As I walked into the main classroom at the Duke Physician Assistant Program, I was excited to see all of my classmates fresh off the second-to-last rotation of the clinical year. At the same time, I also was trying to focus on the Pediatric End of Rotation Exam that I was about to take.
I returned to my seat (the same seat I chose on the first day of class nearly two years ago), got out my laptop and listened to the now familiar instructions we receive before every computerized exam: “make sure to maximize your test screen window … there will be two sections of 60 questions lasting 60 minutes each with no pause in time between sections … only one person may use the bathroom at a time... .”
Once I finished my exam and clicked the submit button, I felt a simultaneous sense of relief and dread. Fortunately, our scores were released a mere hour later, a new record for the End of Rotation Exam score turn-around time. Looks like all those hours of studying viral exanthems and congenital heart defects paid off!
Call Back Day
This is the typical beginning to what is referred to as a “Call Back Day,” or a day in which the entire class returns to campus for testing and various lectures and advisory meetings. This particular call back day was the last official gathering of our class until the final two weeks of the PA program, known as “Senior Seminar.” We were reminded just how far we have come when one of our clinical coordinators announces that our class has collectively logged almost 100,000 patient encounters throughout our clinical rotations, and we still have one more to go.
Next we learn about the application process for becoming licensed with the North Carolina Medical Board, a daunting task that represents one final hurdle in the journey to becoming a full-fledged practicing PA.
After lunch, graduates from the Class of 2014 offered advice on everything from preparing for the PANCE (the national certifying exam) to how to negotiate salary and benefits packages with potential employers. It was reassuring to hear their individual paths to securing a job and to see the wide variation in their current clinical practice settings. PAs can truly work in any specialty imaginable, as evidenced by each of the panelists’ experience in jobs ranging from the CTICU and neurosurgery to outpatient psychiatry and addiction medicine.
When asked the question “What do you know now that you wish you had known while you were still in PA school?” one of the panelist’s responses was “my value.” She elaborated by recalling the challenge of being a second-year PA student, where every month you were thrown into a completely new environment and tasked with navigating the expectations of a different preceptor, preparing for the inevitable “pimping” that is so ingrained in medical culture, trying to be helpful to the nursing staff, and most importantly, listening and learning from your patients. By the end of the year all of this can begin to take a toll on your self-confidence, which is why hearing her response was a much-needed validation of just how well we are prepared for whatever career path we may choose to pursue in the future.
‘Art of Medicine’
As I listened to the words of wisdom from those who were in my shoes only one year ago, I reflected on the highlights of my previous clinical rotations and noticed a recurring pattern. While I certainly had those enlightening moments when I made a connection between disease processes I had only read about in a book and the actual clinical presentation in patients, it was the personal encounters between patients and their providers that were the most memorable. Often referred to as the “art of medicine,” that ability to genuinely listen to a patient and recognize his or her concerns and wishes, to anticipate their unspoken fears, and to communicate in a way that the patient can fully understand is a skill that can only be learned by experience.
One such interaction took place on my nephrology rotation when I observed the empathy and patience with which the medical director explained to a patient that a procedure would do her more harm than benefit. It was a valuable lesson in how to have those difficult conversations. Another example was when a nephrologist in the emergency room took the time to carefully and compassionately give a patient all the facts so that the patient could make the best decision regarding her own health.
I have also observed those conversations that all providers look forward to. Delivering good news after a surgery is one of the most rewarding and humbling aspects of practicing medicine. Other equally compelling experiences include providing counseling and education, explaining the appropriate use of antibiotics, and discussing treatment options.
Throughout my PA education at Duke, I have been taught that the history and physical examination is often all that is needed to arrive at a patient’s diagnosis. As a modern practicing clinician, I hope to never lose sight of the invaluable information that can be gained merely by listening to a patient’s words and interpreting his or her history in the context of the current presentation. I am eager to apply the lessons learned on clinical rotations in my daily practice as a new graduate and to continue to have an open and honest dialogue with those patients whom I am privileged to care for.