what’s been up with my experience as a resident.

 

As of my last post, I was finishing up another month of the ER and excited to start anesthesia. This turned out to not be as wonderful as I had anticipated, but at least I was able to get some experience at intubations through various means- not just direct laryngoscopy, but also with the “light wand” and the new toy in the hospital, our own glidescope with LCD monitor. What was equally important to me was getting down the proper method of bag-valve-mask ventilation; I didn’t realize all the errors I had ingrained in myself with BVM’s when I was an EMT. Yes, I did a few LMA’s as well, which was fine since I hadn’t played with those much prior to PA school- and hey, at least it’s a temporizing measure. The frustrating part was fighting with the CRNA students at the hospital for procedures; this has been an ongoing problem at our facility for the physician ER residents for quite a while, and a fundamental overhaul of the anesthesia rotation is likely. So what I got out of the rotation was truly a matter of how aggressive I chose to be. I could’ve gotten a couple more intubations, but overall I felt I did enough to at least get comfortable with the action.

 

At the end of the month I finally had a week of vacation; I chose to travel to Boston, which was the last major Northeast city I had yet to see. Boston in December probably wasn’t the smartest idea for a vacation, but it was quick, easy and something new to see.

 

Upon return, all the ER residents (physicians and us three PA’s) split up into two groups- one half was going to work over Christmas, and the other over New Years. I chose to work the two weeks over New Years, which meant that I started LAB WEEK- a week devoted to procedure practice and lectures about those procedures, as well as refreshers in ACLS, PALS and ATLS procedures. The first day of lab week involved ENT procedures- this was the day where we performed nasopharyngeal laryngoscopy on each other with the video fiberoptic scopes. I really wanted to be the guinea pig so I knew exactly what this felt like, so after a lidocaine neb treatment and Cetacaine spray in the throat (sour bananas!), up went the tube….and oh man, is that ever uncomfortable. But once it was in I got to see my vocal cords and use my iPhone to take a picture- how cool is that??? The rest of the week involved running multiple megacodes, chest tubes, cricothyrotomies, peritoneal lavage (yeah, it ain’t used much anymore, but they still wanted us to know how), slit lamp examinations and some minor stuff.

 

After a week spent back home in Texas for Christmas, I returned for six straight weeks in the ER, which I’m now wrapping up. This recent stretch of ER work has been a real turning point- thanks to one of our attendings (who used to run the physician EM residency and is now the chief academic guy at the hospital), I’ve learned the proper perspective of how to approach any ER patient. And I’ve seemed to arrive at some level of respect among the nursing staff (especially with the tough-as-nails night crew). It makes work so much more bearable, and is starting to feel like “home”, even if I end up leaving here at the end of my residency. I also like to think that myself and my two fellow PA residents have come to some level of respect among the physician residents; they've certainly been nothing but accomodating and helpful to me. One of them was kind enough to give me all her stuff from EMRAP that's available only to Emergency Medicine Residency Association members...an organization we're not quite able to join ;)

 

Next week, I’ll be finding out exactly what the potential EMS fellowship will entail, and will choose to extend my contract for it or not. It’s also almost time for the next round of interviews for potential PA residents to start, and I’m quite excited to meet those folks who were in my shoes at this time last year.

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Thanks for the update. That residency really sounds like a truly amazing experience. Make sure you let us know what they have in store for the EMS fellowship. Koodos to them for getting PAs more involved in EMS!

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