With his permission, below is a photo of this great teaching moment!
Now that we have finished all the guts and their glory, we have now moved on to learning about some extremities. As many people know, the arms and legs are full of muscles and nerves. Since there are so many nerves that have different functions, we really have to focus and discipline ourselves during the studying for the next test. One way our professor helped to teach us the different pathways for the nerves was very unique. At the beginning of the lecture he was rustling with his tie and microphone, finally taking them off. Before we knew it, he appeared in gym shorts and a Warrior Dash t-shirt in the front of the class. I was extremely confused as to what was going on until I saw the Crayola markers—He was going to draw the nerves on his arms… and legs! I never had a teacher do something like this to help us learn such a confusing topic, it was really awesome. Standing before all of us, he began with the upper extremity and explained the major nerves that stemmed from the brachial plexus such as axillary, radial, musculocutaneous, median and ulnar nerves. Each nerve in a different color he traced a line down his arm whilst explaining the functions. Just when we thought he was finished coloring his arms, he walked to the back of the room tracing out the various lower extremity nerves including the sciatic nerve. At first I felt overwhelmed after taking a look at all the nerves we needed to learn, but after he demonstrated the major routes and functions I feel like I have a much better grasp. It’s crazy how much someone can learn in just one lecture!
With his permission, below is a photo of this great teaching moment!
This weekend the director of our program suggested that some students volunteer for kidney screenings in Cohoes. Along with myself, three other PA students volunteered to spend their Saturday morning screening patients for kidney function. Most of these patients were already diabetic patients or prediabetic and it was our job to take intake vitals, assess their albumin and creatinine levels in their urine as well as drawing blood for creatinine, hemoglobin, hematocrit, glucose and lipid panels. This was definitely a unique experience because I have not helped with something as specific as kidney screening. The focus of this event was mostly to make patients aware of their kidney functions and how they could best manage their health. After the patients stopped by our stations they were counseled by a dietician about their diabetes. Even though this was a small event, I would definitely do it again in the future! We were able to help some wonderful patients and work with some amazing volunteers! Click below to check out the Northeast Kidney Foundation! They have a Run/Walk coming up on June 14th this year and a kickball tournament with various colleges and teams in the Albany area on April 11th.
Monday we started with a basic medical terminology evaluation. This included various prefixes, suffixes and definitions of medical words and roots. For almost everyone, this was the easier of the three this week because it required simple memorization and very little application. Tuesday was our written test for anatomy. This unit was thorax, abdomen and pelvis, so the questions on the test varied form differentiating direct and indirect inguinal hernias to detailing portal hypertension. In addition to the written part of the test there were multiple choices as well. Finally, Thursday we went to the cadaver lab to identify some tagged items ranging from muscles and bones to nerves and orifices. Overall, I would say anatomy is the class that takes up most of my studying and time in general. This week was the most stressful week so far in PA school. The upperclassmen have been telling us that this week is just a snapshot of what the summer term is like all the time. If this is true, I am completely dreading the summer.
After the lab practical on Thursday, I took some time to help out at the Joan Nicole Prince Home in Scotia from 3 to 7. Usually I am busy until 4 on Thursdays but today I was in the group testing at 12:30pm; Bonnie (the volunteer coordinator of the Home) emailed me in desperation for someone to help out at the home today. Luckily, this was the only Thursday all semester where I was free for a 3 to 7 shift! I met the two residents (because I have not been able to volunteer since early winter). They were very pleasant and one is even planning for a wedding! So exciting! One of her last wishes is to get married to her soul-mate she's been with for a long time. I think it is great that the home can help their residents in so many amazing ways like this! Volunteers are coming together to help with tuxedos, dresses, altering, catering, and planning. Someone even donated a beautiful wedding dress! I hope I am able to help out with the wedding when the date gets closer. I also hope that I can visit and volunteer the home more often, a 4 hour shift is so short that I think I can fit it in the busy PA school schedule here and there.
I will be taking part in the 5K race the home has on April 25th in Schenectady's Central Park. I hope to have many other PA student run or walk with us as well! I will definitely update more information on that as the date gets closer.
Part of learning physical assessments includes the GYN exam. I have not had experience performing one of these exams myself; however, while working in the ER the PA's and Doc's performed these almost as often as I performed EKG's. I gained some great experience from the PA's so when we practiced on the mannequins it did not seem as awkward as I thought it would. I could picture what our PA's at the ER did and how they performed the exam which made learning the steps so much easier. I recall one of the PA's telling me "its all in the wrist." Now, this may seem silly, but she was kinda right! The fluid movement of rotating the speculum really helps ease and discomfort for the patient. Nevertheless, I only performed this on a pelvic model so far and not a patient. Next week I will be practicing on one of the simulated patients (real person) to make sure that I know how to exam everything effectively. I am very nervous just because it may be awkward and uncomfortable for me as a student to be performing the exam for the first time on someone that can give me feedback. I guess after next week I will be able to say I can and know how to complete a GYN exam.
For the first time, we have experienced practicing our skills on a "real patient." Normally, we practice the skills for physical assessment on one another, however, it would be a little strange to practice a breast exam on one another, so we are fortunate enough to practice on someone else.
This skills day was like no other. Our instructor, Deb, arranged a whole round-robin type of event where we would practice various parts of the skills sheet in different rooms, ranging from a male breast exam to the female "real patient" exam. The patient was so friendly and very encouraging during our practice. She let us know if our pressure was good and what she liked and didn't like about our presentation. Usually, we just practice going through a physical exam with out partners and then one person gets tested. This week, we all have to perform this exam and we are all getting reviewed.
Below is the "skill sheet" that we are following.
Each week, we have a different one of these sheets and we are responsible for learning this entire sheet before Friday (and ready to perform it within a 10 min time frame).
As you can see on the right there are two columns, one for performance and one for verbalization. Performance is self explanatory where we have to perform that step. Verbalization requires us to literally recite the information in that line. This is because the instructors are not "in our minds" and do not know if we are actually looking for color, thickening or enlarged pores if we are just inspecting the breast...so the only way they know that we know what we are looking for is if we verbalize it.
The "C" in the performance column: critical step, if you forget it or do it wrong you instantly fail.
The "S" in the performance column: this is a special test that is only performed if indicated by the instructor
the reason for the special test is to see if we can tailor the exam for the patient in front of us and show a wider range of skills and knowledge
Hopefully this gives some readers a better idea about what our "Physical Assessment" class consists of.
I plan on posting more of the skill sheet documents, especially the neurological exam.
Next week is hell week. We have three tests, each worth a significant portion of our grades for those classes and one term paper that is worth 60% of the ethics class. Needless to say, I am very stressed and crunched for time. Over time I have slowly been studying for these tests, but until a week before the test, I really cannot focus and seriously study. That being said, most of my effective studying is happening starting Wednesday this week. As usual, I showed up to the cadaver lab today thinking that I knew my information, however there were many structures in the pelvis that I still have more covered and could not even identify. Two of the tests next week are in Anatomy. I may have mentioned this before, but we have a lecture and a lab test for each unit we cover. This unit's test is on the thorax, abdomen and pelvis.
I really feel like I am working better under stress more-so than I did in undergrad. I think its mainly because I don’t have a large incentive to study so far in advance here. I know that I will pass the exam even if I wait until the week before to study and I am not striving for a perfect 4.0, I am just trying to learn as much as I can in the time I am given. Fortunately, this passive strategy for PA school has been working really well, but I am sure once the summer term starts that I will have to shift back into my obsessive school mode.
So every now and then we take some time to celebrate a classmate's birthday or major event in their life. Today, two of our classmates wanted to go out for "real New York pizza." They chose a place out in Watervliet called Hilltop Pizzeria where some of us joined them in a little dinner. This is a great example of how we don't always have our nose in textbooks and we can actually have time to socialize as well.
In the past two months that we have been in school, we have celebrated many birthdays in various ways from going out in Albany and even baking cupcakes! I cannot wait for the rest of PA school where we can celebrate everyone's birthdays, life events or big accomplishments! Over the past few months our class has really gotten to know each other well. And I am being truly honest when I say that I could not be happier with the friendships I have made here. Who knew so many great people would all be in a program like this together!?
As many of you can tell, I am usually very excited or entertained by the cadaver lab for a variety of reasons. This week I was not nearly as enthused or excited. Usually, when I am not excited about learning a particular body system I have a very hard time retaining or even studying the information. I have always had an issue with learning the reproductive system or.... anything in the perineal cavity for that exact reason. I hate to say this, but I really do not have an interest in this field of medicine for some reason. I guess everyone has their body systems that they love and highly (or relatively) dislike. That being said, this lab was interesting in an unusual way.
The lab group before us seemed to have prosected most of the female cadaver's reproductive system making it removable from the body. Not only did this seem extremely strange to me but it was not like any of the other dissections we have done. When we cut out other organs and structures we simply snipped the vessels leading into them or trimmed the fascia around them. This was not the case with the organs of the perineum. Now, the uterus leads into the vaginal canal and out of the perineum surrounded by labia and skin. The lab group before us decided that they would keep all of this together to make it easier to understand the anatomy; however, it made the entire area removable (including the labia and skin) from the body. Nevertheless, this was a great idea because now we were able to trace the path from the ovary down and out of the perineum.
Another anatomical structure in the posterior part of the true pelvis is... you guessed it... the rectum and anus. Next week in physical assessment we will be required to practice a prostate exam on a real person simulated as a patient in the PSCCC. Not only am I extremely nervous for practicing in front of a real person (patient), but we also have to perform the rectal prostate exam! So, I guess practicing on a cadaver is a good idea before we have to try this on a real person. Our instructor helped dissect out the muscles such as the gluteus maximus, medius, and minimus as well as the anal sphincter and all its counterparts.
I guess the overall take home message from this "exciting" blog and experience is that medicine is not always pretty and sometimes, you just need to get down and dirty to learn new things and examine your patients!