Tuesday, 29 January 2013

The Exams begin...

It's been harder this semester to write on this blog. This is what has happened in the program so far. Yesterday we had our first two exams of the semester. We had our cardiology block exam in Adult Medicine and renal & gastrointestinal exam in Physiology. It is harder to get back into the groove of things, possibly because of the snow and cold weather here in Winnipeg. 

This semester the courses are a bit different and I find I have to change my study habits. They throw a lot of information at you and I realized that you can't memorize everything. The most important thing is to understand the larger concepts and memorize only what you NEED to.

All our exams are on Monday this term and we have at least one a week. Next will be our pharmacology exam coming up Monday. It will be on epilepsy, antipsychotic, affective disorders, Parkinson, anxiolytic and pain drugs.  


We each get to shadow PAs and/or doctors at different locations and specialties this semester. I've been at two locations so far....

Cardiology - Two weeks ago I followed a PA in cardiology for the morning. Being this would be my first encounter with patients I was very nervous but we were told that we would only observe. I met the PA I was to shadow and noticed from this rotation and the next that everyone starts with a morning coffee :) Afterwards we walked towards the cardiology ward and was explained the routine. We began rounding on patients. The PA checks each patient on the ward and asks how their night was and if they are having any problems breathing. On cardiology I noticed that we checked each patients legs for edema (swelling), JVP (jugular venous pulse to determine blood pressure) and also listened to heart sounds. I was able to listen to one patient with arrhythmia - I heard it very faintly but I noticed afterwards it was because my stethoscope was on backwards :S. In Cardiology there are monitors in the hallway that has the patients live EKG/ECG (Electrocardiogram). This allows us to see the rhythm of their heart and other cardiac problems. The rest of the morning was focused on charting, here the PA recorded each patient interaction, reviewed the results from previous lab tests and the changed or ordered appropriate medications. I realized how much med talk I need to learn. There are many acronyms.  A few hours later the doctor came in and they discussed about each patient and their plan. A patient I found interesting was a 28 year old male who had a cardiac event (I dont remember specifically what type). It makes you realize that at any age something can happen. It actually just made me worried about my husband who is at that age. :P

Deer Lodge - Last week I followed a PA at Deer Lodge. Deer lodge is a center for patients who need continual care for post-surgery/injury after primary treatment has been provided at another hospital. This was an eye opening experience. The PA was hired to replace a health medical officer (doctor) who left. The responsibilities this PA had was great and made me realize how much PAs can do. From my memory, the PA was responsible for two wards but also responds to code blues (emergency code- patient requiring immediate resuscitation) and the only one on call some nights/weekends for 500 beds. The PA described the logistics of the hospital and we went through how to admit a patient. I was also shown some x-rays and was told that it was also their responsibility to interpret EKGs and X-rays because there aren't as many resources and staff available. If anything remarkable is found on those tests that can't be treated at Deer Lodge, the patient is transferred to the hospital. While I was shadowing, one patient presented with blood in their stool, low blood pressure and low heart rate. The PA went through the differentials with me. I learned the tests needed to be done and what to look and watch for.


Ive learned a lot in the 4 weeks weve been back. Weve definitely stepped out from just learning the basic sciences and are now combining it with medicine. Our classes are focused on our differential diagnosis, on what we would ask in our history, on what physical exam we would do and on what tests we would order. It feels like we our minds are changing to become medical detectives. 

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