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!
In the photo above you’ll see our schedule for the year, although it did vary quite a bit each week. The reason is that many of our lecturers are clinicians and things come up and they have to reschedule last minute, etc. It happens. Some weeks had more class scheduled than others depending on the “block” we were in. I know the schedule looks busy, but it wasn’t always this much class each week. They just put these times on here to “reserve” times we can have class, meaning if a lecturer has to reschedule for any reason, those times are fair game for lecture. So we have to keep these times open for lecture each week.
Clinical Medicine I
In clinical medicine this semester, a.k.a, “clin-med” we covered 5 “blocks”: dermatology, HEENT, cardiology, pulmonology, and hematology. Each block is divided amongst the semester based on the NCCPA 2015 content blueprint. Yes, it has changed since 2014 and our program has made changes to fit the percentages of time we spent on each block to match the percentage of questions coming from each section of the PANCE. Before each block we are given a syllabus with any additional reading resources from Cecil’s and an outline of the objectives we are going to be tested over. Some of our classmates compiled reviews based on the objectives.
Dermatology was the most different from any other block because we didn’t really have any lectures in person. It was self-taught and consisted of modules from the American Academy of Dermatology. It is the same course review that medical students use and the method has apparently had very good success in previous years with our PANCE scores in the dermatology category. We only spent 2 weeks on this block. We learned about warts, molluscum contagiosum, acne and rosacea, psoriasis, fungal (yeasts and dermatophytes), rashes, carcinoma, melanoma, etc.
HEENT was pretty cool because we covered each of the areas individually. For example, in the eye section we learned about ocular emergencies, disorders of the conjunctiva and cornea, glaucoma, and cataracts, lacrimal apparatus, eyelid and retinal disorders. This was a 3 week block. We also covered the “bugs and drugs” again that we had reviewed from pharmacology, so it helped reinforce those again.
Cardiology was a pretty long block. I think we spent 4 weeks on cardiology. We had a nice introduction to EKGs in this block, but we get more next summer. We also had a cardiac sounds lab where we had the chance to listen to different heart beats, murmurs, etc. We learned about pericardial diseases, arrhythmias, hypertension, ischemic heart disease, heart failure, dyslipidemia, peripheral vascular disease, valvular heart disease, infective endocarditis, and cardiomyopathy.
Pulmonology seemed like the longest block so far. We also spent 4 weeks on pulmonology. I thought it would never end. We learned a lot in this block including how to read and interpret pulmonary function tests (PFTs), asthma (and action plans), fungal and bacterial infections, restrictive interstitial lung disease, pneumonia and acute bronchitis, COPD and bronchiectasis, pulmonary embolism, lung cancer, influenza, and pulmonary arterial hypertension. We also spent a day where we learned lung sounds in a lab and learned a little bit about chest x-rays. It was really cool to integrate in person what we had been learning in our textbooks. We get more about this next summer though.
Hematology was another short block. We only spent 2 weeks on heme, but it was so much material. Somehow we got through all of the anemia, leukemia, lymphoma, multiple myeloma, stem cell transplant, etc. It was a really interesting block to close out the semester with and I really enjoyed learning about everything we did.
Pathology is one of those courses where you either hate it or love it. I did not really enjoy it as much because I don’t really enjoy reading 30-45 page chapters each week, but some of the content is pretty interesting. This course moves extremely fast. Like I mentioned, 30-45 page chapters means we covered 1-2 chapters per week. I think overall there were 24 chapters covered in 29 weeks of class with 3 weeks of exams (2 midterms and a final). The final examination covered 20% of the first 2 exams and 80% of the last third of the material. Topics ranged from the basics of the immune system, infectious disease, and neoplasia, to the endocrine system, disorders of the urinary tract, endocrine system, male and female genitalia, senses, musculoskeletal, skin, and nervous systems. Each week there were “case studies” from each chapter with questions from throughout the chapter and the professor would call on people in class to answer them. We actually had 2 professors for the course - Dr. McConnell (the author of the textbook) and Dr. Molberg. Both are physicians. The course was held twice per week from 10-11:30 but we usually got out pretty early. Exams were all paper-based multiple choice, but were around 117-120 questions each and the second 2 were pretty difficult compared to the first!
Patient evaluation is where we learn all of our clinical skills. This course includes a classroom during the week and a clinical component on Thursday nights. We were originally introduced to our interview skills in this course. We also learned basic physical examination techniques such as taking vital signs, using PPE, palpation, percussion, auscultation, etc. We continued the semester with a hair, skin, and nails exam, which we tested on one another. After those first few weeks of practice on each other, we began to have simulated patients come in. They are paid to be our guinea pigs while we practice our skills on Thursdays and while we are tested over our skills as well. We were broken up into groups of 6 and each given a preceptor to teach us the skills and evaluate us while we were practicing and testing with our simulated patients. Each week, our groups each had 3 simulated patients each! I thought that was pretty incredible considering how much organization, time, and money that must cost to get all of those folks together, not to mention the nice facility (UTSW Orthopedic outpatient unit) we were able to use. At this point, we started with a HEENT exam on our patients, a cardiac and peripheral vascular exam, a lung and breast exam, and ended with a male genitalia exam. Overall, we learned quite a bit. We were given usually 1 to 2 weeks for each to learn the clinical skills and practice them on patients before we were tested on them. The physical exams were 15 minutes long in addition to 2 written stations where we had questions to answer about whatever the topic was about (stuff from our lecture/book). The final exam was cumulative, except for the breast exam, which I think we do next semester in lieu of the male genitalia exam since we had a male patient. The final was 30 minutes long with no written stations and we had to complete all physical exam tasks above. In addition to these physical exams, we had didactic exams that occurred after each clinical medicine exam on Monday mornings. After the computer-based clinical medicine exam, we would end that one, and start the patient evaluation exam for the material we had been covering recently. It was nice because most of the material overlapped pretty well and when you study for clinical medicine, you are basically studying for patient evaluation. Exams were usually 20-25 multiple choice questions. Bates’ book is what we used for our course, and it will come to haunt you, eventually. He is so tedious!!
Integration skills is a course that does literally what the title says. It integrates skills from each course. The pathology, the knowledge from pharmacology and clinical medicine, and even some stuff from patient evaluation. Most class periods we are given a case scenario where we are split into different teams - differential diagnosis team, interview team, and oral presentation team. Each team is responsible for different parts of the assessment and report of the patient. The goal is to come up with a quality differential diagnosis based on symptomatology, to learn the interviewing skills necessary to build good rapport, and to learn how to write a SOAP note and present to your attending orally. We also had weekly ROS (review of systems) quizzes in this course that were cumulative to help us remember our ROS for interviewing. In addition this course included a project titled Juliette Fowler, which was a nearby nursing home facility where we were able to interview volunteers and have a chance to practice our skills in real life without restriction or being monitored. It was nice to put into practice what we had been learning and to test what we knew. There were three sessions with the volunteer where we would conduct different parts of the interview (transitional lifestyle, past medical history and social history, and family history). In each interview we practiced different types of interview skills. After each interview, a written report was due and an oral presentation of our patient was presented to our small class groups (usually 6 students) as if we were presenting information to our attendings. Definitely good practice for clinicals.
Pharmacology was one of my favorite classes this semester, mainly because I learned so much. I have never had a pharmacology course and didn’t know what to expect or how to handle the massive amount of information, but eventually I got the hang of it. I’ll be posting tips about how to tackle pharmacology soon, so be on the lookout. In this course we were required to learn the mechanism of action, indications for use, contraindications, pregnancy category, boxed warnings, adverse reactions, monitoring, common interactions (drug-drug, food), and drug toxicities for each drug. But don’t worry, we didn’t have to do this alone. Our class created “drug cards” that included all of this information. Our class president divided up each of the drugs we had by class member and we divided and conquered this using our lecture material and textbook. It made studying and organizing a heck of a lot easier. Our professor would review our drugs cards for us before the test to ensure the content was simple and there wasn’t anything missing that we needed to know. This semester we covered dermatology medications, antibiotics, over the counter medications, hypertension and heart failure medications, angina medications, arrhythmia medications, lipid medications, chest medications, anticoagulants, antiplatelets, fibrinolytics, antivirals, pulmonary hypertension medications, antifungals, antimycobacterials, and chemotherapy. We also covered prescription writing and medically important bacteria and how to tackle them with antibiotics. Pharmacology also had wonderful writing assignments called correlates - not. Being totally sarcastic. They help you prepare for the test, but they are basically case scenarios where you have a patient that you have to decide a drug regimen for and talk in detail about the drugs and why you chose each drug and then talk about the patient education involved. They are not terrible, but time consuming. They do help reinforce understanding though, especially for things like tuberculosis medications, etc. Exams were mixed. If you know how to study for them, you’ll do great! They were about 65-75 questions multiple choice computer-based exams.
Professional Development (IDEAL)
IDEAL stands for Interdisciplinary Development, Education & Active Learning. In this class we work with prosthetic and orthotic students, physical therapy students, nutrition students, and several other students from the other health professions to learn about team-based care. This is the first part of the course (1 of 2) and it is pass/fail. We receive “full credit” once we complete the second part (2 of 2) in the spring. Some of our topics for the semester were behavior styles, communication, learning about the different health care professions, cultural considerations, and EHR. Additionally, we have lectures once per month to attend where we learn more in depth information about particular topics like DISC, professionalism, and health literacy. Most of the time in this class we just show up and participate and we get credit. There are only two extra requirements we have to do, which are a presentation on a health profession and an introduction to Epic (EHR software) online.