To all you paramedics out there...

[CCEMPA]

Good evening everyone,

This question is geared specifically for current PA-S, PA-C, or anyone who would know the answer to these few questions I have. I'm currently a paramedic working in a emergency only, mid-size city, and have been working in EMS for six years. I'm wondering..

1. How useful has your background as a medic been? Did the previous experience and knowledge really benefit you with the rigors of the PA curriculum?

2. Do you believe that your education/experience has a EMS provider was the "boost" you needed to set you apart from the rest of the applicants (in addition to strong gpa, interview, etc)?

3. Anything could offer to shed light on the transition?

 

Cheers, and thank you

[BenRRT]

I'm confident that your HCE as a medic will make the clinical portion of PA school much easier. There's an active member on this forum, a former medic, who will be able to answer these questions in more detail.

[flyingsquirrel]

The short answer is yes, it's helpful. Obviously, the first year it will help you more with cardiology and pulmonolgy than things like neurology and endocrinology...but more importantly you have learned more about the ins and outs and successes and failures of the medical system than anyone who worked as a candy striper for three months could ever hope to know. As a paramedic you will be way ahead on the 'hard skills' and that's great, but both you and I could probably teach a relatively smart chimp (and that candy striper) to start IVs without too much effort. Where paramedics (and others coming into PA school with YEARS of real health care experience) have an advantage is in the soft skills. You know how to talk to patients. You know how to talk to other providers. (You probably know how to talk to other providers who don't like you without it getting personal.) You can deal with "problem patients" and have difficult discussions with their family members. These are the things that cannot be taught and can only be learned through experience.

 

There are some programs that really value "high quality HCE" and there are others that will say...'that's nice that you have 12,000 hours of documented work as a paramedic, but we really wish that you had shadowed more. Make sure you apply more to the former (and nail your interviews) and you should be all set.

 

The transition? It's rocky.

[Just Steve]

Time as a medic enhanced my student clinical experience by expanding my exposure to the language of medicine. It implanted logical thinking during high pressure times that spanned the process from first glance at patient to parting wave as we dropped them off at the ER. This helped enable me to assimilate faster into the culture, opened doors of enhanced opportunity, and overall kept me from hyperventilating about much of anything concerning patient care. I don't have all the answers but I can tell "sick" from "not sick" at a drop of a hat and that enables me to apply the proper amount of pucker factor and not feel like I am stressing the whole day. I have no issue with saying "I have no idea but we can find the answer" and while it sounds simple enough, I see students who don't have an breadth of experience get paralyzed at the thought of saying something like that.

 

as far as the actual soup and nuts of the medical knowledge surrounding my paramedic knowledge...we know A LOT about a very tiny, superficial part of the pie. PAs are not pre hospital providers concerned with the patient's immediate life safety for next 10-60 minutes. PA school wants their students to be knowledgable about far more things that are not related to anything that resembles EMS. For the six credits of scholastic learning in emergency medicine during my didactic year, I didn't stress so much. For the other 100 or so credits...my nose was in the books.

 

My time as a Navy Corpsman has proven far more useful.

 

That being said...being a medic educates us in many subtle ways regarding bedside manner, patient interviewing, confidence during skills, physical exam skills, problem solving, investigative/critical thinking, interpersonal communication skills, teamwork, life experiences...so on and so forth. It's great experience. Just don't expect it to carry you very far all by itself.

 

i am attending MEDEX which stresses previous experience. 50% of my class at the Yakima campus were paramedics or combat trained military medics. The other 50% were RNs, CT techs, ER techs, Surgical techs...being a paramedic in that class is just being another face in the crowd. Doesn't stand out at all. It might have been different at another school but have no idea.

[CCEMPA]

Thank you very much to the both of you. Both posts held the insightful and well articulated thoughts I was hoping for. I certainly have no delusions that my background would allow me to "breeze" through anything to do with school. I was very curious as to how it helped, if at all. I have found, and perhaps the two of you can relate, that the reason PA school appeals to me so much is this "thirst" for knowing more, and going beyond the care that stops once I drop my patients off at the ED. I also was wondering if either of you could shed any light as to how hard it is to abandon the "pre-hospital" train of thought that you mentioned Just Steve.

[Guest]

Let's just say you will have an easier time in school than non-medics. I had the fortune of working with many medics as an EMT-B and they are all wonderful and very knowledgeable. When you put it into perspective, it is a very advanced training.

[PM2PA]

I don't think you should ever totally abandon that pre-hospital train of thought. I think it will set you apart from other PAs, nurses, docs, etc no matter where you work. It is definitely a skill that I personally don't want to loose either as a medic about to start PA school myself. I'm sure you can relate but no matter where I get calls (nursing homes, doctors offices, etc), the complete lack of proper PTA care for serious 911 complaints is saddening. And this comes from those who are supposedly "better educated" than us pa-ram-a-dics.

[CCEMPA]

I hear you, but what I mean is the transition from thinking prehospital and short term to more definitive treatment. I think thats going to be harder. Like one of the other posters mentioned, our world is very limited when it comes to the larger picture of medicine. Albeit, coming from an emergency background, if i was accepted/completed a program I think thats where I'd like to be. However I wont know that until I cross that bridge. And pa-ram-a-dic? Whats that? Last time I checked I was an ambulance driver

[Just Steve]

The ability to transition is only hemmed by your ability to accept the role of a life long learner. I mean no disrespect to paramedics..I love being one and I am very proud of my history as one but a lot of our medicine is/was cookbook. "If X presents, do Y" and that cookbook was a fairly thin volume. Chapter 1 is dedicated to "Sick and about to die", Chapter 2 is "Sick, probably not going to die today", Chapter 3 is "Won't die despite whatever we do to them" and then Chapter 4 is "not sick, not sure what's wrong, but can give them a ride".

 

A paramedic differential diagnosis list is short...or at least the list we care about is pretty short..."what can kill them in the next few hours" and we focus on that. As a primary care provider, we need to think about "what will kill them today, tomorrow, next month, and in 10+ years".

 

Your willingness to open your mind to the fact that there is a LOT of medical information buried within the history and physical that we never even begin to approach as a medic because we didn't have a need. Recognize the need as a PA student, be vested in the patient's overall health, and your transition should go quite smooth. Stay humble, stay a student for life, and don't "wing it". You'll do fine.

[FfIghter23]

Agree with most of the above. As a paramedic who is now in PA school, looking back I felt I knew so much about medicine. In reality, I was just following a protocol of steps until we arrived at a hospital. Yes, paramedics get to do some pretty cool things: delivered seven babies, synchronized cardioverted, RSI'd patients, got to stabilize some cool traumas, looked at hundreds of EKG's, and more... but they were all situations that were pretty cut and dry and I had no other choice but to follow the protocol. When I didn't know what to do as a medic... guess what... "load & go" and went to the hospital and let someone else take care of it.

 

I'd say about 10-15% of the material in PA school so far I had a good grasp on coming in. The rest is all new and way more in-depth in every way. I would disagree with the statement that medics have an advantage coming in. Most of the people with medical experience have a chip on their shoulder and aren't as open to learning new things. There is a former foreign medical doctor in my class and they run circles around everyone else. The only thing medics have an advantage on is the clinical phase. A paramedic already knows how to stay calm under pressure and multi-task. Those things are hard to learn and only gained through experience.

[Will352ns]

I hope my military experience and paramedic will help during clinicals.....but for the most part, I will keep it to myself and purposely not lean on it for knowledge during didactic, other than practical stuff (hands on). Clean slate and all that.

 

Nice to hear the perspective of medics currently in school.

[EMEDPA]

my personal experience was that the medic job was invaluable background for pa school. I still get jobs today because I am comfortable with medic level skills that many pa's are not. the top 3 students in my program were all medics....#4 was an rn, #5 was an RT.

[PM2PA]

If you think about it, isn't medicine as a whole just one giant protocol? Of course it's not so black and white all the time, that's where diagnosing and other skills come in. You have/suspect this, do these things, order that, reevaluate and reassess.

[Just Steve]

If you think about it, isn't medicine as a whole just one giant protocol? Of course it's not so black and white all the time, that's where diagnosing and other skills come in. You have/suspect this, do these things, order that, reevaluate and reassess.

 

Yes it is...some people call it Evidence Based Medicine. However, there are many paths to achieve the desired end goal. As a paramedic, those paths were dictated for us. As a PA with a good working relationship with your SP, you get to customize that path to ensure it's the best path for your patient. Take HTN for example...how many ways can you think of to control this condition? Does any one way truly do the best for all patients? That's where the autonomy as a primary care provider really starts to shine.

[Medic207]

I really agree with the medic/PAs above:

I too have gotten jobs based upon my experience as a Paramedic, and for that have kept the medic license active, and even though I haven't flown on the chopper much in the past few years I still hang out at the station and play with my medic friends. EMS is where my roots came from so I guess it will always be a part if me, even after 20 years.

 

Here is my advice:

Be open minded in school. 99% of PA school is not critical care. PA schools teach basic primary care, and aside from your EM class, and skills labs, you'll need to be open minded to that,

 

Cardiology is a lot more than just CPR, MIs and EKGs. Although your experience will help, you will also need to know a lot more.

 

Pharmacology, if it is taught right, will challenge you way beyond the basic drugs in the rig. There is much more to learn here too!

 

Be proud of your EMS background just stay grounded and know when to scale back the critical care, and do not get big headed thinking this will be a piece of cake. Some of the strongest Medics I knew struggled in PA school because they took for granted all the little stuff because they were too comfortable with the material. The non medic newbies would score higher on exams because they were not biased on how to approach something. My experience was that it was like being cursed sometimes because I would see a question and think "well I would do (XXXX)" when in reality the question was really about YYYY. So again, just know when to think like a medic, and when not to. Remember the Medic textbooks had a bunch of "nice to know" material, and then what you "needed" to know material. Then the medic exams tested you on the "need" to know stuff. Well.. PA school is all "need" to know stuff.

 

Lastly, The answer isn't always "oxygen"

 

 

Good luck!

 

Sent from my iPhone

[PM2PA]

I'm going to be lost if scene safety isn't one of the choices!

[flyingsquirrel]

I'm going to be lost if scene safety isn't one of the choices!

 

I had an exam question that described a patient with fever, hemoptysis, pleuritic chest pain, night sweats, and significant weight loss. The question was what do you do first. Put on a mask was not one of the options.

[MediMike]

Immediately start your own TB regimen?

[Just Steve]

I had an exam question that described a patient with fever, hemoptysis, pleuritic chest pain, night sweats, and significant weight loss. The question was what do you do first. Put on a mask was not one of the options.

This illustrates a great point...ssssooo many of PA questions isn't "what is it" but rather "what are you going to do about it". Apply diesel and turf to ED isn't the answer either.

[dreatx]

BSI!

 

Ok, I guess not.

[tcd1976]

After graduating from college with a BS Biology, I was an EMT for about two years before I went to paramedic school. I was certified as a paramedic for eleven years, mostly in the fire service as a firefighter. I worked in a highly liberal EMS system that was anything but "cookbook," and where WE, the medics, wrote the protocols. Actually, it is a pretty unique system and I feel really fortunate to have had the privilege to work and learn in such a system. I am also REALLY thankful for the docs who were willing to teach me (and still do so today).

 

My BS coursework was directly applicable to our didactic year in PA school, especially the first couple of quarters, and for that I am truly thankful. Between that and my training as a paramedic, the best analogy I can offer has to do with file cabinets. Being a paramedic is a great point from which to embark on this journey. You have the file cabinet built, and inside of it are many of the files you'll need to access. Most of them may be empty, but they are present - you've heard of these conditions, but know little or nothing about them. Your didactic year will be about organizing and filling those files, as well as adding many more of which you'd never thought. Depending on your paramedic program and educational/life background, you may or may not be ready to stick your nose to the stone and not let up, even when there is no skin left and all you want to do is cry, "UNCLE!"

 

If you are anything like me, most drugs will be a piece of cake - except antibiotics. Those kicked my butt and continue to do so. I just keep working on it.

 

Most procedures and physical exam skills will be second nature, but for us, they were tested IN ORDER. Out of order? Deduct points. I was certain I was going to earn a negative point value on one of my exams because the order I had developed over the years was different than that on which we were tested. I was also not accustomed to sitting still to take a history and then performing a physical exam - I always did it simultaneously. I had to learn to take a breath and slow down. I also had to learn how NOT to write in ALL abbreviations.

 

Where you will shine is when it comes to compiling a list of priorities and developing a treatment plan. You've had to make a decision, choose a treatment, and ride it out. You've had to learn to read your patient and evaluate trends to know when to stick with it just a *little* longer because the tide is going to turn and know when to cut and run (and change your plan because you are behind the 8-ball). Amazingly this particular skill is applicable whether considering critical care, observation, primary care, and many other specialties. This includes dealing with both inpatient and outpatient behavioral medicine clients... SERVING your patients... Procedures... And all of the synthetic learning that is packed into your clinical year.

 

Stay humble, keep your eyes and ears open, find YOUR organizational scheme, and let 'er rip. It's a great ride. :=D:

 

 

Best wishes!

 

***Edited to add, "compiling a list of priorities" and developing a treatment plan.

[PAruby]

These are questions I thought I had figured out before PA school - and had them mostly dead-wrong. I was formerly a Paramedic in a high-volume EMS and interfacility transport company, with experience for 4 years as an ER tech prior to that. In the two years immediately preceding PA school, I ran an average of 8-10 emergent calls a day in 13 hour shifts for a grand total of A LOT of HCE compared to many of my classmates... here's what I will say about your questions. (i know it's long, i got carried away, but hopefully it'll benefit you!)

 

 

1) Medically, my background was invaluable. While my classmates struggle to associate syndromes and even "classic presentations" of things like MI, kidney stones, etc., I am able to put patient experiences to those facts and that makes them a TON easier to remember and expand upon. Familiarity with basic blood labs, medication families, and even just having heard of diseases in the past was so helpful. That being said, my former knowledge HARMED me in some cases, especially learning about complex plans of care for diseases because I either jumped too far ahead and didn't answer the question relating to step A and went straight to step B... or I didn't associate symptoms with the right diagnosis because I had seen them elsewhere. In many instances, especially for exams, I found it most helpful to forget everything I knew and just learn what the lecture said and only LATER apply prior clinical knowledge and figure out how to put the pieces together - As was mentioned before, I answered X when the question was about Y... It's a double-edged sword for sure. I also came to appreciate those "less than awesome" practitioners I'd come into contact before previously - If they got through a program like this, they cannot possibly be incompetent and likely I just misunderstood them while I was being set in my pre-hospital ways and thinking I knew about medicine (laughing at myself now!). It's fun to learn beyond what you already know and really get into WHY things are the way they are.

 

2) I have mixed thoughts on this. I certainly think the HCE helped set me apart (my 10,000 hours to the average 750 hours), but I have been told (whether fact or fiction I'm not sure) that some programs descriminate against pre-hospital providers, especially Paramedics for two reasons. 1) We tend to have this ego about us - not all of us, but enough to make them annoyed by us and 2) our training is so largely practical knowlege and hands-on that we tend to struggle academically in a program as rigorous as this. PA school is Paramedic school on steroids, 3x longer, and 50x harder... Personally, I'm not as strong in the books as some of my classmates with almost no HCE in certain academic sections. They're better at studying, reading, listening to lectures... I'm confident that the clinical, patient-interaction learning curve will be a little steeper for them though, so it's a bit of give and take. Whether these biases are real or not, I'm not sure... I got into the program with HCE and a good personal statement, GPA, and passion for medicine, etc. I interviewed with several other paramedics & EMTs, only 3 of us made it to the class. It's not a sure bet.

 

3) I expected PA school to be hard, but realize it'll be a bigger challenge than you can imagine. The transition is enormous, especially if you've been out of school working in the field for a while. The train of thought is different and more extensive, and I occasionally find myself missing the old "load, go, & get rid of them before they die" mentality that simply doesn't exist when you're on the receiving end, but I'm much more excited to know the why's and now-what's... I thought paramedic school was challenging, and between that, and working full time while taking full-time course load to finish pre-reqs, thought I was ready for just about anything and well-prepared to say the least. I was wrong, there is no such thing as well-prepared, just better-prepared... Realize that if you're a type A personality, you probably won't get all A's or do everything perfect (an initially hard pill for my perfectionist self to swallow), but that you do the best you can with the time you have and you'll get out of it what you put in....

 

also, as was pointed out to me in another forum post, it's wise to travel away for school. People think you're busy now, but they truly won't understand your program and won't change their expectations of you. It's not an option for everyone, but definitely something I think I should have considered more. Finally, not that this applies to you as you seem to have all the right motivation, but for others, don't pursue PA because you're tired of being a medic, do it because you want to do MORE for your patients... I have a friend going through PA school after 20 years in the FD. He's burnt out, and hating life mostly because he lost that passion for people. Another friend, same thing, absolutely loves it and is succeeding beyond belief because he WANTS to be there not because he's tired of what he was doing before.

 

Good luck to you! I know this was long, Sorry, but hopefully provided the insight you were looking for!

[hught89]

Im currently trying to get the HCE need to apply, would say your time as a paramedic or ER Tech prepared you better for PA school?

[EMEDPA]

paramedic.

er tech was the basics. as an er tech you never make pt care decisions. as an er tech you learn a lot about the culture of medicine. it was a great intro and made being a medic easier.

as a medic you have to make decisions based on your own exam and stick by them.

" I thought it was chf and not pneumonia because xyz which is why I used tx ABC not DEF".

[Friction]

paramedic.

er tech was the basics. as an er tech you never make pt care decisions. as an er tech you learn a lot about the culture of medicine. it was a great intro and made being a medic easier.

as a medic you have to make decisions based on your own exam and stick by them.

" I thought it was chf and not pneumonia because xyz which is why I used tx ABC not DEF".

 

I'd definitely agree with this...

 

I was in medic school before I had to drop b/c of some health reasons and I've also worked as an ED tech for the last year. As a medic, you really learn interventions and how to apply them based upon presentations and protocols. As a tech, you'll learn some good stuff but its more about how to do things and not why... How to perform suturing, how to drain and pack an abscess, how to do a lumbar puncture, etc. That's mostly a product of assisting providers with these things. You're not really learning why a provider is using certain medications or running certain tests.