2015 AAPA Annual Conference – San Francisco, CA

The 2015 AAPA Annual Conference was held in San Francisco, CA this year, conveniently 50 minutes away from my home town. This made it all too easy for my family to visit me, and visit me they did. Thanks for coming out Dad, Jami, and Bryan! In fact, the trip wouldn’t have been the same with out them. Specifically, it would have been drastically different if my sister hadn’t had the time off from work because she was able to hang out with me and three classmates as we used her car to site-see. With her help, we were able to visit Twin Peaks, Ghirardelli Square, Crissy Field, Lombard St., Fisherman’s Wharf, and Pier 39 in record time — all of which I have seen before, but it was cool to play tour guide to my friends.

Twin Peaks

My sister and I atop Twin Peaks

Group pic at Twin Peaks

Lombard St.

Isn’t it obvious?

Golden Gate Bridge from Crissy Field

Pier 39 seals

Alcatraz Island, SF

Sunset at the port

The conference itself was… well, actually I can’t really speak of the conference because I only attended 1.3 presentations. It was truly difficult to sit through PowerPoint presentations for continued medical education (CME) credits knowing that the credits would reset as soon as I obtain my license to practice. Instead, I spent most of the trip doing what you just saw in the above eight pictures.

Many of you know that I was one of three members of my school’s National Medical Challenge Bowl team, and I was really hoping to have some great news about how well we performed, but I don’t. We didn’t make it on stage this year, despite how prepared I felt we were. Before you jump down my throat, Michael Pulley, the reason we didn’t make it on stage was predominately due to a faulty audience response system (ARS) remote. Three of our answers weren’t recorded because the damn thing glitched. I was fervently pressing the answer key and the tiny digital screen was showing a big fat circle w/ a line through it.

Annoying

We weren’t the only team this happened to either as about 7 teams around us had the same problem during the same three questions. We all raised our hands in protest but absolutely nothing was done to remedy the situation. Eventually the remotes started working again, but with each question worth 40 points, not answering three questions is a deathblow. Had we made it on stage, I don’t know how we would have fared because the questions were just awful. The moderator had to refer to the judges for > 75% of the answers and the scores for the four teams on stage were frequently -20 to -10 to -20 to 0. It was a joke compared to last year. San Joaquin Valley College won the contest, which is ironic because their board exam pass rate is 82% and ours is 94% over the last five years — points where it actually matters I guess. Nevertheless, here’s your Touro University of Nevada team.

Photobombed team pic before the Challenge Bowl. Lynne, Me, Greg.

As I explained in my last blog, the month of May brought about my community medicine rotation and a lot of freedom. Apart from taking ample time to complete my portion of the community medicine group project, I was also able to complete both of the written assignments that are due at the end of May and June. Moreover, I was able to do a lot of studying/practice board questions, work on my truck, run errands, and complete tasks that I have been putting off for over half a year. With only a few days remaining in May, I’m going to relish all the time that I have left.

Mmm. Relish.

My good friend Amber also visited earlier this month which was a lot of fun. We did touristy stuff like party/gamble on the strip, but also went hiking at Red Rock which never gets old.

Double-fisting empty glasses for a picture

Amber and I at XS. My head looks huge. 

Red Rock

Red Rock

The Navigator

June marks the start of my next rotation — psychology — which means I’ll be returning to my two blogs/month routine again. I can only imagine the literary gold mine I’m about to encounter. Oops! I meant to say, I hope my ability to listen and empathize will be a guiding light for my patients. 

OSCE the Grouch

It is not lost on me how privileged I am to have held a live, human heart in my hand, let alone witness and contribute to the surgical correction of its many inevitable downfalls. However, despite all it’s beautiful intricacies and precision techniques, surgery is not for me. I will always appreciate the opportunity to see and do what I saw and did, but I do not long to work in the operating room. Perhaps if I ever did find myself working in a surgical practice, it would not be of the cardiovascular variety. The cases are just too long (many last beyond 6 hours, up to 13 hours).  Also, surgical patients are boring (because they’re anesthetized the whole time), and the ergonomics are terrible (standing all day, hunched over the patient).

Before I was accepted to PA school I shadowed a cardiovascular surgery PA for 2 months and I truly believed that this is what I wanted to become. However, as I progressed through school I began to realize that not only can I reach more patients in a general practice setting, but I actually enjoyed the inherent problem solving and detective work of general practice and emergency medicine. I have learned so much in the past two years and I intend to retain as much of it as possible. The best way I can think of to do this is to work in primary care where I will constantly be faced with a variety of disease processes and treatments thereof on an hourly basis, day in, day out.

As for my cardiovascular surgery rotation, it came and went, and I passed my end-of-rotation (EOR) exam on Thursday of last week. The following day was our first objective structured clinical exam (OSCE), pronounced “aws-key”. It’s funny — when I was researching PA schools and taking part in interviews during the admissions process, I thought about these OSCEs a lot. At the time, I mostly thought about how intimidating they seemed. Essentially, an OSCE is a performance-based practical exam in which a student has 20 minutes to interview, examine, interpret lab tests, and diagnose a patient. Then we have another 20 minutes to write down all of the findings in a SOAP note. As if the task wasn’t intimidating enough, there is a faculty member lurking over our shoulder during the whole encounter, taking notes and grading our performance. It’s the quintessential test for measuring a student’s ability to accurately assess and treat a patient, just as they would in the real world, and that is why it is a graduation requirement that we pass the final OSCE at the end of the year.

^^ How many classmates felt after the OSCE

As a PA school interviewee, this idea of “pass the OSCE or don’t graduate” was mightily unsettling. What if I pick the wrong diagnosis? What if I forget what to ask/do? Will I get a second chance if I fail? Will I have to repeat the entirety of PA school all over again?! All of these were real concerns for me at the time, but they weren’t priority concerns as my main priority was to be accepted. Now that nearly two years have passed and I have completed my first OSCE, I realize just how prepared I am to perform under pressure and time constraints. And, while I won’t deny that I was nervous upon entering the exam room, the anxiety quickly dissipated once I began interviewing the patient like I have done so many times before during my clinical rotations. I simply fell into my groove and treated it as any other patient exam.

Fortunately for me, the diagnosis was an easy one to identify — pericarditis — as it presents with classic signs, symptoms, and exam and lab findings. Accordingly, 5 minutes into the interview I comfortably had identified my primary diagnosis. In fact, although I felt relieved to discover the patient’s diagnosis so soon, it brought about a new challenge, selecting differential diagnoses, i.e., identifying other disease processes the patient could also have. It’s very important for the sake of, not only the OSCE, but every patient evaluation, that several differential diagnoses are considered and ruled out. For example, if it’s winter and you see so many patients/day with viral upper respiratory illnesses that you miss the patient with a staph aureus sinusitis that develops into endocarditis, the patient could very easily die, or, best case scenario, require a heart valve replacement and anticoagulation therapy for the rest of his/her life. Thus, in medicine, as in life, it is important to keep an open mind and never jump to conclusions. 

I’m unaware of my OSCE grade as of yet, but I’m fairly certain I passed. Even if I didn’t, this OSCE is generally considered “practice,” and the OSCE that takes place at the end of the year is the one everyone must pass in order to graduate.

Speaking of the end of the year, time continues to amaze me in it’s unrelenting and unforgiving speed. Six months separate me from graduation, the board exam, working as a PA-C, and the bliss that follows it all. Here’s a quick breakdown of the next six months:

May:

• Community medicine rotation in which my team of four others and I are working with a hospice facility to develop PowerPoint presentations and informational brochures regarding the benefits of therapy animals in hospice patients. This means no clinic for an entire month which translates into: I can finally run errands and fix things that have been broken since November.
• AAPA National Conference in San Francisco, including the National Medical Challenge Bowl. I can’t wait to compete this year as I finally feel like I know a thing or two.

June:

• Psychiatric medicine rotation. Yay -__-

July:

• Tanzanian medical mission.

August – September:

• Internal medicine rotation.

October:

• Elective second emergency department rotation as I am considering working in the ED for my first job.

I graduate on November 1, 2015. Le sigh. 

One more thing before I start being productive today. This list reminded me that my Tanzania medical team created a GoFundMe page in the hopes that we can raise some money to buy supplies. Please check it out by clicking this link. Read about it, share it with others, and donate if you have the means to! If everyone that read my blog donated, it would make a hell of a contribution. We thank you!!

Grateful Tanzanians

Here’s the link if you wish to share 🙂

http://www.gofundme.com/TanzaniaMedMission