Confused about PA school

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Apple5

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Alright I am about to go out on clinical rotations.. and I am very confused..
I am finding myself disappointed with PA school up to this point. I am learning so much.. its great, but I feel like my medical science education stinks.. We have so much material to learn in such a short amount of time that we dont learn the “why”..
For example in class we learn a patient has gout, these are the signs and symptoms, diff. diagnosis, and treatment.. SO we are learning how to recognize disease and treat it.. But what is the disease.. what the pathophysiology behind it..

I understand that a huge difference between MD school and PA school is the basic science background.. So..

here is my question, is this common that students feel this way in PA school.. do MD students feel the same way to some degree? Will this change on rotations, through out my career as a PA?? I am a bit of a nerd.. I like science and would potentially some day get a PhD in physiology/biochemistry. Do other PAs also have this issue or am I too immature in my PA education to be worried about such things??
 
I will answer your questionas as best I can, but my background is pretty different. My undergrad was medical technology and you could almost consider it a degree in pathophysiology.


Apple5 said:
Alright I am about to go out on clinical rotations.. and I am very confused..
I am finding myself disappointed with PA school up to this point. I am learning so much.. its great, but I feel like my medical science education stinks.. We have so much material to learn in such a short amount of time that we dont learn the "why"..

Part of that is just the nature of PA school. They are trying to cram sooo much information into your head in such a short time ("Drinking from a firehose") that something has to suffer. That having been said, there is nothing to stop you from learning on your own. In fact, that is what is expected of you and is integral to the process of rotations whether you are in PA school or medical school. One of the things you will find on rotations is that when you see a condition in a real, live patient it is more intresting, you are more motivated to learn about it, the information sticks in your brain better and things will click that you missed or did not make sense in didactic. In addition, whatever you did not pick up in didactic, you need to pick up on rotations and if you don't get it there then you need to keep studying when you get a job. In fact, you will never get to the point where you know it all and you will always need to read. If you ever get to the point where you think you know it all then you are dangerous and have no business treating patients. It is normal to feel like you are not prepared and is part of the learning process. Once again, if you are not worried then you scare me.


For example in class we learn a patient has gout, these are the signs and symptoms, diff. diagnosis, and treatment.. SO we are learning how to recognize disease and treat it.. But what is the disease.. what the pathophysiology behind it..

Keep a notebook while on rotations of the things you don't know and study them. Learning does not stop in the classroom. In fact, I read and retained more on rotations than I ever got from a stupid PP lecture.


I understand that a huge difference between MD school and PA school is the basic science background.. So..

here is my question, is this common that students feel this way in PA school.. do MD students feel the same way to some degree? Will this change on rotations, through out my career as a PA?? I am a bit of a nerd.. I like science and would potentially some day get a PhD in physiology/biochemistry. Do other PAs also have this issue or am I too immature in my PA education to be worried about such things??
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It is good that you are worried about these things young Jedi and I would suspect that most medical students feel the same way, although probably not to the same degree. Most folks go through different phases throughout their career in school and beyond. I started out a little ahead because of my background, but I think most of these phases occur for most students be they in med school or PA school.

1. Acquiring basic medical knowledge. (I started out with a pretty good background and so I started on step 2.)

2. Some basic knowledge to where you could follow along better when something is being discussed, but details were lacking in the extreme. For instance, an instructor would say that a patient presents with these symptoms and you kind of get tunnel vision and jump to a diagnosis. Sort of a false confidence stage. Sort of you don't know what you don't know.

3. The last stage is the longest and is terminal. Some folks and a lot of PAs (I'm gonna catch some flak for this) never get to this stage. This is where you are presented with signs and symptoms and you begin to think in differentials, body systems and anatomy.

That is CP can be an MI, PE, anxiety/hyperventilation, tumor related, can be costochondritis, GERD, pneumothorax, asthma, aortic dissection, pericarditis, arrythmia, shingles, ulcers, pancreatitis, etc. You need to know what happens commonly, what is going to kill them/cause disabilty and what needs to be ruled out for medico-legal reasons (did I really just say that ****).

You develop your own style and some folks have a more formal and some a less formal way of ruling things out. This is where the ROS and pointed questioning helps you. The ROS (I truly think this) is not a particular part of the history, but is rather, spread throughout the HPI, formal ROS and the physical exam. This is where you should start mentally ruling things in and out and what you need further testing to clarify.

You also need to be familar with zebras, symptoms that don't fit, when there is more than one problem and when there is a red flag. Honestly, one of the most important things about rotations is developing your sixth sense. That is when something does not fit, something that sets off your alarm bells and knowing by looking at a patient that something is bad wrong and you need to get help right away.

The short of it is that, I persoanlly, think you are right where you need to be and you should never be satisfied with imperfect knowledge, even if it is unobtainable.
 
Apple5 said:
Alright I am about to go out on clinical rotations.. and I am very confused..
I am finding myself disappointed with PA school up to this point. I am learning so much.. its great, but I feel like my medical science education stinks.. We have so much material to learn in such a short amount of time that we dont learn the “why”..
For example in class we learn a patient has gout, these are the signs and symptoms, diff. diagnosis, and treatment.. SO we are learning how to recognize disease and treat it.. But what is the disease.. what the pathophysiology behind it..

I understand that a huge difference between MD school and PA school is the basic science background.. So..

here is my question, is this common that students feel this way in PA school.. do MD students feel the same way to some degree? Will this change on rotations, through out my career as a PA?? I am a bit of a nerd.. I like science and would potentially some day get a PhD in physiology/biochemistry. Do other PAs also have this issue or am I too immature in my PA education to be worried about such things??
Click to expand...


I am an MD who currently practices and teaches both PA and allopathic medical students in both pre-clinical and clinical subjects. First, as a physician assistant (same as a physician) you are going to be a life-long student. You have to continue reading and studying your discipline as long as you plan to practice. There is nothing stopping you from reading as much as your free time will allow. You will not (and don't have to) take a formal class in something to learn the "hows" and the "whys" of what is going on. Your formal education (same for physicians) gives you a knowledge foundation upon which you will build according to your eventual specialty.

Second, nothing is stopping you from purchasing any of the major tests for whatever discipline you want to study in more depth. For example, if you want to know the "hows" and the "whys" of Internal Medicine, purchase big Cecil's or Harrison's and start reading. If you want to know the "hows" and "whys" of General Surgery, purchase any of the "big three" texts (Sabiston's, Greenfield or Schwartz) and read to your heart's content. If you want to study Biochemistry in depth, then grab a copy of Voet & Voet or Baltimore's text and read away. For Pathology, grab a copy of either Big Robbins or Big Rubins and

If your clinical preceptors are good, they will sprinkle in some things that will help you to link your pre-clinical work with your clinical work. In short, they should help point the way for you to enrich your clinical experiences with a deeper knowledge of your basic science work. If not, you will have to do this on your own with your reading. This would be the same whether you were in medical school (or any other professional school for that matter).

When I hit General Surgery residency, I had an in-service exam yearly that tested my knowledge of basic science (and clinical science). If I did not keep up with my reading and journal work, I would have scored poorly on that exam. My journals (and yours) will keep you as up to date as possible if you read them regularly.

On the other hand, if you find that you feel that your scope of practice is limited as a physician assistant, then you may want to consider medical school, not for the coursework but because you want to expand your scope of practice.

If you feel like you want to study one of the pre-clinical sciences in depth, then you may likely wish to obtain graduate study in one of those disciplines which will give you the tools to research some aspect of that discipline in greater depth.

As a surgeon, there isn't a day that passes that I don't read my journals. As a research scientist, there isn't a day that passes that I don't read my journals. Over the course of a week, I will generally read no less than 20 - 25 journal regularly as part of my practice.

What you should not expect is that coursework will present everything that you need to know. As a future professional, your learning will largely take place outside of the classroom. The extent of this learning is largely up to you and your licensing requirements.
 
Very good answers by both Chronic Student and njbmd. I would add, though, as a PA planning to return to med school, sometimes we DO want to return for the coursework. I've studied lots of Cecil's, Harrison's and Big Robbins on my own but I need some prompting and accountability (read: tests) to make myself learn something well.
I agree that we are all lifelong students. Hopefully this carries over whether you are a PA or a nurse or a physician or surgeon or....and sadly I agree that there are plenty of PAs (and nurses and probably a smattering of physicians) who stop learning once they get out of school. I don't know how it's possible, personally, since I'm continually presented with new patient problems in clinical practice. Very few patients ever read the textbook, so to speak...you have to figure them out too with the limited information they give you.
Read every day. During rotations, make it a habit to find, research and understand thoroughly two clinical questions a day. Your preceptors should help you with the questions--and a good preceptor won't let you slack on answering them.
Honestly, this is a very typical feeling at this stage of the game. You know more than you think you do. The fact that you're feeling inadequate is normal and IMO a good sign of humility--you are teachable. Don't ever feel that you've reached the limits of your knowledge--if you do feel that way, it's time to reset the bar.
Good luck
Lisa
 
Thank you all for your replies, they are much appreciated! I think it is just hard because I do feel like there are so many pieces of the puzzle still left to figure out. I worked as an EMT through my bachelor's & master's degrees, then went straight to PA school a week after I finished my previous master's. I have never been out of school and had the experience of learning things just to learn/understand them, I guess that time will be approaching soon though. I do think rotations will be great though, as said I probably know more then I am giving my self credit for.

Again thank you for all of your comments.
 
primadonna22274 said:
Very good answers by both Chronic Student and njbmd. I would add, though, as a PA planning to return to med school, sometimes we DO want to return for the coursework. Lisa
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If you don’t mind me asking, why you came to this decision and what are the pros/con of PA turning to MD.. is to all about the scope of practice and knowledge??
 
Yes and yes. I'm too tired to answer more thoroughly now but if you search my previous posts you'll find my reasons.
L.

Apple5 said:
If you don’t mind me asking, why you came to this decision and what are the pros/con of PA turning to MD.. is to all about the scope of practice and knowledge??
Click to expand...
 
Apple5 said:
Alright I am about to go out on clinical rotations.. and I am very confused..
I am finding myself disappointed with PA school up to this point. I am learning so much.. its great, but I feel like my medical science education stinks.. We have so much material to learn in such a short amount of time that we dont learn the “why”..
For example in class we learn a patient has gout, these are the signs and symptoms, diff. diagnosis, and treatment.. SO we are learning how to recognize disease and treat it.. But what is the disease.. what the pathophysiology behind it..

I understand that a huge difference between MD school and PA school is the basic science background.. So..

here is my question, is this common that students feel this way in PA school.. do MD students feel the same way to some degree? Will this change on rotations, through out my career as a PA?? I am a bit of a nerd.. I like science and would potentially some day get a PhD in physiology/biochemistry. Do other PAs also have this issue or am I too immature in my PA education to be worried about such things??
Click to expand...

You're still in school. It takes time for the didactic and the practical, hands-on stuff to form a synthesis in your brain. In medical school, I frequently learned, memorized, but had no clue what it was I was memorizing. It wasn't until residency that the information clicked or made sense. Once you're out practicing, it'll click and start to make more sense to you.

Also, like others have said, if you want to learn more, read journals, engage in self study, and keep up with your CME.
 
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