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.  

MY EARLY EXPOSURE

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 patient’s 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 patient’s 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 don’t 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.

---------

I’ve learned a lot in the 4 weeks we’ve been back. We’ve 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. 

2nd Semester

Learning how to properly put personal protective equipment on and when to and how to appropriately wash our hands :)

After a good 3 week winter holiday break we immediately dove into our classes this semester. This is what we are taking.

1. Obstetrics/Gynecology - This course has self-directed lectures with an in class discussion on assignments and cases. Here we are learning about the physiological changes during pregnancy and what to expect during labor. We also look into some diseases and issues that can occur.

2. Psychiatry - As the name implies we will be studying the conditions of the human mind :)

3. Adult Medicine - This course will take place this semester and the next. (Yes! We have a third semester which follows this. Our third semester continues until August.) Adult Medicine is broken up into blocks of the different systems. The first one we are looking into is renal and gastrointestinal. This also includes a CI (curricular integration) component. In CI we are given a short case where we discuss our differential diagnosis, what we would ask in our history of patient illness, past medical history and family history. We then discuss what we would do in our physical exam and what tests we would order and how we would use this information to rule out or decide on our differential diagnosis. An example of the case we did last week was "A 48 male comes in with edema". This is broad to get us thinking of all the different causes of edema.

4. Pharmacology - A continuation from last semester. We will continue to learn the different drugs with the pharmacy students. This will include psychotics and other drugs we did not cover in first semester. This also includes a case base study component also given in CI classes.

5. Curricular integration (CI) - CI is a course which is the bridge between class-based learning and clinical scenarios. Here is where we take what we have learned from Adult Medicine and Pharmacology and apply it to real cases found in patients. Time in this course is also given in topics that we feel need to be further explained.

6. Patient Assessment – This semester we will learn the cardiovascular, thorax, lungs, abdomen and comprehensive physical exams. We will also learn about the approach to a pediatric patient and continue to hone our history taking and communication skills.

7. Early Exposure  - I’m very excited for this! Here we are shadowing physician assistants and doctors in the different medical fields. I will let you know how it goes each week :)

------ 

On our second day back the 2^nd year PA class presented some clinical cases they had on their rotations. I did not understand most of what they presented :S. I had this overwhelming confused feeling and thought to myself “Is this how much I should know next year?” All I can do is put my faith in the program. The faculty said not to worry and that the 2^nd years were at the same point as we were a year ago and to look at where they are now. 

I must admit it has been hard to get back into the groove of things. We have our first two exams scheduled Jan 28^th and at least one exam each week following until finals.

More to come. I will try to update once a week. Thanks for dropping by!

Happy Holidays!

School is around the corner and I've been meaning to post this picture for the holidays :p

Look forward to updates on what is in store for us in second semester :S

I know the quality isn't to good - I took a picture of the picture then posted it :)