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Advice for beginning PA students

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I have been asked for advice by many new PA students over the past few years and, since a new batch is about to begin at Mac in a month I thought I would jot down a few things in this post in hopes that other current PA/MD students will jump-in with more advice for our new colleagues.


Just to get the ball rolling:


1. Get as much early clinical exposure as possible through horizontal electives/longitudinal placements/clinical skills (IER) placements etc., etc.


2. Practice developing wide differential diagnoses for common (and not so common) presentations. Think about what is most dangerous that needs to be ruled out, what is most common, and what more rare things could this be.


3. Try to connect pathophysiology to clinical presentations/disease processes. Being able to think through things physiologically is an important skill to start practicing now. Don't just memorize facts, understand why and how things happen in the human body.


4. Practice your history taking and physical exam skills as much as possible.


5. You are a member of a profession now, a body of collegial persons who should treat each other, and other professionals, with dignity and respect. Act accordingly.


6. Ask questions. It is OKAY to not know stuff. It is NOT okay to pretend to know stuff. If you don't know something, or don't understand something, ASK!


7. Ask questions


8. Ask questions


9. Don't lie


10. Don't lie.


11. History is usually more important than physical exam


12. Don't order a test unless you have a good reason to order that test. Ask yourself why you are ordering a test. Chances are, if it isn't going to change your management, you don't need it. A good history and physical exam are, in many specialties, more important than any tests. Tests are just tools. You job is to develop clinical acumen and make your own decisions using tools to assist and inform.


13. Get an EKG book you like and read it. Then read it again. (I like Malcom Thaler's The Only EKG Book You Will Ever Need.)


14. Read every EKG you can get your hands on. Never miss an opportunity!


15. Start developing and practicing your approach to plain film xrays. Chest xrays and abdo xrays are common and chest xrays can be very high yield. Like EKGs, you should read every xray you can get your hands on.


16. Take responsibility for your patients. As a student/clerk you will have residents and staff making the final calls so it can be easy to not be thorough. But soon enough you will be making those calls so you'd better get used to thinking that way.


17. Sleep well.


18. Eat healthy.


19. Exercise.


20. Take ACLS


21. Be enthusiastic


22. Your job is to do your job.


23. Occam's razor


24. Residency makes a physician, working on the job makes a PA. One of the disadvantages of being a PA is that once you graduate school and start work you will not be exposed to the breadth that a resident physician gets. The corollary to this is that the advantage you have as a new-grad PA is that you get to develop your depth within your specialty a lot faster.


The stuff you learn as a PA student is really just the foundational basics. Once in practice, you will find you don't know squat and will hopefully respond to this realization by reading like crazy around your cases. Then, after a few years, you will still feel like you don't know squat.


25. Be afraid of what you don't know. The problem with what you don't know is that you don't know that you don't know it.


26. As soon as you feel certain about something, you should question yourself. The hair on the back of your neck should stand-up and you should think "hey! what am I missing here?"


27. Don't forget to have fun and have a life


28. Be kind to nurses, they will save your ass and make your life easier or harder depending on how you treat them.


29. Be kind to your patients and their loved ones, even when they are annoying you. It can really suck to be in their position, act appropriately.


30. Be an ambassador for the PA profession; it is fairly new in civilian Canada.

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