Since our comprehensive examinations, we have been on our LAST ROTATION, preceptorship. It is bitter sweet because it is the end of our long journey, but also finally a sign of accomplishment. At this point we are expected to be taking on our own patients, creating our own set of orders, and determining appropriate course of stay and therapeutics. Originally, when I thought about preceptorship, I was nervous. Nervous that I wouldn't be able to work as independently as they wanted, nervous that I would have to play "catch-up" with everything that I should know and somehow didn't. After just a few days on site I realized that I was more prepared than I ever thought I would be. Common cases were great because I was getting more familiar with diagnostics and treatment regimens. Complicated cases were still not easy, but not impossible. My first ER rotation was in July, and I was no where near as proficient as I was during my preceptorship. Clearly all of the hours and studying put in over the past 10 months paid off.
This is it! Last week our class took our final examinations before graduation. Below I highlighted a little about each of them.
Clinical Competency Examination (CCE):
As mentioned before, we have patient simulation cases where we get to practice our skills independently on actors before we are on our own. As we have been doing this all year, these cases were not terrible difficult; nevertheless, they are always nerve racking when you are being graded so heavily. We had three cases one day and three the next.
2 cases were "communication" cases, these types of cases are typically counseling of some sort, tobacco cessation, weight loss, delivering bad news of some kind, abuse, domestic violence, and many others.
4 cases were typical medical cases where patients presented with a common chief complaint where we had to get a problem focused history and physical, then provide the patient with our plan.
These cases were not purely based on our accuracy, but also our ability to communicate and converse effectively with our patients. We got "points" for asking how the illness impacted the patient's life, if they have any questions, for checking understanding of the assessment and plan, and for summarizing our plans at the end. We were graded by the patient actor, however, we also wrote a SOAP note upon completion of each encounter for additional grading. Since this was a requirement for graduation, it was considered a "pass/fail" examination. Each of us were notified a few days after the cases on our status. (Let me tell you, I didn't think I could be happier after getting the email stating that I passed and did not have to repeat those cases :p)
Comprehensive Examination ("Mock Boards"):
As you may know, upon graduation, we have to take a national competency examination known as the PANCE. Our program prepares us for the boards by hosting their own examination similar to those boards two months before graduation. The PANCE itself is 300 questions, but our Mock Boards were 210. Before the exam I was extremely nervous, there was so much riding on this exam. Like the CCE cases, we need to pass to graduate. Luckily, it was only about two days before we were notified about our status for that exam. Just when I thought I was happy to pass CCE, I was much happier to find out that I passed the Mock Boards, especially because this is supposed to be the simulation for the PANCE and has been a very good predictor for estimating which students will pass come June.
Finally, all of the high stakes exams are finished for now, and all I have to focus on is studying for the real exam... the PANCE! Come June, I hope that I will be ready! But until then, I will keep chugging along, studying daily and focusing on my last rotation (The Primary Care Preceptorship) in Emergency Medicine.
**As many of you can tell, I graduated AMC's program in May of 2017. Current plan is to start a new blog related to my Fellowship after PA school. Stay tuned for the link and updates :)**