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Second year is all about bringing all the pieces of the puzzle together.

Second Year Student Blog: Serena Sam

There are many things you hear—or read on the internet—when you first start PA school. For example:

  • “It’s like trying to drink from a fire hydrant.”
  • “It’s going to be hard, but it’ll be worth it.”
  • “It goes by so fast.”

As I am wrapping up my ninth of 12 rotations, I can attest to that last one without question. Two years ago, I was reading these student blogs as a prospective applicant. In just over three months, my class will be eligible to take the PANCE. While I can’t claim to feel 100% ready to be a practicing clinician, I can say that my growing medical knowledge, patient care skills, and ability to work effectively with other members of a medical team comes in large part from the difference between the 1st and 2nd year of the Duke Physician Assistant Program.

When people talk about drinking from a fire hydrant, that is a perfect description what first year felt like for me. With at least one (but often two or even three) exams a week, first year often felt like an endless cycle of learning one unit of medicine in class—gastroenterology, for example—while trying to study for an upcoming exam on a different unit—neurology, perhaps—after school. Class, study, eat, sleep, and repeat. I often felt like I could barely fit one topic in my brain for the exam, and it was forgotten as soon as I started studying something else.

Trust the system

But, another thing you hear a lot is that you’ll remember more than you think when it comes time for clinical rotations. And it’s true. My first clinical rotation was inpatient psychiatry. I’ll be the first to admit, I didn’t remember much about psychiatry from first year, so I was a bit nervous on what I would be asked to answer. But, on my first day my preceptor suddenly asked me, “What’s a good treatment option for refractory schizophrenia?” I automatically said, “Clozapine.” So, it’s true. You will remember more than you think.

During first year, I was told to trust the system. A lot. It sometimes felt disjointed to be in lecture for a few hours then jump to patient assessment and counseling (PAC) groups, or be in the midst of preparing for standardized patient encounters (CPX) and then switching to a medical ethics discussion. During this all, I constantly had a voice in the back of my head telling me I needed to study for the next upcoming exam. In moments when I felt like the first year schedule was crazy, hectic, and perhaps inefficient, I had to remind myself to trust the system. It’s the Duke PA program, after all.

‘It is all worth it’

Yet again, “they” were right. Second year is all about bringing all the pieces of the puzzle together. I wasn’t nervous to start working in-depth with patients because we had so much exposure throughout first year between our PAC courses and CPX encounters. Things that were once foreign to me, like writing a patient encounter note, are now almost second nature in part because we had so much practice over the course of the first year.

The second year of PA school takes those disjointed-feeling pieces of first year and makes one cohesive almost-fully-functioning clinician. Even though I don’t remember everything we learned, it comes back quickly whenever I review it—and it sticks better, because it helps to relate the material to specific patients I have worked with.

With each passing rotation, I think more critically about what is going on with each patient. Working with providers of all backgrounds with different styles and expertise allows me to define what kind of provider I’d like to be throughout my career. Every time something “clicks,” or a patient thanks me for taking the time to listen and explain, I am reminded that they were right. It is all worth it.