These Are a Few of My (not so) Favorite Things

Clinical year is the most anticipated part of PA school (besides graduation of course). It is where all your hard work from didactic year starts to pay off. Instead of having your nose in a book trying to absorb all of its contents, you are finally able to interact with patients, perform procedures, and get a taste of what it is like to be a real PA.

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Yet, as fun as clinical year is, there are still a few road bumps you’ll experience along the way. Things like being overwhelmed in a new environment, feeling a little tongue-tied in front of patients, and being in awe (yet a bit intimidated) by your very experienced preceptors are all hurdles that need to be cleared during clinical year.

So let us begin to dive into a few of these bumps and let me tell you how I’ve combated them so far.


Being pimped– This comes with the territory of being a student during clinical rotations. You will be asked tough questions by your preceptor, other doctors/PAs, and even your patients from time to time. And let me tell you, being put on the spot is as tough as it was during your PA school interviews. Starting clinicals is a whole new world to get use to, and your brain is truly put in overdrive when your preceptor asks you questions that can be relevant (or completely irrelevant and random) to the topic at hand. Some things to remember about being pimped is:

  • You’re not going to know the answer every time (and that is ok). Sometimes the hardest thing to say is “I don’t know” because it makes you feel ill-prepared and for lack of a better word “dumb” (at least, that’s how it made me feel). The best advice I was told going into clinical rotations was that it was ok to say “I don’t know” but it was never ok to leave at that. What is ok to say is: “I don’t know…but I will make sure to find the answer.” This response shows that you’re proactive with your learning. Preceptors do not expect you to know the answer every time (for goodness sake we are students) but it sounds a lot better when we make an effort to go find the answer to these questions.
  • Cut yourself a break. I would get really ticked at myself when I wouldn’t know something my preceptor was asking (regardless if I had learned it before or not). I pride myself on being prepared, but sometimes the amount of info your brain has stored up there does not always process and spit out the info in the 10 seconds you’re given to answer. I don’t know how many times I would have an answer on the tip of my tongue only to say “ugh I knew that” as soon as my preceptor told me the answer or I looked it up. So once more, cut yourself a break and then refer to the bullet point above.
  • And to help you retain the most info/prep yourself for a full pimping session I highly recommend buying a book from the series: Deja Review (and preferable you can buy a used version off of Amazon for way cheaper). They have books for any rotation you may encounter and are full of common pimping questions regarding that rotation’s major diseases, procedures, treatments, and much more. I found them extremely helpful to page through during downtime during the day and they prepared me for (almost) any question my preceptor was going to throw at me.

Getting comfortable with being uncomfortable– this pertains to truly anything during clinical year. You are the new kid on the block for every rotation, and everyone knows it. Depending on your rotation length, you have to re-learn and re-adjust to a new rotation every 4-8 weeks. My family medicine and emergency medicine rotation are both 8 weeks, which makes for a little extra time to adjust and get comfortable in my environment, but for internal medicine, surgery, and my elective I find myself in a new home every 4 weeks. That means new preceptors, new clinics/hospitals, and new staff every month. I found that by the end of my 4-week rotation, I was beginning to get the hang of the procedures, was given more freedom by my preceptors, and was feeling a lot more confident overall…only to be tossed to the next rotation to start all over. You know what though, it gets much easier as the rotations go on. After rotation 1 and 2, you start to get more confident in what the flow of rotations is going to be. You start realizing important things to know, when it is appropriate to do what, and who to turn to when you’re in a bind (aka nurses…be kind to those lovely folks).

In addition, I think it’s so important to “trust in the system” that your PA school has in place. When they say they will get you to where you need to be, they mean it. I cannot even count the number of times during didactic year when I was camped out in the library til the early hours of the morning and was questioning why the heck I was doing all this work and if all this info would actually stick in my brain. Guess what, it did (for the most part)! There have been countless times when I have had my doubts but in the end, my program had a reason for doing what they did and proved me wrong. So I’ve learned to just trust in the process. The sooner you do that, the smoother things will go for you in PA school!

Having patience with patients (and yourself)- You can be smart, you can be charismatic, but sometimes when you get in front of patients you lose your mind and whatever you were about to say.

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All through didactic year, we had multiple opportunities to break the ice with patient care starting with classmates as “patients”, then standardized patients, and then monitored real patients. In clinical year…it is nothing but real patients! It can be challenging at first, as you want to seem dignified and intelligent in front of the patient, but once more you’re put on the spot to come up with the right questions to ask in order to guide your patient to lead you to their diagnosis. While asking these questions, you are concurrently trying to think up a differential diagnosis while also determining what tests you want to run to narrow down on a correct diagnosis. This process is an art, and for most students (including myself) it can take a while to get the hang of it. In a perfect world, your patients will be perfect historians, have the classic signs and symptoms of their disease, and will have no underlying co-morbidities that cause complications. I learned in my first week of rotations that this diagnosing thing is a lot harder than I thought it would be. Thankfully, as students we are not the sole deciders on our patient’s diagnosis and treatment plan (that is where our wonderful and intelligent preceptors come in).

Another thing I learned early on, is it can be hard to get straight answers out of patients. I remember during my family medicine rotation I was trying to get to the bottom of whether my patient’s asthma was controlled or not. The patient informed me that she was having an ok time breathing, did not feel she had to take her medication for shortness of breath, and basically led me down the trail to believe that she was a well controlled and an asymptomatic asthmatic. Of course, I pranced back to my preceptor’s office and reported this to her. Needless to say, my confidence bubble was popped when my preceptor and I went back into the room and after my preceptor asked about 3 questions I realized that this patient was far from controlled and actually needed her medication bumped up to a higher level (epic fail, Jourdyn). I was embarrassed at how off-base I was but my preceptor laughed and said that will happen from time to time where the story changes quite a bit depending on how and what questions are presented to the patient, if the patient remembers their history correctly or leaves stuff out that they remember later, and if the patient just doesn’t want to disclose info to the student vs. the preceptor (who they obviously have more confidence and history with). This is part of the fun of learning how to interact with patients and it taught me a valuable lesson on being more cognizant about my interaction and interviewing of patients. Moral of the story: patient interactions are a fun and critical part of clinical year, but it can take some growing pains to get to where you want to be.


Preceptors- This truly can be luck of the draw when it comes to preceptors and their personalities. You put your faith in the hands of your clinical year coordinator to place you with a wonderful, caring, and naturally gifted preceptors. Sometimes this happens, other times it does not. As a PA student, there are three main groups of preceptors you will be placed with (at least on the official papers): PAs, doctors, and NPs (or a combo of the 3). In reality, you may be spending time with many other experts including x-ray technicians, diabetes educators, nurses, medical assistants, casting/splinting techs, EMTs, and many more. I have also had classmates who have had a main preceptor whom they spent 2-3 days with over the course of a 4 or 8-week rotation, and the rest of their time they rotated with other providers in the clinic/hospital. This may alarm some people, but in reality, if you are feeling like you are learning something each and every day…then you are doing your rotation right!

In addition, you may find some preceptors keep you on a short leash. I’ve had rotations where my time spent was more like a shadowing experience than it was a rotation. If you feel like you’re only shadowing your preceptor, don’t be afraid to ask for a bit more independence. For instance, I had a preceptor where I followed him around for about 2 weeks before I braved up and asked if it was ok if I tried interviewing patients (because at my prior rotation I became accustomed to going into a room and interviewing a patient solo prior to my preceptor coming in). After talking with him, he informed me he had never had a PA student before and wasn’t aware of what I was comfortable with. He happily agreed to let me lead the interview with our following patients and the rest of our rotation went very smoothly. On the flip side, I had another preceptor that had been burned with prior students and did not feel confident letting me or his med student go in solo to talk to patients. Although I felt a little annoyed that I wasn’t able to work on my interview skills, I realized that I could still learn a lot through observation. These preceptors are professionals in their field and if they are chosen to precept, chances are they have been in their job for quite a few years. Pay attention to the questions they ask, how they interact with their patients, and what tests and treatments they order. Even if you feel like you’re not contributing much, remember that you can learn something from everyone and every situation.

On a very serious note: in the rare case that you find yourself with a preceptor who is disrespectful to you, makes you feel uncomfortable, or anything else that you may deem unacceptable (within reason), remember to be in contact with your clinical year coordinator. My coordinator made it abundantly clear that they want to know about the good and the bad (and especially the really bad circumstances) that unfortunately can come up. These coordinators want you to have a good experience and may have a solution to help this happen. So don’t be afraid to reach out to these wonderful folks when you find yourself in a bind!

Lastly, I don’t want to end this blurb on a bad note so I will say most preceptors I have worked with and have heard of through my classmates are incredibly excited to have students and are beyond fabulous at teaching! Even my “shadowing-like” rotation was incredible and I absolutely adored my preceptor. So enjoy your time with these fabulous folks because they really are good at what they do and can teach you a ton!


Other Odds and Ends and a Few More Bummers-

Long commutes- sometimes your rotations won’t be your first choice of location and can end up being up to an hour each way commute. Besides feeling a little drained by the gas money to get to your rotation you can also feel the aches and pains of getting up early, getting home late, and running into nasty weather or traffic that makes your commute even yuckier. Solutions to make it less annoying: 1. Check to see if the rotation has housing. Some places frequently have students and have come up with fairly decent housing options for a small fee (or free if you’re lucky). If you work out the math and find that it’s cheaper to pay rent for a few weeks vs. drive, this may be an option for you! 2. Podcasts are a really good way to study and pass the time to and from your rotation. Some good ones I have enjoyed are: PABoards, thePAPlatform,  The Audio PANCE and PANRE by ThePaLife.com, and I’ve also downloaded lecture captures from my didactic year into audio files! Listening while I drive makes me feel that I am being productive during my commute and takes my mind off driving too!

-Feeling Like You’re at the Bottom of the Food Chain- as a PA student, you may find yourself interacting with a variety of other students at different levels of education: med students, residents, NP students, and other PA students. Unfortunately, you may find there is a “pecking order” and that you are closer to the bottom. Once again, you may find you need to adjust your rotation to fit your needs or adjust your expectations to fit the rotation. In surgery and now in my emergency medicine rotation, I found myself sharing schedules with med students and residents. One solution that my EM preceptor found to combat an overcrowded learning environment is to coordinate my schedule opposite of the residents so that we are not “battling” over patient interactions and procedures and I will be able to make the most out of my learning experience. Yet, it isn’t always terrible to work with other students. Like I said before, you can learn something from everyone. The medical student I worked with during surgery was finishing up his 8-week rotation when I was just starting and was happy to give me pointers and tips on how to rock my rotation. Residents have gone through their rotations in med school and are now learning to become experts in their given field. They can also be awesome resources for pointers on how to do a certain procedure or are fabulous to watch interview patients too! Plus, in reality, we are all students and are trying to figure out what the hell is going on, so we can all laugh a bit at that.

Being asked for the millionth time “so what specialty are you leaning towards”- This is a struggle because 1. You may not know what you want to do 2. You may know but don’t want to offend your preceptor/fellow staff members when your answer isn’t their specialty or 3. You literally hate every rotation and are seriously considering dropping out of school (just kidding!! ). I’ve always given the answer: “I’m trying to keep an open mind with every rotation and have not decided yet”, which in reality is my honest answer. I also tell every preceptor at the beginning of my rotation that I want to get as much experience as I can in their specialty so that I can learn the good things and the bad things that come with it. This means I want to be on-call, work full shifts, and see as many patients as I can. Even with a full 8-week rotation, I find time flies by and that there is still so much to learn. So make the most of your rotation and by graduation maybe you will confidently know what specialty is calling you!

Being busy all the time– during rotations you’re constantly running around, find yourself missing meals, and your feet hurt from standing or walking around (especially during your surgery and ED rotations). Make sure you always have a spare set of clothing, comfy shoes, and a snack packed with you. You will soooo thank yourself later!


So these are a few of my (not) so favorite things and a few hurdles you may find yourself encountering during clinical year. I will end this post on a good note by saying without a doubt clinical year has been a thousand times better than didactic year and it is for sure the light at the end of the tunnel when it comes to your education. Every day is a new and interesting experience during clinical year: new patients, new procedures, and variety all through the day. No two patient experiences are the same. In addition, you are finally doing what you set out to do when you applied to PA school: helping patients become their best selves. Even as a student, you are improving these patients lives by offering education, providing a fresh take on information and patient care to preceptors, and most importantly: having fun! So enjoy your clinical year, because if you thought didactic year went fast (and in retrospect, it totally does even if it doesn’t feel like it during the year) clinical year goes a million times faster!

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Clinical year is truly where the fun happens! And before you know it, you’re going to be a PA-C!

-J

 

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