10 Most Helpful Study Tips for Physician Assistant Students

10 Most Helpful Study Tips for First Year PA Students

The way you studied in undergrad may not always be the most effective or efficient way of studying while in PA school, as I have learned. As you begin your journey, or if you are already well on your way, you might find a few of these study tips helpful to increase the breadth of knowledge you are able to digest.

Anytime I get bogged down in the amount of material we are required to know for an exam, or how uneventful a lecturer may make your Friday morning at 8:00 AM, I just remember that I am learning this information to help save someone’s life one day. We can never forget that. What may seem unimportant or like “useless” information will probably be the most important thing you’ll learn your entire career and it could potentially mean the difference between life and death for a patient. The day that you decide that it is acceptable to receive poor grades in a course “as long as you pass” is the day you have failed your profession.

Certificates of Added Qualification (CAQ) Exams for Physician Assistants

Specialty Certificates of Added Qualifications (CAQ) Exams

CAQ exams for physician assistants are utilized for one purpose: to receive recognition for having obtained advanced clinical training and skills in your specialty. Since September of 2011, these exams have been given by the NCCPA just like the PANCE, and awarded to those who perform exceptionally. The CAQ emphasizes that PAs are grounded first in generalist medicine and then pursue additional qualifications in specialites. It serves as excellent documentation of knowledge, training, and experience in specialty practice. It also helps to avoid the confusion of any new PA “certification” program or any new specialty certification designation, as this credential is achieved in addition to the PA-C. According to Janet Lanthrop, old CEO of NCCPA, there were two desires in producing this exam: to have documentation to show hiring physicians that PAs were knowledgeable in specialty areas and to give hiring physicians assurance that the PA had experience in the specialty to come in at a certain level of acuity than your typical newly hired PA.

Private Scholarships, Grants, and Fellowships for Physician Assistant Students

Greetings readers,

Below you will find a list of scholarships, grants, and fellowships that PA students (and some PA-C) may apply for. Most of them are for students in graduate programs, so I apologize if you are seeking a bachelor’s degree, associates, or certificate and do not find these useful. However, there may be a few scholarships you can apply to if you are not enrolled in a Master’s degree program, just check them out to be sure. I listed a few UTSW specific scholarships at the bottom. If you have any to add, please leave them in the comments section or e-mail me at mymathtutoraustin@gmail.com.

I appreciate all of you reading and keeping me on my toes.

Private Scholarships for Physician Assistant Students

AAPA African Heritage Caucus Scholarship

• Must be a PA student currently enrolled in a PA program
• Must be in good academic standing
• Must be a member of African Heritage Caucus
• Must submit transcripts with application
• Must obtain 2 letters of reference (one from faculty advisor or program director)
• Must complete essay (500-750 words)

Hematology List of Most Commons for Physician Assistant Students

Most Commons in Hematology

• Iron Deficiency Anemia - most common cause of anemia
• Anemia of Chronic Disease - most common cause of normocytic anemia
• Glucose-6-Phosphate Dehydrogenase Deficiency - most common RBC enzyme defect
• More common in males
• Highest frequency among Mediterranean regions, Africa, and China
• Most commonly seen in tropical geographic areas prevalent for malaria
• G6PD “A-” is the most common variant
• Sickle Cell SS disease - most common and most severe of the sickle cell disorders
• Warm-antibody AIHA (autoimmune hemolytic anemia) - most common of all AIHA
• Immune Hemolytic Anemia - commonly DRUG related
• Idiopathic Thrombocytopenic Purpura (ITP)
• Acute ITP - most common in children, preceded by viral illness, self-limiting
• Chronic ITP - most common in adult women (20-40), idiopathic, not self-limiting
• Thrombotic Thrombocytopenic Purpura (TTP)
• Most commonly acquired due to an inhibitory antibody that blocks ADAMTS 13 activity
• Hemophilia A and B - most common in males
• X-linked recessive bleeding disorders

Am I A Competitive Physician Assistant (PA) Applicant?

What Makes a Competitive PA Applicant

Last Updated: 08/03/2015

“Am I a competitive PA applicant?” is a question thousands upon thousands of applicants ask themselves each year while applying. It is a question every admissions committee will be asked during a prospective session, and a question all PA coaches can be expected to be asked by their students. There is a lot to learn from our peers, including organizations like Physician Assistant Education Association (PAEA), who has recently re-instated the Matriculating Student Survey (MSS) data collected from first year PA students to gauge their academic background, application and admission experiences, including a multitude of other characteristics I will cover shortly. The surveys were conducted in September of 2013. If we do the math, this was PA students who matriculated (entered) PA school in 2013, so these are students that are one year above my current PA class.

Second Semester at UT Southwestern

First off, thank you all for reading. I started my blog about one year ago with the intention of keeping myself updated about current events in the PA profession as it is rapidly changing with our developing healthcare system. While I have yet to write many articles that have needed writing since the beginning of this semester, I plan to write a lot while I have a one month break this winter. Thank you for reading my blog and for helping me reach 200k views! -Paul

We finally completed our second semester (Fall I) at UT Southwestern. It was a doozey. Much harder than I had expected. It made summer semester seem like a breeze!

Pulmonology List of Most Commons for Physician Assistant Students

This topic deserves an introduction. Why? Because it is Lung Cancer Awareness Month. How many of you have ever heard of Lung Cancer Awareness Month? Exactly. That’s probably because Breast Cancer Awareness Month probably stole its light in October. Unfortunately, breast cancer does not cause the most mortality in the United States, lung cancer does; that goes for men and for women. Why is this? Probably because there is not a unified and inexpensive diagnostic screening method for lung cancer as there is for breast cancer. Lung cancer causes almost double the number of deaths per year as breast, colon/rectal, and prostate cancers. Nonsmokers living with smokers have more than a 30% increased risk for developing lung cancer, regardless of whether or not the smoker is physically smoking around the nonsmoker or not. A diet rich in fruits and vegetables may protect against the development of lung cancer in smokers. However, high dose supplements of beta-carotene (also found in carrots) has been shown to increase the risk for lung cancer and is not recommended. So there you go. I have increased your knowledge about lung cancer in a matter of a few minutes. Hopefully now you will remember that every november is Lung Cancer Awareness Month and that you will remember to include lung cancer in your differential and to screen folks for it when necessary.

Most Commons in Pulmonology

• Cough - Most common complaint seen in outpatient setting
• Dyspnea (difficulty breathing) - common complain at emergency department
• COPD - most common respiratory disease; 3rd leading cause of death in US
• More prevalent in males
• Most common cause of COPD - cigarette smoking
• Most common bacterial pathogens in COPD are: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
• Asthma - most common in children
• More common in male children
• Prevalence changes to adult women after puberty
• Most common in Caucasians
• Most are categorized as moderate persistent
• More common in obese individuals
• Most common Interstitial Lung Diseases
• (1) Usual Interstitial Pneumonia (idiopathic pulmonary fibrosis) - idiopathic interstitial pneumonia (IIP)
• (2) Sarcoidosis - idiopathic, granulomatous
• (3) Hypersensitivity Pneumonitis (HP) - known cause, granulomatous

PA School Tuition Decreases!

Hallelujer, praise da Lort! (I hope you've seen Madea) 

Our professors recently went to Philly to the PAEA Conference where some very interesting information was presented. For those applying this cycle or next, take a look at this:

Data revealed from the 29th Annual Report:

1. If you apply to one PA program - you have a 25% chance of getting in
2. If you apply to 12 programs (or more) - you have a 49% chance of getting acceptance
1. No additional benefit for more than 12 
3. As age of applicants increases, GPA was lower 
4. With each cycle, GPAs are increasing
1. In 2007 (avg: 3.39), while in 2011 (avg: 3.49) - matriculants (people who got accepted)
2. In 2007 (avg: 3.12), while in 2011 (avg: 3.16) - non-matriculants (who did not get in)
5. Health care experience decreasing steadily
1. In 2007 (avg: 3.43 years), while in 2011 (avg: 1.88 years)
6. Number of applicants increasing - not surprising, honestly
1. As of September 30, 19,000 applications were submitted 
7. 60 programs in the queue to be accredited - estimated 10,000 PA graduates by 2018
1. There are currently 204 PA programs - this is insane! But only 177 programs participate in CASPA. 

Now the FINALE!

1. Resident tuition at public school programs dropped 8.0% in 2013
2. Resident tuition at private school programs dropped 2.3%
3. Non-resident tuition at private school programs dropped 3.2% 

Sources:
http://networker.paeaonline.org
Twenty-Ninth Annual Report of Physician Assistant Educational Programs in the United States, 2012-2013

AFL vs. NH vs. SNF

AFL vs. NH vs. SNF

A topic that we don’t talk often about is geriatrics, but it is very important. In the inpatient and outpatient setting, these are the patients physician assistants will see the most. Although 65+ year olds comprise only 13% of our population, they make up 35% of all prescriptions we write for.Not all geriatric patients live in nursing homes, although 70% of all people who reach age 65 will need long-term care for at least some period of time before they die.

• Nursing Homes
• 65 years or older - 5%
• 75 to 84 years - 6%
• 85+ - 22%

So, what is Long Term Care?

Long Term Care is an umbrella term and covers a range of facilities

What is the difference between:

Assisted Living Facilities (AFL)

Assisted living is kind of like a hotel. Meals are provided but they have to come down to get them; laundry is done often, and rooms are cleaned. It is expected that people can do their own ADLs (activities of daily living) and if they can’t, they need to  pay to get dressed, bathed, and to be given medications. Only 1/3 of assisted living facilities have an RN on site. ALFs are considered like the patients’ own home and they are called residents rather than patients.

Nursing Homes

Nursing homes are very regulated facilities that provide 24-hour nursing care. Patients in nursing homes have major problems with function or cognition. Staff provide assistance with ADLs. It is usually for very frail patients. Many patients would prefer not to go to a nursing home.

Skilled Nursing Facilities (SNF)

Skilled nursing facilities are often located within a nursing home. They provide care for patients who have had a CVA (stroke), hip fractures, etc. that is debilitating. They give antibiotics and administer IVs, etc. There is an interdisciplinary team and they have PT’s and OT’S on site.

Sources:

Special thanks to Dr. Vivyenne Roche for her help!

http://longtermcare.gov/the-basics/what-is-long-term-care/

Cardiology List of Most Commons for Physician Assistant Students

Dear Readers,

Below are the most commons in cardiology that I’ve put together from this block. I’m sure once I enter rotations I will be adding many more. Can I just say that one of my biggest pet-peeves right now is the incorrect pronunciation of medical terms? For example, angina. This word has been produced in two ways by various professors, but there must be a correct way to pronounce it, so naturally, I looked it up. “An-jen-uh” is the correct pronunciation, while “an-jine-ah” is colloquially used, but incorrect.

Cardiology Most Commons

• Most common pathologic process of the pericardium - Pericarditis
• Most common etiology of Acute Pericarditis - coxsackievirus A and B
• Most common cause of death in the U.S. - Coronary Artery Disease (CAD)
• Coronary microcirculation disease more common in women - this is why CAD affects more women than men annually
• Exercise electrocardiography less accurate in women
• More women die each year of CAD
• Most common cause of sudden cardiac death: ventricular fibrillation
• Most common cause of sudden cardiac death in young athletes: hypertrophic obstructive cardiomyopathy (HOCM)
• Hypertension
• More common in women as age increases
• More common in men in young and middle aged people
• More common in African Americans and lower socioeconomic groups
• African Americans develop at earlier age compared to other races
• Secondary HTN - more common in children
• White coat HTN - affects more treated women than men
• HTN is the SECOND most common cause of CKD

Dermatology List of Most Commons for Physician Assistant Students

Most PA programs teach in a systems-based style of learning with “block” style approaches to navigating through the mounds of medical factoids we must learn and know. It’s often talked about how PA students should start their own lists of “most commons” in medicine for each block or system in preparation for course examinations and the PANCE. It has come to my attention that this is most definitely the case. As such, I’ve decided to create a list of most commons for each block we cover, the first being Dermatology!

Most Commons in Dermatology:

1. Most common treatment for keloids: triamcinolone acetonide (corticosteroid) in concentrations of 10-40 mg/mL at 4-6 week intervals
2. Most common cutaneous cyst: epidermal inclusion cyst (EIC), also known as cutaneous cysts
3. One of Top 3 Skin problems in children: verruca vulgaris
1. Most common primary treatment: cryotherapy and salicylic acid (cure rate improved by combining both therapies)
4. Human Papilloma Virus (HPV) is one of the most common STIs causing Condylomata Acuminate, also known as External Genital Warts (EGW)
5. Most common type of psoriasis: Plaque Psoriasis (affects 80-90% of patients).
6. Most common clinical pattern seen in Psoriatic Arthritis:
1. Oligoarthritis - swelling and tenosynovitis of one/few hand joints.
7. The “Butterfly Rash”
1. Many facial rashes are described as malar or “butterfly” rashes
2. Most commonly, they are either: seborrheic dermatitis or rosacea, NOT systemic lupus erythematosus (SLE)
8. Most common dermatologic condition in infants: Diaper Rash (diaper candidiasis)

Anatomy Tips and Tricks for Physician Assistant Students

Anatomy can be a doosey for everyone, so don't let it get you down if you're having trouble. A few mnemonics and acronyms can be your savior if you are really struggling. Just make sure you have them straight and practice saying them out loud. Remember that sometimes, the most silly or inappropriate mnemonics or acronyms can help you recall the toughest things! Be creative and have fun with anatomy, it will help it stick. Some of my acronyms and mnemonics may not be helpful or useful to you if you don't understand them, so try making your own. When in doubt, draw it out! Drawing vasculature or nerves from beginning to end can take some time, but can be worth it in the long run. Typically, I would draw out sections of vasculature or nerves and then go to the lab to identify them. It really helped me solidify relationships.

When I was in anatomy, I would read the lab manual the night before, taking notes on things I thought were important for the lecture test. To my surprise, much of what I originally thought were minor details, were actually very helpful in locating structures for the lab exam. Knowing relationships between structures can aid your learning in anatomy, because if you can find landmarks like nerves, vessels, or bony structures, you can often figure out what something is.

For your practical, if your school offers any old exams, you might make a list of all of the terms that have been tested on in the past and their occurrence. You and your classmates might also join Quizlet and start your own flashcard deck. Our class created decks for each exam that helped to quiz when the lab was closed. Creating tables with muscle origins, insertions, and actions will also help reinforce your learning. Remember, teamwork makes the dream work!

If you have anything to add to this list, please leave it in the comments section below. Thank you all for reading! Much thanks to the UT Southwestern PA Class of 2015 for their help.

Helpful Links

• Free Online Anatomy Practicals
• Virtual Cadaver Lab
• BioDigital Human
• The Skeleton Dance - for help with bony landmarks
• Shoulder Articulations
• Brachial Plexus Parody
• Drawing the Brachial Plexus in 37.6 Seconds

Upper Body

• Suprascapular nerve/artery with the superior transverse scapular ligament (bridge)
• Army goes over the bridge, Navy goes under it
• = Artery superior to ligament, Nerve inferior to ligament

Physician Assistant Scope of Practice Laws by State

Thanks to Barton Associates (the locum tenens experts) and AAPA, an interactive guide to physician assistant practice laws was created detailing the ins and outs of each state. It offers a very good overview of the laws restricting or enhancing the profession by state and region (northwest, midwest, southeast, etc.). It highlights Six Key Elements, decided by AAPA. They are 6 elements that should be part of every state PA practice act. To learn more about each element, review AAPA's State Law Issues Brief.

1. "Licensure" as the regulatory term
2. Full prescriptive authority
3. Scope of practice determined at the practice level
4. Adaptable supervision requirements
5. Chart co-signature requirements determined at the practice
6. Number of PAs a physician may supervise determined at the practice level

For AAPA members, you can also view this interactive guide in tabular format or map format provided by AAPA.

Moonlighting, Locum Tenens, Concierge Medicine and Physician Assistants

Moonlighting for Physician Assistants

Updated: 08/06/2015

Moonlighting is by definition, “having a second job in addition to one’s regular employment.” While moonlighting is very popular amongst the physician community, physician assistants (PAs) may also find moonlighting useful to boost income sources and pay off student debt, or simply to increase the amount of experience in their current area of practice or another. As PA students are not yet certified in their clinical phase, they may not moonlight. However, if a PA-C wishes to moonlight as a resident or during a fellowship, they may legally provide medical care as licensed physician assistants. Currently, no survey shows the number of PAs who are moonlighting, but it seems that interest in these positions as secondary jobs are becoming more popular. Declining reimbursements and skyrocketing student loan interest rates seem to be the main drivers of this type of work, but it’s up to the PA to determine how much work is enough before they are burning themselves out.

According to the Accreditation Council for Graduate Medical Education (ACGME), residents are restricted to 80-hour work weeks, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting. This limit was created to enhance the education of residents while allowing for necessary rest, conducive to productive learning. However, there is no limit for currently practicing physician assistants (PA-C) that are not enrolled in a residency or fellowship program.

First Semester at UT Southwestern

Dear Readers,

I sincerely apologize for not having been as active as I was previously. Today I completed summer I at UT Southwestern. I can tell you all that it was no easy task. All of the rumors are true! While I definitely enjoyed my first semester here in Dallas, I have to say, it was probably the most difficult semester I've ever endured. Here is a snapshot into each course and my overall experience thus far. I hope you future PA's enjoy this post!

A look at a typical week in the first semester of PA school. This is Summer I at UTSW.

International Volunteer Opportunities and Missionaries for Physician Assistants

International Volunteer Opportunities and Missionaries for Physician Assistants

Whether you’re a pre-PA, a PA student, or a professional PA looking for international volunteer opportunities or mission trips to enhance your global impact, look no further! In this post, you’ll find a variety of resources to get you started on planning your trip and even links to places you may have never heard of before. If you have any resources or comments to contribute to this posting, please leave them in the comments section below and I’d be happy to include any and all changes or additions.

First off, I’ll start by directing your attention to AAPAs “Before You Go--Preparing for International Practice.” This is not only useful, but essential on so many levels! You’ll find links for researching the country you’ll visit, passport information, visa information, insurance, immunizations, physician supervision, guidelines for working internationally, and much more!

Now, let me direct your attention to AAPAs International Volunteer Opportunities page, where you’ll find out:

• What you need to know before making a trip
• The “Before You Go” checklist of travel information and questions to ask before accepting a volunteer position - found above
• A list of volunteer databases (given by AAPA) known to accept physician assistants including, but not limited to:
• International Medical Volunteers Association - contains resources for international volunteering
• International Healthcare Opportunities Clearinghouse - a list of more opportunities
• Omni Med - database of global health service opportunities

In addition, the International Practice guide lists guidelines for international licensure, liability coverage, and transporting medical supplies that may be helpful.

A list of International PA Caucuses involved in the delivery of international healthcare are:

• Physician Assistants for Global Health
• Fellowship of Christian Physician Assistants