An update is in dire need!

I officially passed the PANCE, though not by much. Passing is all that matters though! I celebrated by going on a 3 week road trip with three of my classmates around the country, which was one of the best decisions I have ever made. I highly recommend everyone exploring this country. It's pretty amazing.

Lastly, I have a job! I start Oct 15. I will be doing family practice in a little fishing village, which is pretty much what I envisioned myself doing. Not only that, my work found me a place to rent right on the ocean with a beach, which is even better. I feel incredibly blessed. 

PANCE

The PANCE is over!

I took it yesterday. It went fairly well, and it wasn't nearly as bad as I thought. I am satisfied with my study strategies over the past month. I am very thankful that it is over now!

Now I play the waiting, and enjoying having nothing to do, game. I have another interview this coming week with a place that has tentatively offered me a job. I should hear back about the PANCE on Thursday.

The end is here!!!!

My Delaware rotation ended last Friday. Overall it was a great rotation. The doctor I was with loved to teach, and I feel much more comfortable managing chronic illness than I did going in. I am very thankful for my time there.

I also loved being there with my classmates. It was easily the best month of PA school, let alone my recent life. The funny thing is that I was still tired all the time despite the fact I didn't have to study crazy hours any more, mainly because I would stay up so late enjoying my time with my classmates.

Tuesday we had our last assignments of school, case presentations from a patient we saw during our elective rotations. We then had a class pool party which was a blast. It was a ton of fun to hang out with everyone.

Yesterday (Weds) I went out with more classmates for some good thai food!

Today is our formal class dinner, and tomorrow is grad.

:)

Delaware has been fine and dandy. I love the doctor that I am working with. He loves to teach, and I am allowed to do everything (see whatever patient comes in, do all my own charting, etc). The staff are nice, I get free lunch everyday, etc. It is a good way to wrap up my education.

The best part of being in Delaware is this beautiful condo that I am in 3 miles from the beach, with 3 of my favorite classmates. I feel like I almost have a normal life again. We cook big meals, and eat for 1-2 hours, stay up late playing scrabble, etc. I can't believe how lucky I was to be allowed to come down here. What a way to finish the year :)

I'm done. I survived. I don't know how I did this for 60 weeks straight, but going hard for a whole week has wiped me out. I'm exhausted from being in lecture all day, the getting up super early to study for the exams. The heat hasn't helped, bc it makes it hard to sleep at night! Ha. But I'm done. I can't believe it.

I got super lucky though. One of our exams was a comprehensive patient encounter, where you basically see a patient and get graded on it. My patient had GERD (reflux), which is a fairly easy complaint to work up and manage. However, some of my classmates had diabetic neuropathy, which meant they had to do an entire neuro exam in like 10 mins (should take much longer, and the neuro exam is so complicated).

Our skills exam was a joke. We had to be prepared to do stuff like intubate, start IVs, put in nasogastric tubes, etc. I had to put on a volar sprint for a wrist fracture, do three horizontal mattress sutures, and then do an ABG. I think everyone got 100s, haha.

Our 250 question written exam was kind of a joke too. They broke it into two sections, 125 questions each, and I was done each one in abuot 25 mins. It's funny that it was supposed to be a cumulative exam over everything we've supposedly learned for the past two years, but it was probably the easiest exam of the entire program. They took 95% of the questions from online question banks we've been using to study from all year, haha.

No more exams ever (except for my board exam in August)! Woohoo!!!

I JUST FINISHED MY LAST DAY OF LECTURES IN PA SCHOOL! :D

This week is comprehensive review week. It's actually a 3 credit course, that is how intense the week is. Lectures for 4 days straight, then three exams covering everything we've learned in PA school....a graded practical encounter with a patient, a skills exam where I could be tested on anything from giving shots to placing catheters to intubation, and then a 300 question written exam. Then I'll be moving to Delaware for a month with classmates enjoying the beach and doing my elective rotation in internal medicine, without having any exams to study for :)

Family med is almost over, or should I say, the last rotation that I'll have to spend exorbitant amounts of time studying for is almost over. Weds is my last day, and I've been thankful for my time at the office I am at. It's been a very basic family med rotation. I like my patients and they seem to like me. I enjoy developing relationships with my patients, as some I have seen a few times.

Big things are coming up though. Thursday I present my senior research. I also have a phone interview (WHATTTT?!?!?!?!) for a job that I applied for and really want. Friday is my family med cumulative exam. The following week is filled with a board review coarse, and my three cumulative PA school exams (written, skills, and patient encounter). And then my friends, I will OFFICIALLY be done with PA school exams for good.

Only a PA student can see the relief in that last sentence. When you're caught up in the drudgery of being at school 90-100+ hours a week, taking 2-3 exams every week, it doesn't seem like it will ever end. There is an end in sight, and I am looking forward to it immensely :)

Family Practice

I am officially a week and a half into my newest rotation, family medicine. I like it a lot, which is good because this is the field that I think I am going to be going into initially. It's sooooo nice having normal work hours again (8-4 with Friday half days), compared to the 5:30-5:30s with 26 hour call every couple of days during OBGYN. I love being able to sit and chat with my patients, and actually treat everything. Throughout my entire clinical year, I was always told "Don't worry about that, that is their primary doc's concern, only treat the problem at hand." That was hard for me, to see such a blatant problem and have to ignore it because it wasn't within my scope of practice. Now that I am working with their primary doc, I've had to get back into the habit of looking at the patient's ENTIRE chart....all their recent lab work, their past few progress notes to see what issues they have been dealing with, their consuls, cardiology workups, etc; even if they only came in for a runny nose or med change. I feel like this rotation I'm actually using critical thinking skills, and I find myself that I'm able to counsel my patients more than before. A lot of times the doctor will ask me in the patient's room what I think is going on and what I want to do, which can be nerve racking because you don't want to look wrong in front of a patient. Thankfully I've been mostly on par with my diagnoses, and usually close with my plans. My biggest challenge right now is knowing what meds to choose and why. I generally know the classes of meds, but knowing which of them to choose can be a challenge. Especially diabetes medications and antibiotics. Thankfully I am doing an elective in internal medicine so I can get more practice managing hypertension, afib, diabetes, COPD, etc.

The one thing that I don't really like about this rotation is that the patient's entire chart is on an ipad that I use. I have to be very conscientious about making sure I'm not staring down at the ipad the entire time that I am with a patient, which can be tricky (usually because a lot of patients aren't very good at knowing their medical problems). I like the EMR that the office uses, but it is internet based, so I have to wait for the pages to load sometimes.

The other big thing that is going on is that I've had to start getting serious about looking for jobs and studying for the PANCE, the physician assistant certification exam. I graduate in less than three months (!!!!!!!!) and things feel real. My CV is done and being reviewed by a career counselor at school. I haven't registered for the PANCE yet because I don't know where I am going to be to take it....still deciding between Maine, Mass, and Philly (all places where I have significant ties). I have decided that I am going to take it three weeks after graduation. I'll use the first week to move and let my mind rest, then use the next two weeks to study. In terms of jobs, I am proceeding with going with the rural family practice route. If I do loan repayment through the NHSC, I'll either get 20k or 30k each year from the government (depending on how rural I am), tax free, to use towards my student loans. As someone who is pushing $150k in debt, this is a very appealing option to me. Plus I grew up in a somewhat rural environment, so it is not like it will be a big adjustment for me. I'll be looking primarily in the Northeast and Northwest...I think it could be interesting to live in the Washington/Oregon area for awhile.

But wow...I am graduating soon! I have been having conversations with classmates about how it does not seem real to be graduating. It seems like such a lonnnggg time ago I started the program. The didactic year is so tough, and when you are in it, you don't see an end in sight. Also, I'll have to learn what it's like to live like a normal human being again (and I'm serious about this). After two years of 90+ hour work weeks (including study time), I don't know what I'll do with that being halved and having all this free time to my hands.

Good things are happening folks!

OB GYN is officially over. I arrived back in Philly (after a miraculous traffic free drive from NYC) Wednesday. Exam was yesterday, and now I have the weekend free before I start my family med rotation in south Jersey. I'll be staying at a friend's apartment while she's away for her OBGYN rotation. She lives close to Penn. I'm kinda nervous about having to park my huge car in the city, but she says that it really shouldn't be a problem for me.

Also, I graduate in less than three months. It's scary! I have my family med rotation, then I have to present my senior thesis. We have a week long review course/skills exam/comprehensive exam, then our elective. I'm doing my elective in internal med site in Delaware, and I'll be staying at a school paid-for townhouse with three of my classmates...I'm very excited about that. It should be a great way to end the program. After grad I plan on giving myself either 3 or 4 weeks to study for my board exam. I'll probably take the first week off and just do nothing and vacation and relax for a bit.

I also found out recently that it'll be 2-4 months after I graduate before I'll be allowed to work, due to licensing issues. I hadn't thought of that before now...all that time off with nothing to do, no money, and loans to pay? Yikes. I'm going to have to get a temp job! I might move back in with my parents and substitute teach again while I wait. I told myself that I'll worry about that after I get through this rotation.

In the meantime, I'm writing my CV this weekend and sending it to our career services lady to look over. As soon as that is done, I'll start sending it out and applying for jobs. My plan is to do loan repayment by working at a rural site through the NHSC. They'll give me either 20 or 30 grand a year (depending on how rural I go) towards my loans, and it's tax free. I could essentially pay off 150 grand in student loans in 5 years by going that route, assuming I still live a modest lifestyle. Not only that, a lot of these sites pay higher than avg for due to the fact that not a lot of people want to work there because of their rural location. Currently there are a couple spots open in Maine in fishing villages right on the coast, which would be ideal. I'll be applying all over the country though (well, the northeast, northwest, and northern states...I can't see myself in the South at all). I'm fairly interested in living/working in Washington/Oregon for a while.

I just can't believe that an end is in sight. I feel like I've been doing school forever, and I also can't imagine having a normal lifestyle. Working 40 hours/week instead of 70-90?? Not having to spend 80% of my non-work time studying?? Being able to work out/play guitar on a regular basis/get involved in church activities? I don't know what I'm going to do with myself ;)

Two weeks have past since my last post and I'm getting better at all things OBGYN. It's funny to think how scared I was doing my first pap smears and pelvic exams, and now they are not a big deal to me at all. My OR skills are getting better, and I feel confident now that in the event I had to deliver a baby outside the hospital, the baby would have a legitimate chance of living! (barring that it didn't have any major problems). I assisted on a c-section on a an HIV positive patient, and then rocked a two hour presentation on the management of HIV in pregnancy. My attending is wonderful and I have learned so much from her. Next Wednesday is my last day. I've definitely enjoyed OBGYN more than I thought I would!