Tearing off Training Wheels

PA school is super stressful and overwhelming.  Graduating and starting your first job and your first year out in the real medical word is equally stressful; but, in different ways.  I started my first job and felt like I had no idea what I was doing and like I hadn’t even prepared in the least to walk around a hospital.   Not because I didn’t get a good education at Pitt.

I believe there are several factors as to why I felt like I was attempting to ride a uni-cycle at first.  First, just as elementary and secondary schools are pushed toward performing for a test–so are PA students.  We spend 2 years obsessing about passing the PANCE and all of the horrific things that can happen if we fail.

Second, the PA profession was derived around filling the shortage of Family Physicians.  Thus the education model we follow although follows a general medical concept has a strong focus on family medicine. As I have talked to students who have gone through the same program as me I hear that they are adapting and learning different information and procedures to adapt to the ever diversifying role PA’s are filling.

Third, PA school is FAST.  There is only so much time to learn a lot of information.  I look at the doctors I work with or PA’s with  couple years more experience than me and I think damn “when will that be instinctive for me?”  I quickly decided I would treat my first couple of years in medicine as a resident would.   I do a lot of reading and ask A LOT of questions.

The next reasons are a bit more unique to me; but, perhaps others have experienced them as well.  Before PA school I did not obtain my HCE in a hospital or medical setting.  Even though I had a couple of rotations in hospitals they were pretty sub par despite my constant asking to learn ad do new things my preceptors weren’t particularly helpful in these settings.  So, when I started work I felt like I was still acclimating to a lot of things.  The job I took was also pretty low acuity patients with repetitive problems. The group I was with was great; but, once I got out doing hospitalist work I was like “holy shit”.  I worked basically taking care of post operative patients medical needs.  It got really repetitive pretty quick–every once in a while we had a unique case.  Usually it was standard post operative stuff surgeons didn’t want to handle.

So, when I started my position as a travel PA as a hospitalist at the largest medical resource between Pittsburgh and Philidelphia I felt really intimidated.  I remember my first night getting my first page I had to go and assess a patient.  I felt like I forgot to do a H&P and how to critical think.  it was a really weird feeling that I  can’t quite explain.  I look back at that day and I laugh to myself.  I’ve come a long way since then.  Practicing more independently and handling floor patients in the middle of the night pretty much independently (unless you have to push adenosine–then you call your Attending because–well that was above my pay grade to do that alone the first time on a patient who was a no code).  I’ve become more comfortable responding to RRT’s, even getting a system down as to what I would do to assess the patient and what questions I would ask the nurses.

I still feel like I’m losing my balance some days.  I partially think that is the nature of medicine and also being a PA–we’re expected to know about a lot of things in a short amount of time.  However, I think back a lot to my first day of PA school and my first clinical semester and first rotation, etc.  I realize I’ve come really far.  Even if some days I feel like I know nothing when it comes to a really complicated patient.  Then I remind myself that I would rather feel stupid temporarily and learn as opposed to feeling like I know everything all of the time.  First because that is dangerous and second that would mean I’m not being challenged.

The past can be evil, but it can also be our friend.  Make sure to realize how far you’ve come and everything you’ve learned!  Feel lost, ask questions and take things on before you think you are ready.  You will be ok and your medical knowledge and skills will advance. I sure as shit had never heard the term protein losing enteropathy before and I remember feeling super intimidated by trying to figure out how the hell to order sliding scale insulin.  I still don’t know much about protein losing enteropathies; but, I’m pretty sure I’ve gotten insulin and a lot of other things down since I was cut lose a year ago.  Always remember progress is always being made!!

 

One thought on “Tearing off Training Wheels

  1. I can completely relate. I am in the process of leaving outpatient internal medicine to hospital medicine and I feel like Im starting PA school all over again. As long as you have a good mentor transitions become doable.

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