In addition to our fascinating anatomy cadaver dissection labs on Fridays, we have the Patient Assessment and Counselling I (PAC I) course to look forward to. While half of our class is in the anatomy lab exploring parts of the body on cadavers, the other half is in PAC I learning the relevant non-invasive physical examination technique on our class partner. We prepare for PAC I each week by watching a prerecorded lecture and taking an online quiz to ensure we will be ready for the session. Once Friday rolls around, we begin class dressed in an oh-so-flattering patient gown over athletic wear. We watch carefully and feverishly take notes as our faculty small group leader, a practicing physician assistant, demonstrates the exam on a classmate before we break off into pairs to practice. Our PAC groups are small with just ten students in each, which allows our faculty leader to observe and help us individually polish our techniques.
We learn a different organ system every week including general survey with vitals, HEENT (head, eyes, ears, nose, and throat), chest and lungs, heart and peripheral vasculature, abdomen, musculoskeletal exam, and a neurologic exam. My partner and I are far from strangers now that I have examined her nose, auscultated her heart, percussed her lungs, palpated her liver, tested her reflexes, and so much more. Now near the end of our first semester, we can do a complete non-invasive physical exam from head to toe! Invasive exams such as breast, genital, and rectal exams will be taught by trained professional educational instructors later in the didactic year.
Since we are practicing on our young and healthy classmates, the findings are almost always normal. However, that will not be the case for many of our future patients, which is why all our PAC groups participate in a Skills Session to see, hear, and feel pathological conditions and diseases. Over the course of several hours, each group cycles through the various stations of the Skills Session with abnormal models. There were pictures of patients and skin diseases we had to describe as if we were actually documenting them or giving an oral presentation to our preceptor. We looked into head models with our ophthalmoscopes and otoscopes to see eye and ear pathologies and even felt life-like breast models to detect fibrocystic masses and changes. Last but not least, we listened to heart murmurs and abnormal lung sounds on life-sized simulators named Harvey.
As I looked around the room at my nine classmates surrounding the amazing breathing and pulsating piece of technology that is Harvey, I couldn’t help but laugh to myself a little. There we were, hunched closely over Harvey and holding our stethoscopes tightly to our ears as we tried to listen to abnormal heart sounds, striving to add yet another skill provided by each of the different stations. Some abnormal heart sounds were difficult to distinguish, but we immediately helped each other identify the patterns once we heard it. The spirit of teamwork in our program’s non-competitive setting is refreshing, and I know I can count on my classmates for help and advice on anything.
To some, this Skills Session might just be another task, another lesson, or another hurdle to leap to earn our PA-C; but to me, it is yet another reminder of how lucky I am to be in the country’s oldest and most experienced PA program. Here at Duke, we are provided with all the right tools, knowledge, and skills to become competent and confident physician assistants. Even though the path to becoming a PA is long and arduous, I know I can get there with my classmates’ support and vast program resources.