Jump to content

Sitting around and wondering what it'll be like in PA school if and when you get in?


Recommended Posts

  • Replies 161
  • Created
  • Last Reply

Well it's the end of the third week of PA school. Another Friday update. The crux is that it's about 3 a.m. on Saturday morning and if I had any common sense I would be in bed. I need to finish this liter of water before I sleep if I want to be worth a darn later today though.

 

Ok, from class....imagine a person in the desert trudging along with no water to drink, hoping desperately to find an oasis. It's unbearably hot and they have been on the move with nothing to eat or drink, just trudging for a day or so. It's miserable.

 

Finally, the Gods smile upon this poor soul and there is an oasis. He drinks like a camel. What electrolyte imbalance does he now share with every cardiac patient who had edema? Why does he share it? What are the pathways?

 

Anion gap. Heard of it? Tell me about it?

 

Friday night study session out on the town turned out to be more taxing than I had planned. Good night for now.

Link to comment
Share on other sites

Well it's the end of the third week of PA school. Another Friday update. The crux is that it's about 3 a.m. on Saturday morning and if I had any common sense I would be in bed. I need to finish this liter of water before I sleep if I want to be worth a darn later today though.

 

Ok, from class....imagine a person in the desert trudging along with no water to drink, hoping desperately to find an oasis. It's unbearably hot and they have been on the move with nothing to eat or drink, just trudging for a day or so. It's miserable.

 

Finally, the Gods smile upon this poor soul and there is an oasis. He drinks like a camel. What electrolyte imbalance does he now share with every cardiac patient who had edema? Why does he share it? What are the pathways?

 

Anion gap. Heard of it? Tell me about it?

 

Friday night study session out on the town turned out to be more taxing than I had planned. Good night for now.

Link to comment
Share on other sites

So how do you study during PA school? Because I've heard most studying is done in study groups. Do you just discuss and quiz each other or what? Do you read books or get most your info from notes or lecture? Do you take time to do "homework" or is it more just taking in a ton of knowledge and hoping it comes back to you? How often do you take tests?

Link to comment
Share on other sites

So how do you study during PA school? Because I've heard most studying is done in study groups. Do you just discuss and quiz each other or what? Do you read books or get most your info from notes or lecture? Do you take time to do "homework" or is it more just taking in a ton of knowledge and hoping it comes back to you? How often do you take tests?

Link to comment
Share on other sites

So how do you study during PA school? Because I've heard most studying is done in study groups. Do you just discuss and quiz each other or what? Do you read books or get most your info from notes or lecture? Do you take time to do "homework" or is it more just taking in a ton of knowledge and hoping it comes back to you? How often do you take tests?

 

UW's program has four campuses. Anchorage Alaska, Seattle Washington, Yakima Washington, and Spokane Washington. We all began a 14 week A&P review online in the winter that carried us to early June. For me, that was all self study. Since we are coming from all over the country, I think most people did self study from the A&P book. I do know of a few study groups that happened where people knew other folks who got into the school and lived close, but that was the exception more than the rule.

 

Now for 6 weeks all four campuses are together here in Seattle. There is a large majority of us living in the graduate dorms. That is an instant study group. I believe in the method of "see it, do it, teach it" to really hammer it into my melon. In class we see it. Then we come back to the dorms, study up on our own, then around dinner time we meet up and "teach it" (sorta, not literally) but the verbal banter back and forth, asking each other questions, explaining fuzzy material to each other, it helps learn it. There are a few people who are going at it on their own and from the rumor mills...they are not doing so well in class. It's a struggle and their grades reflect it. I am no whizz kid but I have been able to strike a very workable balance of studying in this manner, and still have some time to get out to vent some energy and feel human, and knock on wood, I am very comfortable with my average test score so far.

 

Frequency of tests...the online portion was a test a week. Here in Seattle it is about the same. Typically tests are held on Mondays. Yesterday, our medical director gave a review over the week's information to help us flesh out the true sticking points that we need to study over the weekend. The review was about 2 hours long and really helped get everyone on the right track. The plan is to meet up for study groups Sunday evening.

 

They give us printed notes for each lecture. Sometimes it is just powerpoint slides, other times it is more narrative form. They include a recommended reading of texts which we have purchased as part of the mandatory book list. In addition, we also take notes during lecture. Sometimes I follow along the notes given to us, making comments in the margins where I need to brush up, but usually I use 8.5x11 yellow legal pads and a pencil...just ended our third week and have filled one completely and well into my second. Not too crazy.

 

The summer program is not an intensive deal. It's a warm up. I think we are carrying around 10 credits this term, maybe 12, I can't remember. Come the fall and winter we ramp it up to 19 or 20 credits per term. I'm enjoying the opportunities to get out when I can...I know those will get fewer and fewer.

 

The "Friday night study session" is about venting the mind, body, and soul so that we can digest and absorb more information in the coming week....some people call it cocktails and dancing. I really didn't study until 3 in the morning on a Friday night :-)

Link to comment
Share on other sites

So how do you study during PA school? Because I've heard most studying is done in study groups. Do you just discuss and quiz each other or what? Do you read books or get most your info from notes or lecture? Do you take time to do "homework" or is it more just taking in a ton of knowledge and hoping it comes back to you? How often do you take tests?

 

UW's program has four campuses. Anchorage Alaska, Seattle Washington, Yakima Washington, and Spokane Washington. We all began a 14 week A&P review online in the winter that carried us to early June. For me, that was all self study. Since we are coming from all over the country, I think most people did self study from the A&P book. I do know of a few study groups that happened where people knew other folks who got into the school and lived close, but that was the exception more than the rule.

 

Now for 6 weeks all four campuses are together here in Seattle. There is a large majority of us living in the graduate dorms. That is an instant study group. I believe in the method of "see it, do it, teach it" to really hammer it into my melon. In class we see it. Then we come back to the dorms, study up on our own, then around dinner time we meet up and "teach it" (sorta, not literally) but the verbal banter back and forth, asking each other questions, explaining fuzzy material to each other, it helps learn it. There are a few people who are going at it on their own and from the rumor mills...they are not doing so well in class. It's a struggle and their grades reflect it. I am no whizz kid but I have been able to strike a very workable balance of studying in this manner, and still have some time to get out to vent some energy and feel human, and knock on wood, I am very comfortable with my average test score so far.

 

Frequency of tests...the online portion was a test a week. Here in Seattle it is about the same. Typically tests are held on Mondays. Yesterday, our medical director gave a review over the week's information to help us flesh out the true sticking points that we need to study over the weekend. The review was about 2 hours long and really helped get everyone on the right track. The plan is to meet up for study groups Sunday evening.

 

They give us printed notes for each lecture. Sometimes it is just powerpoint slides, other times it is more narrative form. They include a recommended reading of texts which we have purchased as part of the mandatory book list. In addition, we also take notes during lecture. Sometimes I follow along the notes given to us, making comments in the margins where I need to brush up, but usually I use 8.5x11 yellow legal pads and a pencil...just ended our third week and have filled one completely and well into my second. Not too crazy.

 

The summer program is not an intensive deal. It's a warm up. I think we are carrying around 10 credits this term, maybe 12, I can't remember. Come the fall and winter we ramp it up to 19 or 20 credits per term. I'm enjoying the opportunities to get out when I can...I know those will get fewer and fewer.

 

The "Friday night study session" is about venting the mind, body, and soul so that we can digest and absorb more information in the coming week....some people call it cocktails and dancing. I really didn't study until 3 in the morning on a Friday night :-)

Link to comment
Share on other sites

Ahhhh another Friday. This past week has been all about Genetics and we also received back our first draft of a research paper that was meant to introduce us into Evidence Based Medicine. We had a list of topics to pick from and as a student in the Bachelor degree track, we only had to deliver 2-3 pages. Wasn't too taxing at all. Nothing super exciting to write about. The week has been a brain drain as my genetics exposure prior to this was a day in my previous A&P course. However, three hours of lecture followed by 3 hours of "PA role development" classes then the rest of the day is free....have had plenty of time to exercise and study. Yesterday afternoon and this afternoon our medical director held a multi hour review session for all interested parties to help us prep for our test on Monday. I love his review sessions...really boosts the confidence.

 

In keeping with the spirit of what to think about as a Pre PA in anticipation of getting in...consider some genetic counseling situations. For example...Grandpa had Huntington's disease. You, as a grandchild, stand at risk of contracting it and want to know if you have the genetic marker for it. Your parents don't want to know their status. It is an autosomal dominant gene. Right now you are thinking "autosomal dominant doesn't skip generations, so parents would have to know already"...the answer is "no, they don't know yet" and my question is why don't they know? Now, as the role of a genetic counselor, do you tell the grandchild their status? What are some of the possible untoward outcomes of telling a minor about their genetic marker for this disease?

 

Get used to drawing pedigrees. Make it second nature.

 

Enjoy

Steve

Link to comment
Share on other sites

Ahhhh another Friday. This past week has been all about Genetics and we also received back our first draft of a research paper that was meant to introduce us into Evidence Based Medicine. We had a list of topics to pick from and as a student in the Bachelor degree track, we only had to deliver 2-3 pages. Wasn't too taxing at all. Nothing super exciting to write about. The week has been a brain drain as my genetics exposure prior to this was a day in my previous A&P course. However, three hours of lecture followed by 3 hours of "PA role development" classes then the rest of the day is free....have had plenty of time to exercise and study. Yesterday afternoon and this afternoon our medical director held a multi hour review session for all interested parties to help us prep for our test on Monday. I love his review sessions...really boosts the confidence.

 

In keeping with the spirit of what to think about as a Pre PA in anticipation of getting in...consider some genetic counseling situations. For example...Grandpa had Huntington's disease. You, as a grandchild, stand at risk of contracting it and want to know if you have the genetic marker for it. Your parents don't want to know their status. It is an autosomal dominant gene. Right now you are thinking "autosomal dominant doesn't skip generations, so parents would have to know already"...the answer is "no, they don't know yet" and my question is why don't they know? Now, as the role of a genetic counselor, do you tell the grandchild their status? What are some of the possible untoward outcomes of telling a minor about their genetic marker for this disease?

 

Get used to drawing pedigrees. Make it second nature.

 

Enjoy

Steve

Link to comment
Share on other sites

Profound hyponatremia. Love it.

 

The pathway - a lot is going on here. The oasis guy has lost H2O and Na+. He replaces his H2O with hypotonic oasis water - no Na+ to speak of. He does this at a rate that his body is unable to make up for. He rapidly becomes fluid imbalanced. His Na+ has stayed stable, but his free H2O and thus serum have increased, thus making his blood hypotonic as well. Now, the patient in the cardiac unit has profound water retention which causes the same hyponatremic state but his is due to fluid overload. What you'll find in the cardiac patient over time is that his Brain type Natriuretic Peptide (BNP) will go through the roof as his heart signals (through changes in receptor configuration and cell signalling) his kidneys to dump Na+ and thereby H2O. The guy in the desert will likely have a different pathway in action - Arginine VasoPressin (AVP) or Anti-Diuretic Hormone will cause him to hold on to Na+ because of his profoundly hyponatremic state without a fluid overload.

 

This is all from memory so if I have mis-spoken, let me know.

 

A good review.

 

A practical application question: aside from the labs I already mentioned, what lab values are you going to use to determine fluid status?

Link to comment
Share on other sites

Profound hyponatremia. Love it.

 

The pathway - a lot is going on here. The oasis guy has lost H2O and Na+. He replaces his H2O with hypotonic oasis water - no Na+ to speak of. He does this at a rate that his body is unable to make up for. He rapidly becomes fluid imbalanced. His Na+ has stayed stable, but his free H2O and thus serum have increased, thus making his blood hypotonic as well. Now, the patient in the cardiac unit has profound water retention which causes the same hyponatremic state but his is due to fluid overload. What you'll find in the cardiac patient over time is that his Brain type Natriuretic Peptide (BNP) will go through the roof as his heart signals (through changes in receptor configuration and cell signalling) his kidneys to dump Na+ and thereby H2O. The guy in the desert will likely have a different pathway in action - Arginine VasoPressin (AVP) or Anti-Diuretic Hormone will cause him to hold on to Na+ because of his profoundly hyponatremic state without a fluid overload.

 

This is all from memory so if I have mis-spoken, let me know.

 

A good review.

 

A practical application question: aside from the labs I already mentioned, what lab values are you going to use to determine fluid status?

Link to comment
Share on other sites

From my understanding in class...you got the desert guy pretty well. The CHF'r though...they are doing a poor job of perfusing their kidneys because of a weak pump. As a result, the JGA/macula densa senses the decreased GFR, so it spits out a bunch of Aldosterone to hold onto the Na. As a result, they retain fluid. The renin/angiotensin cascade and ADH gets fired up, which triggers their thirst mechanism and increases their desire to consume salty food. Since they are not in the desert and have access to both fluid and Na, they consume both. Both goes up. However, their fluid intake typically is greater than their Na intake. So while they gain both parts of the equation, they gain fluid faster...which of course eventually makes it's way into the lungs, they get pulmonary edema, and things start to get even more interesting. According to my understanding, while the BNP gets triggered, the retention mechanism of the ADH, aldosterone, and renin cascade will over power the BNP and the patient will continue to retain, despite their best efforts.

 

As you know we haven't gotten into the clinical medicine part yet...still dealing with pathophys...but my best guess is I'd be curious to see a chem panel. K+ and Cl to get a clue how his ascending loop is doing with it's Na/K/CL pump is doing, curious of his creatine...a ph level would be nice to know...with that K+ shift there may be some issues going on there...I'd expect his specific gravity to be around 1.000..I'm sure we'll get the "holy cow, now he's ....." bit from Dr. Evans soon enough. I love his story telling.

Link to comment
Share on other sites

From my understanding in class...you got the desert guy pretty well. The CHF'r though...they are doing a poor job of perfusing their kidneys because of a weak pump. As a result, the JGA/macula densa senses the decreased GFR, so it spits out a bunch of Aldosterone to hold onto the Na. As a result, they retain fluid. The renin/angiotensin cascade and ADH gets fired up, which triggers their thirst mechanism and increases their desire to consume salty food. Since they are not in the desert and have access to both fluid and Na, they consume both. Both goes up. However, their fluid intake typically is greater than their Na intake. So while they gain both parts of the equation, they gain fluid faster...which of course eventually makes it's way into the lungs, they get pulmonary edema, and things start to get even more interesting. According to my understanding, while the BNP gets triggered, the retention mechanism of the ADH, aldosterone, and renin cascade will over power the BNP and the patient will continue to retain, despite their best efforts.

 

As you know we haven't gotten into the clinical medicine part yet...still dealing with pathophys...but my best guess is I'd be curious to see a chem panel. K+ and Cl to get a clue how his ascending loop is doing with it's Na/K/CL pump is doing, curious of his creatine...a ph level would be nice to know...with that K+ shift there may be some issues going on there...I'd expect his specific gravity to be around 1.000..I'm sure we'll get the "holy cow, now he's ....." bit from Dr. Evans soon enough. I love his story telling.

Link to comment
Share on other sites

I did leave out Aldosterone - thank you. I knew I had gotten off track and left out a big piece of the puzzle.

 

Regarding the clinical aspect - the only point I wanted to make is that sudden fluid shifts will leave the balance of certain things lacking. The first to look for is BUN and Creatinine. Evans will explain this better than I will, but the point is that BUN is freely filtered and reabsorbed in the kidneys to create the osmolality gradient at the bottom of the loop of Henle. Creatinine, on the other hand, can only be filtered by the kidneys, not reabsorbed. So, when there is a lack of bloodflow to the kidneys (in acute dehydration), BUN is reabsorbed by the convoluted tubules in order to maintain a osmolality gradient that will allow appropriate water exchange to occur in the loop while Creatinine continues to be filtered into the loop and excreted in urine. Thus, in acute dehydration, BUN goes up before Creatinine and you have an increased BUN/Cr ratio (usually >25). This is known as pre-renal azotemia (azotemia being a state of elevated BUN) because it is not a problem with the kidneys themselves but rather with the supply of blood to the kidneys.

 

This is not an aim to prove that I learned something - but a clinical correlate to what you're currently learning. Keep the BUN gradient in the back of your mind - it will become important later.

 

Thanks for the reminder on Aldosterone. I forget about the part it plays in CHFers.

 

I will be reviewing this conversation as I study for the PANCE - wish we'd had a chance to study together during didactic year. Heh.

 

Andrew

Link to comment
Share on other sites

I did leave out Aldosterone - thank you. I knew I had gotten off track and left out a big piece of the puzzle.

 

Regarding the clinical aspect - the only point I wanted to make is that sudden fluid shifts will leave the balance of certain things lacking. The first to look for is BUN and Creatinine. Evans will explain this better than I will, but the point is that BUN is freely filtered and reabsorbed in the kidneys to create the osmolality gradient at the bottom of the loop of Henle. Creatinine, on the other hand, can only be filtered by the kidneys, not reabsorbed. So, when there is a lack of bloodflow to the kidneys (in acute dehydration), BUN is reabsorbed by the convoluted tubules in order to maintain a osmolality gradient that will allow appropriate water exchange to occur in the loop while Creatinine continues to be filtered into the loop and excreted in urine. Thus, in acute dehydration, BUN goes up before Creatinine and you have an increased BUN/Cr ratio (usually >25). This is known as pre-renal azotemia (azotemia being a state of elevated BUN) because it is not a problem with the kidneys themselves but rather with the supply of blood to the kidneys.

 

This is not an aim to prove that I learned something - but a clinical correlate to what you're currently learning. Keep the BUN gradient in the back of your mind - it will become important later.

 

Thanks for the reminder on Aldosterone. I forget about the part it plays in CHFers.

 

I will be reviewing this conversation as I study for the PANCE - wish we'd had a chance to study together during didactic year. Heh.

 

Andrew

Link to comment
Share on other sites

I believe Dr. Evans is a mutant. He has some GOF mutation in his "want to help others understand and succeed" gene. He defiantly makes learning fun.

 

Kick butt on the PANCE...I cracked open a review book for the PANCE the other day while browsing the bookstore and ran through a few questions...gave me an idea of just how much stuff I am about to learn in the next two years. Good stuff.

 

While internet banter is not co-studying..it's better than nothing. :-) Good luck to ya and your classmates. Set the bar high.

Link to comment
Share on other sites

I believe Dr. Evans is a mutant. He has some GOF mutation in his "want to help others understand and succeed" gene. He defiantly makes learning fun.

 

Kick butt on the PANCE...I cracked open a review book for the PANCE the other day while browsing the bookstore and ran through a few questions...gave me an idea of just how much stuff I am about to learn in the next two years. Good stuff.

 

While internet banter is not co-studying..it's better than nothing. :-) Good luck to ya and your classmates. Set the bar high.

Link to comment
Share on other sites

  • 2 weeks later...

So typically I had planned to update this thread every Friday. My wife and kids were in town and after not seeing them for a month, it was time for some face to face human contact rather than the keyboard.

 

So catching up..last week was immunology. There wasn't a real "ah ha!" moment while in class this past week. There was a lot of head scratching and staring at diagrams trying to figure out if the MHC-II was on the B cell or on the macrophage and where exactly was the CD4 cell in all this...and what is this damn T helper cell doing? Wait...is that the same as the CD4 cell? What is a antigen again? Do you mean antibody...daadddaaddddmmm!!! Then you add in neutrophils with polymorphic multi nucleus cells with a few basophils, a couple of mast cells, maybe some complement to make it a nice salad and pretty soon you have yourself a pile of vomit that should be some organized notes. Now...if I was a professional antigen presenting cell, that vomit is my version of a buffet table. (if you have not yet had immunology, when you do, that will all make sense)

 

You may be asking yourself "what is Steve's point..." Good question. My point is what was touched on in another thread on this forum the other day...medicine is a culture and a language all on it's own. So while you are going through the Pre PA stage and cranking away on your pre reqs, wondering what it will be like when you get called up to PA school...I highly suggest that you learn the language and culture of medicine to the best of your ability. I am not talking about just transcribing some medical terminology book, but immersing yourself in it. Discussing lab values with people who can explain them to you. When you hear "shift to the left" you have some mental picture of an acute increase in the amount of neutrophils (which are polymorphic multi nucleus cells...which are phagocytes...which are leukocytes....which are white blood cells). When you hear that eosoniphils you realize those are also white blood cells that respond to things like parasites and allergic reactions. When you hear about T cell counts being low, you already have a picture of that patient in your mind's eye. When they say allergic reaction and start talking of IGe and type I hypersensitivity you are not sitting back at "allergic to what?" This way, when you sit in class and they try to cram a semester worth of info into a 3 hour lecture, you are not translating their language into English. You already speak Medicine. Instead of thinking "what are they saying?" you are processing the info and digesting it into your brain.

 

"But I can study and learn this as I go". Yes, you can. You can lock yourself in your study closet and pound the books, trying not to hyperventilate at every test, spending a couple of years not seeing the world around you....Or you can enjoy a mellow week, exercising about an hour a day, having a couple of delicious dinners with classmates, enjoy a great weekend with the family, study Sunday afternoon with a quick read through refresher on Monday morning and bang out a 97% in about 30 minutes then go for another bike ride for the next couple of hours until Microbiology lecture starts at 1 pm.

 

The more you prepare yourself for the immersion, the more balanced your life can be. Take advantage of this time you have now. 16-18 hour days as a pre PA are hard..I know, I did it. But now, as a PA student, all I have to do is get through lecture and study a bit, ensuring I have time to unwind and relax...it makes all those tough days preparing for this moment well worth it.

 

good luck

Link to comment
Share on other sites

OOohhhh yeah...it's Friday once again. Not just any Friday though...it's the last Friday of summer quarter. That means it's a month off to hang with the family before firing up again in about four weeks. It's been a fast summer, learned a ton but it isn't even an ice crystal on the tip of the iceberg of what's coming. This past week was microbiology intro. As a guy who has never had that course, it was a bit of an eye opener. However, somehow, I managed to grab a test grade that one cannot improve upon. The school really wants you to succeed and if you show up to class, read the recommended materials, get a good study group..you too can make it.

 

Lots of people wonder about what is the best school....what I have learned so far is that you really have to match the school to you. My school is a cooperative school..they don't rank students and they don't post grades. Only you know your own score. There is no sheet posted anywhere to see where you stand. They want each student to help each other to achieve the best job that you can. It makes for a very cooperative family style atmosphere that is, in my opinion, head and shoulders above any other style of learning.

 

I'd write more, and maybe I will over the next four weeks of vacation, but right now...I've already got a buzz going and we're grabbing a cab for a blues joint for a live show and dinner. It's time to celebrate :-)

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.


×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More