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PANRE and PANCE Prep: Test Taking and Critical Clinical Thinking

by Stephen · 0 comments

From the official Physician Assistant Certification and Recertification Exam Review Course. Upon Completion you should be able to:

  1. Describe the PANCE and PANRE “Item Blueprint”.
  2. Compare and contrast ”Norm-referenced” and “Criterion-referenced” examinations.
  3. Discuss “Passing Thresholds”.
  4. Discuss “computer-based” testing (CBT).
  5. List and describe common test-taking skills
    1. Familiarity with question formats
    2. Critical reading of questions and answers
    3. Answering questions in a timed environment
  6.  List and describe common test-wiseness skills
    1. Time-management techniques
    2. Error-avoidance techniques
    3. Deductive-reasoning skills
  7.  List and discuss methods to optimize “guessing” on standardized tests.
  8. . Describe methods to:
    1.  Select textbooks and study aids
    2. Improve one’s memory and enhance recall
    3. Create student-generated, focused learning guides

Physician Assistant Clinicals: Day One!

by Stephen · 0 comments

I came across this video on YouTube and I thought it was great. Oh how I remember those first day’s and many an awkward elevator. Hemorrhoids and all!

PANRE and PANCE Review: EKG

by Stephen · 0 comments

From the official Physician Assistant Certification and Recertification Exam Review Course. Electrocardiogram/EKG review by the amazing Carol Sadley, Med PA-C. Check out the complete collection of PANRE and PANCE review material HERE.

Suggested Review Books

Healthcare and the Hunger Games

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Tributes and Patients

In Suzanne Collins wonderful series we are presented with a grim depiction of a future world.

A world in which people are selected randomly to become participants in a game:

A Hunger Game

One in which 24 people must fight to the death.  Set in an exotic arena with the goal of using “augmented natural selection” to crown a lone survivor.

In the book these randomly selected participants become “tributes”. They are reminders of a society that existed 75 years ago when the poor and downtrodden took a stand against “The Capital”.  A cautionary tale of those trapped between the hardship of war, starvation and grave inequality.

Thirteen districts represent different levels, divided into casts and only those in the capital have access to a higher standard of living.  A standard sustained by the industrial products of the working poor.

The Right to Survive

The most basic human right – the right so survive is trampled upon in an age of great affluence.

It reasons that the matter should be considered the most pressing of our times.

It’s not much of a stretch to argue that anyone who wishes to be considered humane has ample cause to consider what it means to be sick and poor in the era of globalization and scientific advancement.

Yet in the United States, in this most modern, “Christian”, globalized society we have built an arena.  A capital composed of a greedy minority, one that seems content to draw names from a hat and watch with apathy as the most vulnerable are sent to their premature deaths.

Those in the capital, separated from the districts are for the most part unaware of the conditions that exist beyond their heavily gated community.  Ignorance seems a reasonable explanation, but it should not be forgiven in lieu of a growing acceptance of the Hunger Games.

Building the Arena

Increasingly I am seeing corporations create workarounds to limit healthcare for their employees. Dole Foods for example a well-known fortune 500 company with 2010 revenues of $6.9 billion is “the world’s largest producer and marketer of high-quality fresh fruit and fresh vegetables”.  Operating in more than 90 countries employs an average of 36,000 full-time regular employees, and 23,000 full-time seasonal or temporary employees worldwide.

They have recently implemented a monthly renewable healthcare policy for their employees, a policy that requires all employees to work the first day of the month to qualify for coverage for that month. Since the implementation of this policy just two months ago I have watched 6 patients of mine lose their healthcare coverage while on disability for a medical illness. Yes, they lost their medical insurance when they needed it the most, all poor, all without viable alternatives.

And this is just the beginning.

Patients as Tributes

We create tributes as the minority of great affluence tolerates a system that would withdrawal medical coverage while fighting a battle with breast cancer, deny the elderly much needed healthcare at a stage in life when it is needed the most, refuse treatment without an appropriate copay or identification card, charge four months wage for an emergency room visit.

We trample upon the most basic of human rights.

We create tributes in a “healthcare games”.

The fact that the arena exists is testament that as Americans we have “retained a silence closely resembling stupidity”.  We speak of democracy, but it is a lazy democracy.

It always starts with small injustices that once accepted creep into society. During times of recession these injustices are easier to tolerate, there is a line of unemployed eager to take the job of every Dole employee, and a corporation who obviously cares very little about their employees.

As I mentioned before the most basic human right – the right so survive is trampled in an age of great affluence.

It is easy for corporate America to turn a blind eye, but it is in my humble opinion that we as healthcare providers should be held to a higher standard.

The Globalization of Physician Assistant’s

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As of 2007, at least seven countries are in various stages of expansion of PA-like medical workers that function under the supervision of a doctor.

  1. Australia
  2. Canada
  3. England
  4. the Netherlands
  5. Scotland
  6. South Africa
  7. Taiwan

With the exception of Taiwan and South Africa, these countries have American-trained PAs working as expatriates, and most are developing educational programs that produce a health care provider functioning as an addition to the doctor.

Each country has made its PA a distinct entity, with cultural and educational influences shaping their roles. Common denominators of these PAs are: they function as semi-autonomous clinicians under the direct supervision of a doctor and have roles that tend to complement those of the doctor.

Historical observations suggest the development of the PA profession in different countries tends to follow a similar path and that lessons learned from these nations may be useful in further expansion of the profession.

Those countries mentioned above are just some of the countries that have recently recognized the progress of PAs and have developed their own PA programs. Yet, assistants to doctors and prototypes of PAs are not new.

Eastern European countries such as Russia and the Ukraine; Asian countries such as China and Malaysia; much of Oceania (eg, Australia, New Guinea, Micronesia, Melanesia, and Polynesia); as well as parts of Africa and South America have employed medical aides for decades.

Even in the United States, the Alaskan Community Health Aides project, inaugurated during World War II and continuing today, produces what can be referred to as prototype PAs.

Common Denominators

Excluding the Netherlands, every country falls short of the desired 3/1,000 doctor-to-population ratio that is recommended by the World Health Organization (WHO).  All use English in the classroom, although for Taiwan and the Netherlands, English is a secondary language. Table 1 shows the population and doctor-to-population ratios of these countries, as well as those of the United States for comparison.

Canada, Australia, South Africa, and Scotland have remote and/or widely separated and sparse populations. In some countries, the size or dispersal of rural populations present formidable challenges to health care delivery.

Educational Development

Education programs have developed in different ways and by different means in the nations described here. The established PA programs in these countries range from 2 to 3 years in length, with a didactic component followed by a clinical component.


This is just a brief summary of a wonderful article published by the Journal of Physician Assistant Education in 2007. I was undable to find more up to date research about PA’s practicing abroad but hope to work on this more, especially as I am contemplating a 2 year hiatus to Australia. Please see the full article with a breakdown of practice and education requirements in each of the above 7 countries: The Globalization of Physician Assistant’s (PDF).

Judge Not, That Ye Be Not Judged

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by Stephen · 0 comments

As medical providers… actually let me rephrase that, as humans we need to see the beauty in everyone.

We should have no place in our heart for judgement.

We do not know a persons background, we cannot pretend to understand what circumstances they have encountered in their lives that brought them to our clinic, our space, this corner of the universe.

So often we are apt to judge.

We interpret a persons actions as black and white.  But it is never that easy… NEVER!

When we judge we deny a person what they deserve when they come to see us, a space to be understood, a space to be free of society’s preconceived notions.

As health care providers there is no greater gift we have to offer, than freedom from judgement.

When we choose to free ourselves from this burden we will become better practitioners… And better people.

We will have the ability to truly change people’s lives.

Physician Assistant Vs. Physician Associate: A Rose is a Rose!

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Juliet:

“What’s in a name? That which we call a rose by any other name would smell as sweet.”

There is a big debate out there. What is the best term for our profession? Is it Physician Assistant or Physician Associate? Or is it something different all together?

Physician Assistant

Patients are already confused by what we do. Wouldn’t a name change just confuse them even more?

Part of this patient confusion comes from the term assistant.  It assumes (rightfully so) that we are indeed  ”assisting” someone; in this case a doctor.

The term itself would lead one to believe that at some point during their office visit they should have time with the actual physician for whom the PA is assisting.

As a family practice Physician Assistant in a rural setting I usually work alongside other PA’s and Nurse Practitioners.  Now-a-days rarely is there a doctor to be found on site.  And that is OK, there is always someone available by phone if necessary.

In other words I rarely “assist”.

But, this in my opinion is just semantics.  I am proud of what I do as a Physician Assistant and the high quality of service I bring to my patients.

When my patients ask me when I am going to become a doctor, I just smile and explain the millions of reasons why I love my job, why I became a PA and why even if given a free “upgrade” to MD I would never even consider it.

Physician Associate

The term associate is not absent of ambiguity.

Just look at one of the definitions assigned by Wikipedia:

Associate, a person who is in league with the Mafia but is not treated as a full member, e.g. a corrupt official.

Not that there isn’t a bit of a “cool” factor that comes with being likened to the mafia.

I think the big complaint about the term “assistant” is that it comes with a feeling of subservience. In a law firm an associate is a low-level lawyer. The problem with this is that PA’s are not low-level doctors they are something entirely different.

Maybe the main problem is the term Physician

A physician is at the highest level of the medical field. And therefore, the term should be reserved for just that.

For a comparison take a look at variations of the term Nurse:

  • Nurse
  • Nurse Practitioner
  • Certified Nurses Assistant
  • Licensed Vocational Nurse
  • Nurse Midwife
  • Nurse Anesthesiologist

These professional deviation from the term “nurse” are far removed from the original intention.

Here are some other common medical professions:

  • Emergency Medical Technician
  • Medical Assistant
  • Respiratory therapist
  • Psychiatrist
  • Psychologist
  • Radiologists
  • Scrub Tech
  • Surgeon
  • Physical Therapist
  • Occupational Therapist
  • Physician
  • Doctor
  • Dentist
  • Dental Hygienist
  • Nutritionist
  • Social Worker
  • Phlebotomist
  • Pathologist

Here you see many different qualifiers such as: “Therapist”, “Worker”, “Tech”, “Technician” and once again “Assistant”.

Outside of the medical field are other types of professions that exist alongside another “main” profession;  Paralegal comes to mind.

One could make the case then for the term Para-medical instead of Physician Assistant, but this is just too confusing.  Especially giving the closely related term paramedic.

A New Profession:

In all honesty the Physician Assistant of 2012 is a lot different from the PA of 1977.

Part of what has happened is that we are coming to terms with the fact that in order to be a good diagnostician in primary care one does not need to attend medical school and complete a residency.

There is a minimum effective dose for primary care, and that is probably the education of a Physician Assistant.

Of course while working alongside a physician in a surgical role the term assistant is always appropriate.

So maybe what we need then is an entirely new professional designation.

It is not the “Assistant” or “Associate” designation we should be concerned about but the term “Physician”!

Otherwise we will always be playing the same game, creating the same patient confusion and constantly struggling to find our own identity.

But, if you want my personal opinion the term “assistant” and “physician” are forever two star-crossed lovers… In the words of  William Shakespeare:

A Rose By Any Other Name Would Smell As Sweet!

Finding a Physician Assistant Mentor

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Find a Physician Assistant to shadow or sign up to precept: Physician Assistant Shadow Online

When I first contemplated a career as a Physician Assistant I was hard pressed to find one.

I was dying to find a PA and pick their brain. Learn about what they do, possibly shadow for a day.

Every single PA I know would absolutely love to be approached by a potential applicant.

I have never met a PA who does not love to talk about their profession.

In fact every time I hear one of my patients discuss the dream of a career in the medical profession (usually as an MD) I make sure to mention “have you ever thought of going to PA school”.

Many still believe that a Physician Assistant is a stepping stone on a career path to Medical Doctor.

If you are interested in a career as a Physician Assistant finding a mentor is simple:

JUST ASK A PHYSICIAN ASSISTANT

Go to a local clinic, urgent care or hospital. Search online for medical facilities in your region.  Drop me a line on this blog.

When you see the PA-C next to their name, reach out and contact them.

Tell them that you dream of a career as a Phsyician Assitant. Tell them why, let them know that you would like to interview them, learn more about their career and what they do.

I can guarantee that they will be flattered.

This may pave the way for a letter of recommendation in the future. It may help you solidify your career goals, it will help you in your PA school interviews and essays.

So if you are thinking of a career as a Physician Assistant the first step it to reach out and find one. Don’t hesitate, you will be met with big smiles from PA’s who will be happy to take you under their wing and teach you everything they know.

The Future of Physician Assistant Education: Stop Stealing Dreams

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I am reading Seth Godin’s free manifesto titled: Stop Stealing Dreams.

In this manifesto he discusses the history of education in American. How it was tailored to create cogs in an industrial machine rather than the much-needed linchpin’s necessary to drive future innovations.

School has become an industrialized system, working on a huge scale, that has significant byproducts, including the destruction of many of  attitudes and emotions we’d like to build our culture around.

In order to efficiently jam as much testable data into a generation of kids, we push to make those children compliant, competitive zombies.

At times I fear the education of doctors and PA’s has headed in a similar direction.

While attending conferences or reading through required CME I feel we have become cogs in a pharmaceutical machine.

One trick ponies taught to think pill first, everything else a distant second.

If we want to create great PA’s of the future it starts with giving our current generation of students the tools they need to overcome the cognitive dissonance that resonates in today’s medical field.

The one that sees an obese, diabetic patient with hypertension as the perfect candidate for Metformin and a new script for Lipitor. Rather than a perfect case for the intense lifestyle interventions and hard work necessary to actually IMPROVE LONG TERM health.

I am afraid many in today’s generation have allowed themselves to be limited by fear.

Industrial, scaled-up, measurable structure means that fear must be used to keep the masses in line. There’s no other way to get hundreds or thousands of kids to comply, to process that many bodies, en masse, without simultaneous coordination.

A Physician Assistant Education of the Future:

Now students have access to more than just the medical textbooks and the best advertising big Pharm has to offer.

We can break the cycle of  prescriptions and compliance.

With this comes empowerment and better health care for our future patients.

Also, a greater responsibility.

To be advocates for our patients, pioneers of new innovations  that offers integrated approaches to health care solutions.

Not passive observers to a health care industry plagued by misinformation, a pharmaceutical focused approach to patient health at a cost to our patients that is truly non-sustainable.

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To be a Great Physician Assistant Focus on Patient’s Not Numbers

by Stephen · 0 comments

I was in the clinic late last night.

If you looked at my “numbers” you may wonder why.

But nothing bothers me more than converting patients into numbers.

It goes against everything I signed up for when I chose to be a Physician Assistant.

In order to do great work we must generate revenue. This is what keeps our passion and business afloat.

Money and it’s influence on medical decision making will always remain a necessary evil.

Without money there is no clinic. Without money the health care we want to provide for our patients can never be a reality. Without money we cannot afford to serve those that we aim to help, who in fact may or may not have money.

So then the gold standard for which we all strive is being able to generate a healthy revenue stream and still run a compassionate, patient-centered practice.

This is a tough balancing act… One that requires constant vigilance.

It requires vigilance because as a business starts to make money it is increasingly easy to obsess about this money and start to focus on the revenue stream.

It is easy to lose focus on what generated this profit  in the first place:

A genuine concern for the consumer and their needs. You know the people who drive your business.

I have found myself falling into this trap at times.  And every time I do I see my business suffer. The numbers of course start to rise at first and it is easy to belive that this is happening because of my efforts to focus on more revenue.

But, I think most of the time it is just a carry over from the previous period… You know the time when I was focused on my consumers.

The patients not the numbers!

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