I survived! This week we had two tests on Monday and another one today. It seems like professors here call their tests "quizzes" and I have yet to figure out why (aside from a guess to make us calm down and not freak out about them). Monday was physical assessment where many of the questions were about simple common conditions that we may see patients with such as hypertension, syncope, skin lesions and much more. This was a fair test in that it was directly from the powerpoints that we learned in class. Silly mistakes are where I lost my points so Ill take that with a grain of salt. The second "quiz" we had on Monday was for statistics. Now, I thought this was going to be much much harder but after studying the powerpoint I as more than prepare for the exam. Again, silly mistakes of not reading questions fully and changing answers were the reasons for the two questions wrong. Grrrr. Finally, we had a test ("quiz") today in diagnostic methods (this semester: EKG's). I love this class and all of cardiology but again, my poor test taking skills got the best of me as I rushed through the test not checking the easy questions and made very silly mistakes that I am kicking myself for now! What is nice about all of these classes is that we are able to fill out a form challenging answers to questions or even the fairness of questions. At first I thought this would be bogus and they would never read them, but after that EKG test, it looks like they do! I guess as long as you have an accurate and rational reason for choosing your answer then they grant you what you deserve. The more and more time I spend getting to know these professors the more I realize that they are all really there to help us =]
This week in lab we were dissecting the muscles of the face and examining the structures of the neck. Before I get to talking about the cricothyrotomy, lemme just say, the facial muscles are so superficial. Trying to reveal them was like basically shaving just a hair deeper. This is probably why when people have face lacerations that we need to use such a fine suture and call the plastic surgeon instead of having the ER docs just sew it up. Unfortunately we only could recover some of the facial muscles to look as pretty as we wanted them to. Our cadaver had lots of facial hair so it was sad to cut it off. I'm sure he was the kinda guy who wouldn't shave for anything (like most men)! We revealed the submandibular glands, and boy were they much larger than I expected! We also cleared away enough to see the thyroid and the cricoid cartilage. Now, I was not able to do a cricothyrotomy myself because someone else in our group was all over trying it themselves. (remember that each person only has one neck, so its not like everyone can do a cricothyrotomy on all the cadavers since we only have 5). One of our group-mates was very enthusiastic about it and tried it on a cadaver. So basically what she did is in the picture below. She punctured the space just above the cricoid cartilage to open the airway. This would be necessary if someone had a blockage above or could not breathe. Since we wanted to get a better look at the internal structures, we used a bone saw to open up the cartilage and reveal the true and false vocal cords. Overall, it was pretty cool. However, we also got a great lecture from one of the doctors in our lab. He went through a detailed lecture on the sagittal section of the head and neck for us to be able to see what was inside.
This was probably the coolest thing I saw so far. Below is an example of what the sagittal section would look like on a model. We were able to see the brain (literally that comparison of tapioca pudding is 100% accurate), the conchae of the nose, the structures of the neck, all the sinuses and so much more. I did not realize what help this cadaver lab would be to us, but it sure helps me remember so much!
Every Wednesday we have a quiz on EKG's. Many of the students here do not have the extensive background us ACPer's have and it leads to great confusion. In Dr. Raley's patho class we learned how to interpret and even map out EKG's which was much more helpful than I anticipated. Our diagnostics class is where we learn how to read EKG's in a fast paced fashion. To many students, this is giving them palpitations--but for us, we are very familiar with these and are just learning the terminology for the pathologies instead of trying to start from ground zero. I would encourage anyone to take a pathophysiology class or even a cardio class in order to prepare for how fast paced PA school is. These tests are very detailed and being off by one beat in a rate measurement will result in an incorrect answer to a question. Basically, you have to know your stuff, and if you don't, its very hard to guess and get lucky. Most of the students are getting very confused and fight with our instructor because they are not comfortable with being nit picky. Essentially, this blog entry is to thank Dr. Raley for his awesome cardio lectures because if it were not for him, I would not be acing these mini quizzes.
Pop Quiz! What is the rhythm of this strip?
Answer: Normal Sinus Rhythm with Multifocal Ventricular Trigeminy
Why? Underlying rhythm is sinus but with events of PVC's after every two normal cycles (which is why its trigeminy) and the PVC's are different looking meaning they are from two different irritable foci in the ventricles. If they were the same irritable foci causing the PVC then that would be unifocal.
If you cannot tell already... I LOVE this stuff.
So our instructor politely graced us with his one hour run through of statistics for our test Monday worth 15% of our grade. Now...I took stats 4 years ago and barely remember what a p-value even is let alone be prepared enough in the material to have a test on it in less than a week! Honestly though, I shouldn't be complaining, there is one student who hasn't taken stats since 1999... I was 6. (I guess it could always be worse). So as we are scrambling to learn the basics of stats for our 30 question test on Monday, we are also preparing for a physical assessment test that same day as well. I am quickly learning that I do not need a 100 on everything like I did in undergrad. In undergrad it was do-able, here, I feel like an attempt of straight A's is insanity. I am going in with an attitude that I will learn as much as I can and whatever grade I get is the grade I get (As long as I pass). Passing here is a 74, so as long as I stay above that, I will be fine. =p I will tone down the academic obsession because it is about learning now, and retaining the information. I need to focus on how I will treat patients with my knowledge, not how well I do on tests.
So as I mentioned a few days ago, on Friday's we are tested on our skills for physical assessment. This week we were learning how to perform a thorough skin exam and general appearance exam. By luck of the draw, I was chosen from my group to perform the skin exam on a patient. Luckily, I passed! I spent the whole week going over the skills sheets and good thing I did. In order to pass we must get at least 18/23 part of the exam correct, and if we do we pass with 100% (it seems pretty easy so far). We are given about an hour an a half to memorize and practice the sheet with one another. This is where we can fine tune things that are a little rocky or routinely missing. Prior to coming to lab we need to have a change a clothes to be the patient and our white coats and professional attire if we are to be examined and pretending to be the provider. Upperclassmen told us that if we seem like we are not well prepared or like we have not looked at the sheet until that day, that the instructors will test you. It is very hard to fail this assignment because if you do not pass the first time, they make you try again that same day or another time during the week. Essentially, there is no penalty for not passing, just embarrassment of your own stupidity. Now this coming week we have the mental health examination where we need to ask our patient many questions about their psychological health, and just because I was chosen this week does not necessarily mean that I cannot be chosen a second week in a row so we always have to be prepared for anything!
We arrived in lab after our first group, and unfortunately, that group of people did not know how to use the bone saw well and essentially destroyed the deep muscles of the back. The point of the lab today was to perform a laminectomy. A laminectomy is where a surgeon will saw through the lamina of the vertebrae on either side in order to release pressure that may be on the spinal cord (as seen in the photo displayed below from: www.yoursurgery.com). When we left lab we had cleared away to expose the multifidis beautifully and when we arrived in lab... well lets just say it was hacked off and no longer beautiful. Our instructor came over to our group and saw what had happened--he quickly assured us that the groups rotate cadavers in different directions to avoid this from happening to the same group all semester. After clearing away some more muscles and fascia, we discovered the articulate processes of the vertebral column in the lumbar region--we were ready for the saw! Now, with the bone saw, it is essentially a powertool that vibrates on bone to slowly cut through (as seen below from: www.medicalexpo.com). I didn't know what to expect but I turned it on and started pushing into the lamina until I felt that I went through bone. When cutting through bone, the dust of the bone flies up in the air and has a distinct smell, but we had hoses nearby that removed smells of fumes and bone dust. Moving from one vertebra to another I could feel when I was in the inter-vertebral space and when I was sawing away at the lamina. The tricky part was that the articulate processes are not present in the thoracic region; therefore, once we started sawing, we needed to try and stay parallel to the spinous processes while at a slight angle to perform a correct laminectomy. Each of our group members had a turn at sawing about three vertebrae at a time. However, we could not simply remove the spinous processes that easily. We were given a small hammer and a chisel to break the lamina and spinous processes free from the vertebral body. This was probably the most gruesome part as the chisel was difficult to get into the back but then to break the chisel free, we needed to rock it back and forth laterally while simultaneously releasing a loud cracking sound. Nevertheless, we successfully performed the laminectomy of the thoracic cavity.
So far we have been given lots of reading for each of the topics being covered. I am quickly learning that you cannot learn everything and memorize everything. Fortunately, our professors give us study guide outlines or study objectives which really help guide our study habits. I am trying to stay on top of everything and study it now instead of cramming before the exam. I hate memorizing so I would rather learn things naturally by reviewing them everyday. Many of my other classmates are thinking that I am way ahead or even crazy but I just need to fill the time that I have during the day. So other than going to the gym for an hour every weekday, I spend the rest of the time reading, making flash cards, interacting with the material in some way because I'm thinking that the more I make this second nature to me, the easier the studying for the test will be. Originally, the information presented to us in a completely disorganized fashion. It was our job to create a master exam schedule with assignments and due dates. This made for a very frustrating week as we were trying to understand what to expect every week as well as prepare for what will be due. I found that using OneNote is extremely helpful because it puts every subject right at my fingertips. If I am studying for anatomy but want to know how the material from Physical Assessment matches up with the topics, I can easily just switch tabs instead of opening new folders and new documents. In the past I have always just organized documents in folders
What is really nice about the classes so far is that the instructors make it clear that they are there to help us become PA's. So even when we go into the cadaver lab (like we will again today!) we are not quizzed everyday. This makes for a much more relaxed learning environment. I don't have to stress about a stupid quiz or an assignment that is due--I can just enjoy my time interacting and learning. I wish all labs were like this (but as we all know, there would be some students who would take this as a free-for-all or an excuse to not do much and skate by). The environment in PA school is very different from ACPHS because all the people here express the urge to learn and become great providers. The students here are not just trying to get a degree and then a paycheck. I love this atmosphere for that very reason. These students here want to learn and enjoy learning because they want to be PA's for all the right reasons.
So the roughest part of Monday is getting up at 8am after having later classes for the past 2 and a half years...but before classes, I prepared this weekend by doing this week's reading ... and more reading and more reading. I heard that students say that we really don't need to read for every class, but being hyper-paranoid I really wanted to make sure that I was too far ahead before too far behind. Anyway, our first class is physical assessment where we learn how to complete a physical exam on a patient and each week we add to the exam so that at the end of the term we will be able to complete an exam including a full neuro exam. This week we are responsible for basic vital signs, general appearance and integument (skin). Every Friday we have to verbalize what we would be doing in the exam on one of our classmates. For example, during the general appearance and vital signs exam, I would state: "I am assessing for general health, if the patient looks frail, robust, or overall well. I am looking to see if their clothes are appropriate for the weather and if they seem well kept and well groomed. I will then move on to assess for mental state if the patient is alert and oriented. I am looking at the patient's face to see if they are in any distress, comfort/discomfort, pain etc. When I look for the posture I will have patient X stand and walk in a line for me to observe their back and gait. Returning to their seat I am taking their oral temperature and making sure the thermometer is completely under their tongue, during this time I am also observing patient's body odor and breath. This is because I am very close to the patient and can easily note these things." after verbalizing these things to the instructor, I will continue the vital signs and the rest of the skills exam. The reason for verbalizing is to let the instructor in our head while we are thinking to ourselves about the patient. This part of physical assessment is graded on a pass/fail basis be it that we complete at least 80% of the assessment. However, there are a few critical steps in the assessment such as washing your hands before touching the patient. If this is not completed it is an automatic fail and the assessment will need to be re-mediated until you pass. We are given 10 min to show our skills and everything on the sheet of verbalizations needs to be completed before we are finished. Anyway, this was all in preparation for physical assessment. We also had a class called Medical Informatics which prepares us for interpreting statistics, research and medical terminology. Currently, we are not actively doing anything other than defining Medical Terms in this class but I am sure there is much more in store!
Finally, about my normal life, I was able to go to the gym for over an hour and a half again! Also, invitations for AMC's formal, at Saratoga Springs, were sent out and hopefully we will have a good group of people to go! I'm sure I will write much more about that in time.
With the first week down I am starting to realize that this may go by a lot faster than I anticipated. There are a lot of reading assignments, but the reading selections from the texts are more interesting and applicable than other homework assignments from undergrad. I find that many of our readings build on things that I already know. Since we really haven't been given too much work other than chapters of reading in Bates' (our PE text) I have been able to go to the gym everyday and spend time with friends still... but I hear that will soon change. We had a mixer with the other PA class years in downtown Albany and one of our profs even showed up! How cool is that? I am so happy that the upperclassmen held this for us, because we were able to not only get to know one another but learn more about what to expect in the next two and a half years here. Something about this program that I did not expect was that everyone is there to help one another. Everyone, including the instructors want us to do well and become great providers! This is something that I am not use to!
Arriving in an aroma of preservative fumes I saw 6 tables covered in maroon sheets. Along my 4 other lab partners, we stood and listened to our instructor overview what we were going to be doing. Before I had time to digest all of the information, he lifted off the drape of one of the bodies... I thought I was ready for this, I worked in health care and prepped bodies for the morgue... I thought I was ready. The second he lifted the drape I was more shocked and started to feel anxious and worried. Repeatedly I kept telling myself that ... these people wanted to be here, the donated themselves for our education, and within just a few minutes me and one of my partners took a scalpel to the back of our cadaver. We exposed the back and observed the latissimus dorsi after sheering and sheering away the fascia around the muscles. This was more work than I had imagined. Little did I realize, we were just one the superficial layer of the back muscles. Time passed and we observed so many more structures like the thoraco-lumnar fascia and trapezius. One more layer deeper we discovered the rhomboid major and minor. Uncovering the serratus posterior superior we also uncovered the serratus posterior inferior and under that was the errector spinae. This errector spinae is divided into three sections, the illiocostalis, the longissimus and the spinalis. Along the spine I felt the facets of the vertebrae in addition to part of the pelvis, the illiac crest. Finally, the deepest muscle we uncovered today was the multificus. Apparently we were the only lab group that discovered this muscle today so our instructor brought everyone to our model to have a look. Overall, I would say that our first lab was very successful and I learned so many new muscles. The greatest thing about the cadaver lab is that I don't need to use flash cards to plain face memorize, I can rely on my memory of this amazing hands-on experience. I cannot wait for what else I will discover in this lab!