Is 2 years enough to become a competent clinician?

[WanderlustPA]

So really we could say that the most competent clinician is the one who never feels as though he/she knows it all. We could ALL agree on that, right?!

 

Back to the OP, I wouldn't expect to be anywhere near close to competent after PA school, and that opinion wouldn't change even if I had previous experience. I expect to be a lifelong student, which is one of the reasons I chose this path. I love learning new things. As an added bonus, constantly stimulating your brain will help stave off Alzheimer's and dementia!

[Hemegroup]

So really we could say that the most competent clinician is the one who never feels as though he/she knows it all. We could ALL agree on that, right?!

 

One of the best lessons I learned from one of my Peds preceptors was when she told me, "I have been a Pediatrician for over 40 years and I know but a drop in the bucket that is Pediatrics". You can see why she would say that when you pick up one of the big Pediatric texts, they're bigger than even some of the Emergency Medicine texts. Good words to live by and I've never forgotten them.

 

I love learning new things. As an added bonus, constantly stimulating your brain will help stave off Alzheimer's and dementia!

 

You are correct. Increasing blood flow is good for the brain. Also, neurogenesis in the adult human brain is a reality (wrote a Neuroscience paper on it in undergrad), so the best things we can do as we age (besides weight resistance to build bone density) are read, learn new skills, take up new hobbies, etc. Also, in parts of India where they eat curry daily there is little incidence of Alzheimer's. It's believed to be due to the turmeric (be sure and look for the supplements that also contain black pepper extract, boosts absorption by up to 2000%) actually dissolving the beta-amyloid plaque fibers found in Alzheimer's as well as it being a potent anti-inflammatory ... I actually have a Japanese study which found it to virtually be a cure for MS. I also recommend it to patients with severe psoriasis.

 

Bit of a ramble there ... ;)

[deborah212]

So really we could say that the most competent clinician is the one who never feels as though he/she knows it all. We could ALL agree on that, right?!

 

I wholeheartedly agree with this. I have voiced before my opinion that HCE is not the be and end all to being and excellent PA.

 

When I have participated in hiring, new grad with 10 years of HCE vs no HCE and 2 years of PA experience- choose the one with PA experience. Working as a PA is so different that any prior HCE. That what makes us special.

 

New grad with 10 year of HCE vs no HCE, it depends on the interview. HCE certainly is factored in, just as are references and ability to be a team player.

[Contrarian]

I think your last example is dead wrong....

 

 

I see that you missed the word "consistently" ...

But hey, since you want to completely dismiss BRM/Muscle Memory/and familiarity with things that go bang/boom... cool.

[physasst]

What should the public, physicians, hospital management and insurers conclude from these discussions? There are two schools of thought here. One school, the experienced masters with most experience and credibility, argues that PA schools produce less competent graduates if those newly minted PAs did not have prior HCE. The other school, a growing minority of younger, less experienced PAs and adcoms, argue that PA schools produce graduates of suitable competence to begin work as supervised clinicians without prior HCE. If there is a growing trend toward admitting students with lesser amounts (or no prior HCE), then these two groups are working at odds with one another to the overall detriment to our profession. That is to say, if physicians, hospital management and insurers subscribe to the view articulated by the experienced cadre that argues that the absence of prior HCE produces incompetent practitioners, then wouldn't one conclude that these groups should come to rely less (and hire less) PA graduates? It would seem that one group here actually does harm to another group.

 

Before we make definitive conclusions based on our individual judgment and experience, I wonder if research would produce a more reliable (or interesting) result. Again,I emphasize the importance of national leadership that shapes the messaging for each and every PA. The RNC does this for Republicans. The DNC does this for Democrats. Perhaps it is time for us to have our talking points consistent.

 

The only paper I am aware of is from 1973. Crovitz IIRC. Basically found after reviewing the Duke program that prior healthcare experience had no correlation with the students being successful in school.

 

The problem with doing a paper like this is defining your outcome measures, IE; how do you tell that a new graduate PA with prior healthcare experience is doing better than one without? Do you use peer review? Standardized? Do you use physician assessment? OPPE? It wouldn't be too hard to do, but you would have to capture a second year cohort, their prior healthcare experience with a good mixture of different backgrounds (for subanalysis) and then you would have to get them to report their PANCE score to you, and then subsequently you would have to have access to their SP or peers to administer surveys. Even then, you can have a reporting bias as you might have physicians who are overly nice to their new hire (I really like him, and he/she's doing as good as I could expect, I'll give him decent marks) versus physicians who are overly harsh. Would be best to find one school that accepts both experienced and non experienced....the reason being that you can control the educational variable.

 

Great project for someone who is interested in this. (HINT EMED....HINT EMED)...

[Howezer]

I am just completing my undergrad so I'll probably be told I'm on the wrong forum, and to go away. With that said, I feel a big piece missing from this discussion is the type of HCE attained before going to PA school. I've been contemplating working as a medical assistant or a phlebotomist. I know other undergrads who are working as CNAs changing bed pans, not to be-little CNAs at all. Just wondering what experienced PAs would say about the type of HCE prior to school.

[Hemegroup]

I know other undergrads who are working as CNAs changing bed pans, not to be-little CNAs at all..

 

Yup, because they know how to get sh*t done.

 

It's about taking care of people, in all ways.

 

Also gives them a heads-up on GI and the alimentary tract.

[Moiraine57]

I see that you missed the word "consistently" ...

But hey, since you want to completely dismiss BRM/Muscle Memory/and familiarity with things that go bang/boom... cool.

 

I didn't miss any words. In my experience, your example re: rifle range shooting is wrong more often than it is right.

 

The larger point here is that the plural of anecdote is not data.

 

Your (presumably) informed opinion led you to believe one thing re: rifle range data. My informed opinion led me to another. The sane thing to do here is not argue harder...it is to get some actual data.

 

Otherwise, we're just sitting around bull$hitting.

 

Same thing goes for opinions on PAs found here in these threads. They're interesting, but not definitive.

 

How can you accurately gauge competency? I don't know, but it seems we've given it up without even trying.

[Hemegroup]

Yes... until the supoena arrives, bites you in the azz and he shoves you under the bus... !!!

 

And that really would be the reason. If a PA with an electronic stethoscope isn't able to discern there being a murmur or not, then they either need to go back to school or consider another profession. I think I just answered the question of when I'll stop letting people cause me to doubt. That actually strikes me as dangerous, like a medic following directions from a bystander. The best part was when he came into my office to ask if he could use my stethoscope to listen to the kid ... afterwards he said he would never doubt my equipment :) I really will never go back to anything other than my electronic again ... can't even hear people talking in the room while I have it on, I have to just smile and nod and say 'one sec, I can't hear you' ... great stuff.

[Contrarian]

Yeah... but the tools aren't "magical".... and you neeeeed the skills WITHOUT the equiptment since batteries die and equiptment fails.

 

AS for Moiraine57... Whatev dude... or should I say... Whatever "'WANNABE" ... as a "Pre"... you wouldn't have the slightest clue.. so yeah... keep trying.

 

As a former officer in the military that could only hack it for 4 yrs...

Just Know that YOUR first attempt was a "NO GO at this station"... FAIL...!!!

Recycle and try again.

 

As for the Practicing Medicine as a PA goes...

 

YOU will always be the equivalent of a O-2 and me a O-5...

 

Again... YOU fail because you won't catch up until I retire out of the game...!!!

 

Go to the range and work on your "Immediate Action Drills" and "Combat Power Point Reloads"... novice... cause as a officer, you know LITTLE about BRM as it was likely a "gentlemans course" for you.

 

Ohh... thank you for your service... and now do some push ups.

[GatorRRT]

Along the same lines as an electric stethoscope, glidescopes, one would argue, make it easier to intubate. Would I ever decide to ONLY use one? NO. Reliance on technology turns to dependence.

[EMEDPA]

My last intubation I actually tried the glidescope first and ended up having success with a regular old miller blade....

[Hemegroup]

Along the same lines as an electric stethoscope, glidescopes, one would argue, make it easier to intubate. Would I ever decide to ONLY use one? NO. Reliance on technology turns to dependence.

 

Great, then put your money where your mouth is and walk to class tomorrow.

[Contrarian]

Great, then put your money where your mouth is and walk to class tomorrow.

 

Touche'...

:heheh:

[GatorRRT]

Great, then put your money where your mouth is and walk to class tomorrow.

 

Nah, I'd rather ride my bike, with one of these in my backpack: :wink:

[Doc Savage]

I think your last example is dead wrong. Some of the best shooters were those with no prior experience, because they listened and soaked up what their instructors had to say like sponges. Some of the worst were the "country boys" who had enough knowledge to where they thought they knew it all, and gaffed off the instructorsThe highest shooter on the range when I went was a guy who had done no shooting prior to rifle range.Practice doesn't make perfect. Perfect practice makes perfect. Bad practice grooves bad habits.Prior experience doesn't necessarily speak to how good you're going to be... On the range, at least.

 

I was a "country boy" and had lots of rifle and pistol training prior to being in the military. Well I shot expert on every single weapon they aloud me to wield. I did listen to my instructors and knowing and being familar with balistics was a great advantage... Knowing how to clean and care for a weapon already was a great advantage...knowing little certain tricks that are not in books or military manuals was a great advantage... As a country boy I think your stereotype is dead wrong. The "That aint your Daddy's Shotgun..." thinking is wrong... my daddy's shotgun was harder to shoot than the M4 the Infantry put in my hands. Oh and and shooting expert in different evironments is another thing... I qualified expert in the hottest of heat of the middle east desert and the coldest of the cold of Alaska... so country boy or no prior experience... the difference is diligence.

 

(diligence - 1. Earnest and persistent application to an undertaking; steady effort; assiduity.)

 

 

so if you were some goof off EMT with no diligence... you may not be better off than the "Green Horn" but I would hope PA ADCOM would be able to filter out the goofs and pick a diligent, consistent candidate. I was a meticulous combat medic for 8 years... because of being deployed multiple times I had a Hurt locker, real world experience on why you have to have attention to detail and never let your guard down or be passive about things and be diligent.

[Moiraine57]

Contrarian- once again, you've failed to address the issue.

 

You consistently make an "argumentum ad populum", I.e. "EVERYONE knows 'X' so therefore X must be true".

 

"EVERYONE knows HCE makes you a better healthcare provider, and I believe it to be true, so it must be true."

 

I'm sorry if I don't find that to be definitive evidence.

 

Also, N.B. not sure which service you were in, but outside of OCS, we Marines went to range every year...with a mix of junior enlisted, senior enlisted, and officers, at the same range pulling targets and shooting with one another. There was no "easy" officer's range.

 

I guess you made an assumption that every experience was like yours, and your experience was universal?

[Contrarian]

... [drivel edit]...

 

I guess you made an assumption that every experience was like yours, and your experience was universal?

 

I see that you still missed the word "consistently" ...

[Moiraine57]

If what you are saying is that your experiences lead you to the conclusion that years of high-quality HCE is a prerequisite to PA, but you remain open to the fact that your experiences aren't universally true, right, and correct, then I think we're in violent agreement.

[Contrarian]

If what you are saying is that your experiences lead you to the conclusion that years of high-quality HCE is a prerequisite to PA, but you remain open to the fact that your experiences aren't universally true, right, and correct, then I think we're in violent agreement.

 

"10 Ring"....!!!

 

My experiences ARE true, right, and correct for ME just NOT universally so for everyone else.

 

The interesting part about this exchange is that your "lack" of experience with marksmanship is peaking out and waving at those who know better.

 

So as a Marine Corp Officer you went to the range in OCS and then 3-4 additional times to qualify in the 4 yrs you were in the military...?

 

As a Army enlisted soldier and NCO, I went to the range in Basic, then twice a yr for the 8 yrs I was in the military. Then got out and continued to shoot casually a couple times a yr for a few yrs. Then was "trained up" to serve as a state department/military contractor in 2005 & 2006/2007... so accumulated quite a bit of "range time" engaging static and "moving" targets. Since 2008 been expending about 3000 rds quarterly through both my Carbine and 9mm... shooting IPSC/USPSA in the "production division" and IDPA.

 

Now that the "gun grab" is on... I'm considering "reloading" because its getting harder to justify the ammo expenditure, but that's another discussion.

 

But of course YOUR 4 times (OCS then Once a yr for the remainder of your 4 yr enlistment) on the range informs MY consistent experiences during YEARS of handling firearms... yeah ok.

 

Again, "Thanks for your service"..!!!

 

But again... this is a excellent example of what happens when guys/gals like YOU... who have little to NO previous DHCE come here and argue that it really isn't important... from the very position of inexperience.

 

You argue that previous weapons handling experience doesn't/didn't consistently provide early excellence and mastery.... because you have very little of it.

[Doc Savage]

Moiraine... I dont know about the academic realm, but when I was job hunting I saw a lot of advertisments for PA jobs that required previous experience. They specified that they would consider a new grad IF THEY HAD XYZ Previous healthcare experience. So like all things in this world the private sector sets the trends... not academia, not the government, not any credentialing or certifying body. I would suspect that this trend will drastically increase in the coming years. So regardless if YOU feel like experience has no pertinence to PA-dom... obviously (not universally) it is important enough to SOME to EXCLUDE you from employment consideration based upon that. Not opinion... just how it is!

 

Maybe I am biased because I went to MEDEX... but the job market is not...

 

Good Luck BTW! Thanks for your Service sir... hoorah!

[Joelseff]

What I don't get is why the no HCE crowd is reluctant to just get the damn HCE? I had to go back to school while I worked and still achieve a competitive GPA. What's the big hold up besides impatience?

 

Sent from my myTouch_4G_Slide using Tapatalk

[Hemegroup]

What I don't get is why the no HCE crowd is reluctant to just get the damn HCE? I had to go back to school while I worked and still achieve a competitive GPA. What's the big hold up besides impatience?

 

Because they likely have zero idea of the reality of healthcare and just have $ signs flashing in front of their eyes. When and if they ever become a PA and realize that for THE REST OF THEIR LIVES they will be taking care of sick, poor, injured people, including some who smell bad ... they'll wish they HAD gotten some HCE before school because it might have helped them realize that they were about to choose the wrong career.

[HMtoPA]

After 20 months in PA school & 9 more months in front of me (plus about 7 years previous HCE as a corpsman), I think I can say with a fair amount of confidence that I will not be a truly "competent clinician" upon graduating. Sure, I can get through a Hx & PE just fine, and generate a pretty good DDx for common presentations, and occasionally I surprise myself with some unexpected insight, but there's just so damn much to know that I think it's going to take a couple of years of post-school practice before I stop feeling like such a noob. As others haves said, it's the combination of Knowledge and Experience (talking post-grad experience here) that make a great clinician. Young PA's should expect to pay their dues, IMO. It's no different in any other profession. Incidentally, this is what I think really seperates a physician from a PA - residency, aka a structured environment in which one acquires experience after all those years spent acquiring knowledge. IPAP, like all PA programs is broken up into two sections, which we call Phase 1 (didactics) and Phase 2 (clinicals). But we also talk about an unofficial Phase 3, which is the period of time immediately following graduation that is basically OJT, with lots of self-directed book learning PRN. I think anyone who expects to be a fully-cooked PA right out of school is kidding themselves. My $0.02.

[HMtoPA]

After 20 months in PA school & 9 more months in front of me (plus about 7 years previous HCE as a corpsman), I think I can say with a fair amount of confidence that I will not be a truly "competent clinician" upon graduating. Sure, I can get through a Hx & PE just fine, and generate a pretty good DDx for common presentations, and occasionally I surprise myself with some unexpected insight, but there's just so damn much to know that I think it's going to take a couple of years of post-school practice before I stop feeling like such a noob. As others haves said, it's the combination of Knowledge and Experience (talking post-grad experience here) that make a great clinician. Young PA's should expect to pay their dues, IMO. It's no different in any other profession. Incidentally, this is what I think really seperates a physician from a PA - residency, aka a structured environment in which one acquires experience after all those years spent acquiring knowledge. IPAP, like all PA programs is broken up into two sections, which we call Phase 1 (didactics) and Phase 2 (clinicals). But we also talk about an unofficial Phase 3, which is the period of time immediately following graduation that is basically OJT, with lots of self-directed book learning PRN. I think anyone who expects to be a fully-cooked PA right out of school is kidding themselves. My $0.02.