Accepted

Over two years ago, my life was quite stable, but stability can be dangerous. I had a full-time, well-paying job. I was a homeowner. I was engaged, even. I eventually gave up all three of those things. I realized I wasn’t where I wanted to be, at all. I took a huge risk and decided to quit my job and move back in with my parents in order to pursue a career in medicine. I became a full-time post-bac student at Thomas Jefferson University and thus began the two most challenging years of my life.

Today, over two years later, I received a call from the Physician Assistant Program at DeSales University, where I interviewed just 8 days ago, informing me that I had been accepted to the program.

I’m in many ways speechless. I truly feel that I am a strong candidate, but I’ve spent the last 8 days overthinking every aspect of the interview day. Did I sit in the best seat during the group sessions? Did I participate enough during the class observation? Did I participate too much? Did I send enough thank you emails? Should I have written what I wrote during the ethical writing sample? Rest assured, whatever I did and said worked. I feel like my experience over the past 11 years speaks for itself. I am a non-traditional candidate in most definitions of the word and I sincerely think that worked to my benefit.

It’s such a strange feeling. First off, I plan to see if I receive any other interviews at other programs. However, what I’ve seen at DeSales has blown me away. Their pass rates, statistics, facilities, faculty, and everything in between are wonderful. I can truly see myself being a student there. I’m considering moving closer to campus, finally getting the other part of college experience I never got since I commuted for undergrad (with no regrets there, by the way). Returning to school, though, gives me a chance to get the best of both worlds. Just thinking about such a massive life change, going away to grad school, makes me so unbelievably excited about the future. I have 13 months until I would start the program and I know it’s going to absolutely fly by. Unfortunately, all of this joy is underscored by my father’s brain injury. Two months ago, he suffered a cardiac arrest and is currently recovering in rehab. His long-term prognosis is unknown at this time but I am remaining hopeful. I know he would be amazingly proud of me.

Here’s to the future. Here’s to never settling. Here’s to my Mom and Dad and my family for always supporting me (and for allowing me to move back in at the ripe age of 30). Here’s to the wonderful world of healthcare, namely Abington Hospital which has been my home away from home for the better part of 11 years. I’ve learned so much from those within those walls and hope to one day give that all back as a PA. Much more to come. I’ll see you on the other side.

The GRE

So I took the GRE last Friday and scored a 311, 158 in verbal, and a 153 in quant. And according to Google, between a 310-320 is competitive. Phew.

I didn’t study as long or as hard as I would have liked to, but I definitely put a lot of hours in. I started looking at example questions back in October, subscribing to the Kaplan Question of the Day, which I would highly recommend. I also started studying GRE vocabulary in October, building a deck of 177 words (maybe 1 of these was on the GRE!) over the subsequent months. So now I can drop words like auspicious, capricious, and kismet in conversations, ha. They also have short workouts you can do. I started studying more heavily probably 1 month before the exam, purchasing 4 practice tests and the QBank. I ended up only taking 2 practice tests and not using the QBank questions at all. It’s very important to take at least 1 practice exam so you can see how fast-paced the quantitative section is. I was shocked.

Through the questions of the day, I was able to take notes regarding my weak areas. I added to these notes after taking the 2 practice tests, unpacking every question I got wrong, and adding vocab words to my deck. I found Manhattan Prep on YouTube to be very valuable for my weak areas, especially exponents (there was 1 question about exponents on the GRE). The Tested Tutor was also very useful for combinations and probability.

The hardest part about the GRE, besides trying to block out the noise of the 6 students that were surrounding me, constantly fidgeting around for some reason, is your speed during the quantitative section. I probably guessed for 8-10 questions on the section, and it’s only 20 questions long. I simply did not have time to even begin those questions. You need to have an answer, even if it’s a guess, for every single question. Do not let the time clock expire without having an answer for everything. What I did was, the second I saw a question and was either like “Yea, I have zero idea how to even approach this” or “This is going to take more than 2 minutes to complete,” I would guess on it, flag it, and move to the next question. Most of the time, I never had time to even revisit that question. It’s that quick. There were entire quant concepts, like statistics (frequency distributions) that I never even studied. There were also quite a few questions about like, there are integers that start with 1, 3, 4, 7, etc. and increase by n + the preceding digit. What are the chances of getting an odd number if there are 100 integers. I tried to math it out, but just couldn’t get the answer.

The other strategy that was very key for me was outlining the verbal passages. They are exhausting to read. And jotting down an outline helped me out a ton. I also skipped some to knock out the vocab questions and then revisited the passages, finding I could focus better knowing I had completed the rest of the section. I had about 5-10 minutes remaining for each verbal section. For the quant section, I ran out of time on both sections (but was sure to guess on the ones I skipped).

But anyway, I did fine and I’m very happy with my score and incredibly relieved that I don’t have to retake it. I should have scheduled it for February so I had plenty of time to take it a second time, but I got lucky. I have exactly 1 month to CASPA!

How Big is Your Brain (Natriuretic Peptide)?

While shadowing some all-star PAs in the ER, I’ve heard the term/lab value BNP mentioned often in relation to heart failure patients. Let’s see what BNP is all about.

BNP stands for “Brain Natriuretic Peptide” or B-type natriuretic peptide and is also called ventricular natriuretic peptide. What a mouthful. It’s a biochemical marker that can help diagnose heart failure and is measured via the serum or plasma of our blood.

In terms of anatomy and physiology which I’m currently studying, BNP is first mentioned in the endocrine chapter as one of two hormones secreted by cardiac cells (the other is ANP, which stands for atrial natriuretic peptide). Now I know what you’re thinking, if these are both secreted by cardiac cells, why on earth is BNP called “brain natriuretic peptide.” Because… reasons: it was initially found in brain tissue of pigs and the name stuck. 

ANP is secreted by cells in the wall of the right atrium, and BNP the ventricles (mainly the left). ANP responds to blood volume and pressure and BNP responds to stretching/tension.

The word natrium (Latin) refers to sodium, -ouresis means urination, and peptide is a protein. This hints that BNP probably increases the expelling of salt in our urine, meaning a fluid loss, meaning an eventual blood volume loss and loss in blood pressure. Natriuresis literally means the excretion of salt in the urine. What triggers the release of BNP is the abnormal stretching of the heart walls. So if our heart is being stretched abnormally, something is wrong, right? Either there is too much pressure or blood, or the heart is weakened and not pumping blood effectively, which is where heart failure comes in. And if the heart is weakened, then pressure and volume will increase as it struggles to keep up. Makes sense.

Remember that heart failure can cause respiratory symptoms, distress even. If there is a problem with the heart, then either too much or not enough blood is going to enter the lungs. If there’s not enough, then proper gas exchange isn’t going to occur and our body will be starved of oxygen, causing us to breathe faster. Fluid build up can also enter the alveoli causing respiratory problems.

Effects

We learn more about ANP and BNP in the blood vessels and circulation chapter of A&P where we learn their effects:

  1. Increase sodium ion excretion by the kidneys. 

  2. Promote water loss by increasing urine volume.

  3. Reduce thirst.

  4. Block the release of ADH, aldosterone, epinephrine, and norepinephrine.

  5. Stimulate peripheral vasodilation.

Yea, so they don’t mess around. Once these five things reduce blood volume and pressure (therefore restoring homeostasis), the natriuretic peptides stop being excreted by our cardiac cells because they’ve done their job. That’s a negative feedback loop.

Let’s talk a little bit about #4 because we just mentioned four other hormones. 

  • ADH, the antidiuretic hormone, is secreted by the posterior pituitary (which also secretes oxytocin). Its function is in its name; it prevents uresis, or urination. In other words, it retains fluids. This is the hormone inhibited by alcohol, which is why we urinate when we imbibe. BNP does the same thing (except for making us drunk); it makes us urinate. BNP is blocking the release of ADH.

  • Aldosterone is secreted by the adrenal cortex of the adrenal gland. I like to think that it keeps “al dos” salts. And salt retention = fluid retention. Aldosterone is involved in the renin-angiotensin-aldosterone system (RAAS). BNP is blocking the release of aldosterone.

  • So what about epinephrine and norepinephrine? Well norepinephrine and epinephrine are vasopressors, which raise blood pressure. BNP is blocking those too.

Heart Failure & Shortness of Breath

When I was studying for the NREMT, I made the following note about heart failure:

LEFT-SIDED HEART FAILURE is associated with pulmonary edema and leads to shortness of breath because as blood is returning via the pulmonary veins to the left atrium and then left ventricle, the ventricle can’t pump out as much and there is fluid build-up in the lungs. Pink and frothy sputum found here. THINK L AND LEFT FOR LUNGS AND LYING DOWN! You will see respiratory issues like shortness of breath. The patient worsens when they lie down and worsens when they exert themselves because they can’t breathe adequately.

“An accurate and rapid diagnosis is crucial for the diagnosis of patients who present to the emergency room or outpatient examination room with acute respiratory distress.” (Yoo, 2014). So respiratory distress is a major symptom of heart failure. There we go.

Questions

  1. What about other sources of high blood pressure? Wouldn’t that trigger BNP? Can’t you have HBP but not heart failure?

  2. Aren’t BNPs block of epinephrine and norepinephrine counterproductive towards making the heart stronger? Don’t these make the heart, that is already struggling, weaker?

  3. If BNP is a protein and water-soluble, can it be detected in the urine?

    The data suggest that urine BNP is a new candidate marker for diagnosis and prognosis of HF mortality and cardiac events. This raises the possibility of using this relatively simple noninvasive test in primary care settings or in specific conditions where the collection of blood samples could be difficult. Source.

  4. Could high salt levels in the urine also point to heart failure?

Sources

Cortés R, Rivera M, Salvador A, García de Burgos F, Bertomeu V, Roselló-Lletí E, Martínez-Dolz L, Payá R, Almenar L, Portolés M. Urinary B-type natriuretic peptide levels in the diagnosis and prognosis of heart failure. J Card Fail. 2007 Sep;13(7):549-55. doi: 10.1016/j.cardfail.2007.04.007. PMID: 17826645. https://pubmed.ncbi.nlm.nih.gov/17826645/

Martini F, Nath J, Bartholomew E. Fundamentals of Anatomy & Physiology. 2018. Eleventh Edition. Pearson Education. 

Yoo BS. Clinical Significance of B-type Natriuretic Peptide in Heart Failure. J Lifestyle Med. 2014;4(1):34-38. doi:10.15280/jlm.2014.4.1.34 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390764/

An Update: Six Months to CASPA

So it’s been a while since I’ve written a post, six months actually, so here goes. Since I finished up P4 and the JeffSTAT EMT program, I’ve since finished A&P I&II, psychology, statistics, and started a new job as a Patient Care Tech in the Abington - Jefferson Health emergency trauma center. I have 398 patient care hours and 120 volunteer hours. I’ve completed 11 EMT shifts and have seen 35 patients as a volunteer EMT. In the month of September, I picked up 168 patient care hours and I’m on target to hit 156 in October. With the remaining six months until the end of April when CASPA opens, I will pick up an additional 936 hours + a few here and there from EMT. I should have just south of 1500 which I’ll be very proud of. If I can pick up a few extra shifts and keep up with EMT I’m sure I can hit that 1500 mark.

An interesting thing that I’m doing is that I feel like I have a lot more learning to do from A&P than I got from the course. It’s a very dense subject. So what I’ve decided to do is keep working at the class even after it’s been finished. I’m StoryNoting (a term I coined myself where you slowly and exhaustively read, outline, and reference a textbook) the entire textbook. I have a 183 page Google doc of A&P and it’s probably one of my most treasured academic achievements. So every week I try and knock out another section or chapter. My goal is to truly have a strong and comprehensive A&P background before PA school. The other thing I’m doing is adding to a pharmacology Quizlet set with medications I hear about or see on EMT shifts or at the hospital. I want to have a basic pharmacology background as well.

I did decide that I want to take the GRE. After playing around with some practice questions, I found it to be challenging, yet familiar, easy, and sort of fun. A lot of the questions are like riddles which I love. Applying to Arcadia and Salus will be great additions to my applications. The other things on my list in the next six months are to pick up some more community service-focused volunteer hours, and shadow some PAs. I also want to make sure though that I take some personal time and relax over this winter break. Then come January I’ll take my last pre-req class for PA school, microbiology. I can’t believe I’ll have been taking pre-reqs for two entire years; the great thing is that they are all through Jefferson so I’ll have just a single transcript. Once my applications are in, I’ll be in a very interesting spot in life. The hustle stops. I won’t be taking any classes for the first time in two years. I’ll be able to truly breathe. I won’t need to volunteer anymore either. It’ll just be me and work, a few wedding shoots, and seeing where I get interviews. April 2022 - April 2023, when I’d be starting school at the earliest, will be the time in my life to live it up and hopefully do some traveling.

I also recently had to make a tremendously difficult personal decision in my life, the hardest decision I’ve ever had to make. I’ve been trying to do a lot of personal reflection and realized I have a lot of work I still need to do on myself, a lot of growing and maturing to do, even at the age of 32. I’ve also been thinking a lot about work-life balance and how much a toll my pre-PA journey has taken on my life and my relationships. It makes me worried about PA school, but I’m trying to go in with a level of self-awareness at what is and isn’t possible from a work-life balance perspective. You can’t do it all and this career path definitely requires sacrifices. I’m trying to stay optimistic and find new life after tragedy. I’m considering casting a wider net and applying to schools out of state, maybe even some across the country. Why not?

Well that’s about it for now. I have two concerts I’m going to solo in the next few weeks, Charmer, and Hot Mulligan, two of my favorite bands. This time two years ago I went on a solo concert spree, seeing The Starting Line / Oso Oso, The Menzingers, and Jimmy Eat World. It’s interesting how life repeats itself.

P4... It's Finished

If you’re a prospective or current P4 student, you can view my survival guide here.


So there it is. Just minutes ago I submitted my final assignment of Thomas Jefferson University’s Postbaccalaureate Pre-Professional Program. It’s over. It’s done. As has been my custom for three semesters now, I listen to Explosions In The Sky’s “With Tired Eyes, Tired Minds, Tired Souls, We Slept” the night of the end of the semester, which is what I’m listening to as I write this.

Where to even begin? What a strange feeling. And this all comes just one day after I passed the NREMT psychomotor exam, which is by far my greatest accomplishment this semester. But back to P4. Just looking around my desk a year later, I’m in a different house, I have a different computer, the remnants of my first semester still lie about my parent’s basement, which has been my “lab” for most of this year. The seven functional groups sit above me, from hydroxyl to carboxyl, to methyl, names that were foreign to me in Bio I and became like a primary language in Orgo. Large post-it notes are still on the walls, detailing cell communication, the citric acid cycle, and more. And my trusty iPad, my greatest technological tool this entire year is lying right in front of me, having been the canvas to everything I’ve written and drawn this year. Of course my iPad is also where I recorded countless videos that now populate my YouTube channel, which became a stream of consciousness of what I was learning. It’s incredible to look back at the first general chemistry videos that I made. P4 has been one of the wildest rides of my entire life. And I can’t believe it’s over. When it began, I wanted to quit so bad. It was one of the most difficult experiences of my life, getting over the learning curve and shaking off the dust that comes with being a career changer student. Change isn’t easy. But here I am, now with the ability to take on a chapter of entirely new information, make it my own, invent mnemonics, make connections… and learn.

I don’t honestly know what PA School is really going to be like. Learning is such a funny thing. What am I really going to remember about the last 12 months? What truly did enter into my long-term memory? I’m just so incredibly relieved for the bulk of my pre-reqs to be OVER. The grunt work, the grind, to even have half of a PA application is done. I’ve officially brushed up on my sciences.

So what’s next? Well, I’m one NREMT exam away from being a licensed EMT-B. That’s WILD. I didn’t anticipate picking that up this year. My plan is to volunteer as an EMT this summer to both sharpen my skills, but also pick up volunteer hours. Then my plan is to return to the birthplace of my healthcare career, Abington Memorial Hospital, now Abington-Jefferson Health, as a Clinical Associate in the Emergency Trauma Center. That’s where I plan to pick up 1500 patient contact hours. And then, just four weeks from now I start my next class, Anatomy & Physiology which I’ll complete over the summer. So yea, it’s going to be a busy summer. The fall will bring microbiology with the spring bringing statistics and psychology, my final two pre-reqs. That will complete two entire calendar years of nothing but preparation just to apply to school. And you know? That’s fine. My goal is to become a great Physician Assistant Student. That is the goal. I don’t want to get ahead of myself. I plan to apply to: Jefferson Center City, Jefferson East Falls, USciences, PCOM, Drexel, West Chester, and Rutgers. That’s 7 schools, all within driving distance, and all without requiring the GRE! If I somehow find the extra energy and take the GRE, I unlock Arcadia, Salus & Temple. And applications are going to open for my cycle in April of 2022. I have 365 days to prepare my application for Physician Assistant School. Whoa. Applications are open until like January of 2023 though, and then interviews. I wouldn’t start until either pre-fall or fall of 2023. So I am still 2 or more years away from even starting school. But that’s okay with me because I’m on a path and a journey and I am loving every second of it.

So thank you P4. Thank you Dr. Barrows, Dr. Belani, Dr. Jensen, and most importantly Drs. Heine and Byrne. You’ve all shaped me from a business student into a STEM student. And thank you to all of my P4 friends; we were able to make a connection online in the middle of a pandemic. That’s incredible. We’re all moving onto bigger and better things.

Roll the credits. I’ll see you in the next one.

On Organic Chemistry

So, days after my last blog post, something happened. Organic chemistry became organic chemistry. A workload unlike anything academically I’ve ever encountered unleashed itself on me like an unstoppable force. My life suddenly became organic chemistry; I spent 5 days straight, 8-12 hours a day doing nothing but organic chemistry, and still got 25% of the exam questions wrong. Thanks to the magic of curves, I ended up with a 90.

So what even is organic chemistry? If general chemistry is math (because it is), organic chemistry is art (because it is). There’s not one exam in orgo that you need a calculator for (except for maybe some basic division or something). There are no mathematical formulas to remember. It’s true that if you hated gen chem, you could love organic chemistry. If you’re into art, drawing, 3D modeling, legos, photography, anything like that really, there is a great chance that you will enjoy many aspects of organic chemistry.

Anyway, that’s really all I had to say. This semester is an absolute grind but I’m surviving, excelling even. I’m already starting to plan my next steps of the spring into the summer and fall with the end goal of being accepted to PA School.

Onward I go.

I'm Still Here... We're All Still Here (??? Weeks In)

I’m still here! Surviving (thriving?) It’s been a heck of a semester so far. I can’t believe I’m learning organic chemistry and just days away form sinking into the Krebs Cycle in biochemistry. I never thought I’d be here but here I am.

I had a lot of big breakthroughs in terms of studying this semester. Last semester I discovered that recording myself learning / teaching topics increased not only by comprehension but my retention. I adopted a modified version of this and started creating videos with my iPad, drawing out and commentating on concepts. Here is one about memorizing all 20 amino acids. The greatest thing about these videos is that they’re not just for me. I shared some of my videos from last semester with the new students and I am sharing my current videos with my fellow students. A couple of them even told me they memorized the amino acids using my video. So cool!

I also stopped taking handwritten (well with Apple Pencil) notes from lectures. I now take notes on Google Docs. The first benefit I saw here was collaboration (the theme of this semester). The value of sharing information with other students is incredibly useful and rewarding. Also, it’s just easier to input screenshots, pictures, etc. And accessing the files from any device is a bit easier. Also, my handwriting isn’t always the best. I can also revisit notes and build an entire journal from a chapter; I keep adding all the way to the exam.

The other new thing this semester is that I’ve been studying on campus. A lot. And it’s like a 50 minute drive but it is absolutely worth it. Doing a problem on a white board just hits different. And collaborating on a white board in person with other students is simply incredible. The simplicity of returning to something like this after quarantine has made collaboration such a powerful moment.

I’m really starting to start to see the light at the end of the tunnel (though still very far away) of going to physician assistant school and becoming a physician assistant.

This semester has been more difficult when compared to the summer in many ways. But with that difficulty has come a lot more fun. Meeting students for the first time after being online for months is an incredibly unique and rewarding experience.

Five Weeks In

Tomorrow is five weeks in to the P4 program at TJU. And to put it simply, I’m surviving. I did really well on my first Biology exam and I feel incredibly proud of that. Each day I learn more and more about how to study, how to manage my time, and how to make sure I save time for what is most important, my loved ones, my family, and myself. There was a point in this last week where I finally felt ahead. It was amazing. Then I quickly feel behind again. That’s how quickly this program moves. I’m starting to plan two weeks ahead of time so that I can keep rolling with the punches. Chemistry I is over next week. An entire undergraduate semester of Chemistry nearly finished. That’s mind blowing.

I can’t end this post without a shout out to the following people:

These wonderful group of people have been my most valuable teachers over the past five weeks. I wouldn’t be surviving if it weren’t for them.

P.S. My laptop died this week which is pretty bad timing. I’m very happy I invested in an iPad Pro which has been an incredible tool this semester.

Two Weeks In

So I’m two weeks in to the post-bac pre-med program at Thomas Jefferson University. I have to be honest; this is unlike anything I’ve ever gone through in my life. This program has so far been the most overwhelming, stressful, frustrating experience of my life. Yet, each day it gets ever so slightly easier.

There is a taste here of the overwhelmed and “on” feeling I had managing the Jefferson Health Hack. That was non stop for weeks. But the stakes here are so. much. higher. I feel like I am furiously trying to outrun a hungry Lion, or trying to out swim a tidal wave, and I am just barely staying ahead. It’s my hope that I can keep increasing that gap.

It’s tough that we are starting this thing as “distanced learning” via online means and Zoom. There’s just so much to do. Homework assignments take 8 hours. I am supposed to remember algebra that I haven’t used since college, even high-school, nearly 15 years ago. Chemistry so far isn’t science; it’s math. So much math. I’m proud of myself though because I’ve all but mastered dimensional analysis (except for some of those density problems) when two weeks ago I had never even heard of dimensional analysis.

During orientation, P4 alumni said this program was hell. They were not joking. Every aspect of my life has now become this program. It’s all I think about. And honestly I think that’s a good thing. Stress can be good; it shows that you care. And I do care. But I have so much riding on this. I am in the process of moving out my own house into my parents basement.

I am trying so hard to rewire my brain and stay positive and realize that spending 2 hours on a single problem is absolutely fine. I am just quickly learning about time management like I have before. I’ve already forged some strong connections with some fellow students which has been so helpful. It’s very easy to feel lonely in this program.

I’m keeping my eye on the prize. I keep thinking about the hundreds of medical and PA students I’ve met and worked with over the years. Even the pre-med students. They all did this. This is so incredibly possible. I know it. I’m keeping a vision in my head of donning a short white coat and diving head first into PA school. And I’m also keeping a vision in my head of one day returning to Abington Hospital, the place I’ve spent so much of my life already, but not as a payroll intern like I was when I first started. I’m envisioning myself returning as a physician assistant, finally able to combine everything I’ve ever learned in my whole life. everything I’ve learned as a patient advocate, as an Innovation communications coordinator, as a UGME manager, and everything in between.

Let’s go.

Flashcards

Flashcards seem to be a popular way to study, but do they really work? Why are they so popular? Let’s take a look.

During my initial research I came across the Leitner system, developed by German science journalist Sebastian Leitner in the 1970s. Basically, it utilizes three boxes and a promotion / demotion system:

The advantage of this method is that the learner can focus on the most difficult flashcards, which remain in the first few groups. The result is, ideally, a reduction in the amount of study time needed.

The Leitner system uses the principle of spaced repetition, which is also used in popular flashcard app Anki. Spaced repetition exploits the psychological spacing effect:

The spacing effect demonstrates that learning is more effective when study sessions are spaced out. This effect shows that more information is encoded into long-term memory by spaced study sessions, also known as spaced presentation, than by "cramming", or massed presentation.

Yet another proponent for the Pomodoro Technique.

I came across a 2017 research article titled Reinventing Flashcards to Increase Student Learning. It cites a bunch of different studies:

In reviewing the efficacy of 10 commonly used studying techniques, Dunlosky and colleagues (2013) identified practice testing (or practice retrieval) and distributed practicing (or spaced practice) as the two most effective techniques. Students can engage in both of these high utility techniques through the use of flashcards (Wissman, Rawson, & Pyc, 2012).

Although flashcards are relatively easy to create and commonly used by college students (Wissman et al., 2012), the effectiveness of student-created flashcards in a classroom is unclear. In an introductory psychology class, Golding et al. (2012) found that students who used flashcards for the first exam scored higher than students who did not. However, the use of flashcards was not beneficial on the second exam, and the effect was only marginal on the third exam. Furthermore, Hartwig and Dunlosky (2012) demonstrated that student-created flashcards use was unrelated to students’ grade point average (GPA). These results suggest that retrieval practice and distribution of practice increases retention of information, but the way in which flashcards are typically used may not be sufficient to be successful in college courses.

Flashcards can facilitate repetitive learning, but repetition is only a superficial level of processing (Brown, Roediger, & McDaniel, 2014). While 82.9% of students in a study indicated they used flashcards to remember vocabulary, no students reported using flashcards to develop deeper understanding of or the application of concepts (Wissman et al., 2012).

The FP strategy begins in the same way as traditional flashcards. Students identify bold-faced terms from the textbook and write them on one side of a notecard. Students write the textbook definition on the other side. Students memorize the definition from the textbook (or the instructor) to increase retention. While most students stop here with traditional flashcards, FP creates deeper levels of learning by having the student perform two more actions. In the next step, students write a definition for the same key term in their own words. Rephrasing the term helps students understand the material that will increase comprehension. Finally, students generate a realistic example of the key term from their own lives that will increase application.

The FP strategy involves one of the most well-known memory-facilitating processes. Remembering is enhanced when the meaning of material is fully processed at the time of encoding (e.g., Craik, 19792002Craik & Lockhart, 1972Paller, Kutas, & Mayes, 1987). For example, students who are asked to create their own explanations of a concept recalled that information better than those who were given explanations passively (Pressley, McDaniel, Turner, Wood, & Ahmad, 1987). Furthermore, information processed in relation to one’s self results in particularly strong recall (Klein & Loftus, 1988Rogers, Kuiper, & Kirker, 1977).

I really like the sound of this method. Fashion your usual flashcard, but create your own explanation, and then relate it to something in your life. It’s expanding using flashcards to “learn” on a surface level and drives a deeper understanding. I imagine this method coupled with Pomodoro might pack quite a one-two-punch.

Note Taking: To Write or Type?

I remember the days in grade school science class. We’d have “notes” days. An entire hour or so of just copying down information from transparencies. I remember the pain in my right hand as I struggled to keep up with the faster writers. Pages and pages and pages of notes; it was just arbitrary labor. Looking back, I can’t believe our teachers got away with this lackadaisical method of “teaching.” What a vapid and boring way to present information. This makes me thing of modern day note taking: typing into a laptop or tablet. I’m sure students still hand write notes. So I’m interested: what’s the best way to write notes? Are notes even a valuable way to collect and retain information? Let’s take a look.

Here’s Jennifer Gonzales, writing for Cult of Pedagogy (2018):

Whether it’s taking notes from lectures (Kiewra, 2002) or from reading (Rahmani & Sadeghi, 2011; Chang & Ku, 2014), note-taking has been shown to improve student learning. In other words, if we want our students to remember more of what they learn in our classes, it’s better to have them take notes than it is to not have them take notes.

The thinking behind this is that note-taking requires effort. Rather than passively taking information in, the act of encoding the information into words or pictures forms new pathways in the brain, which stores it more firmly in long-term memory. On top of that, having the information stored in a new place gives students the opportunity to revisit it later and reinforce the learning that happened the first time around.

Compared with writing alone, adding drawings to notes to represent concepts, terms, and relationships has a significant effect on memory and learning (Wammes, Meade, & Fernandes, 2016).

The growing popularity of sketchnoting in recent years suggests that teachers are well on their way to taking advantage of this research.

I’ve been using an iPad Pro and Apple Pencil to take notes in an emergency room for the past year. Although not an academic setting, it’s made capturing information so much more fun, engaging, and streamlined. Jennifer’s thoughts feed my interest of picking one up to aid in my studies.

Finally, if students collaborate on this revision with partners, they record even more complete notes and score higher on post-tests (Luo, Kiewra, & Samuelson, 2016).

With this in mind, it would be a good idea to plan breaks in lectures, videos, or independent reading periods to allow students to look over, add to, and revise their notes, ideally with a partner or small group. This partner work could happen after students have had time to revise their notes alone, or students might be given access to classmates for the duration of the pause.

This fits in with the Pomodoro Technique that I wrote about last week. It’s good to see some proof that collaboration with peers leads to higher scores.

This research confirms what a number of educators suspect about the negative effects of digital devices in the classroom, and some have taken it to mean they should definitely ban laptops from their lectures (Dynarski, 2017). Others argue that prohibiting laptop use robs students of the opportunity to develop metacognitive awareness of their own levels of distraction and make the appropriate adjustments (Holland, 2017).

Because technology is always changing, and because as a species, we are still adjusting to these new formats, I would hesitate to ban laptops from the classroom. Here’s why:

  • Research on this topic is still pretty young: Some researchers have found no significant difference in performance between paper-based and digital note-takers (Artz, Johnson, Robson, & Taengnoi, 2017). My guess is that more research will pile up and get more refined, so we should take a measured approach for the time being.

Metacognitive awareness. I’m going to use that one. Handwriting and sketching notes, even annotating onto already prepared slides on an iPad could be a great hybrid approach to note taking.

I found a summary via Clearvue Health on a 2014 Princeton Study, The Pen Is Mightier Than the Keyboard: Advantages of Longhand Over Laptop Note Taking. I found four years later that an addendum was published with some corrections. Here’s what they initially found:

  • Efficiency (word count): typing (310 ) wins over writing (173 words). No surprises there.

  • Quality (percentage of words copied): typing (12.1%) vs. writing (6.9%). “Notably, researchers did find that word overlap was negatively correlated with performance, meaning that the less overlap a student had, the better they remembered the material.

  • Learning (conceptual recall): typing loses to writing. “When the students were tested to see whether they remembered what they wrote down, students who wrote their notes remembered more than typing.”

  • Exam Performance: writing wins over typing. “When they scored the exams, they found that the students who wrote their notes tended to score better on the exam on both conceptual and factual recall.” *See first bullet below.

After the addendum, here are the corrections:

  • On factual-recall questions, participants performed equally well across conditions. However, on conceptual-application questions, laptop participants performed significantly worse than longhand participants.

  • Participants who took longhand notes and were able to study them performed significantly better than participants in any of the other conditions.

It still remains pretty clear that longhand notes are worthwhile.

If you’re on the fence, consider writing. It’s low tech, it can be ugly for those with terrible handwriting, and it’s pretty slow. But, in the end, you may just end up learning more.

The Ride of a Lifetime - Bob Iger

Recently I finished reading The Ride of a Lifetime, in Disney World, in fact. I was there just days before it shut down due to the coronavirus. The book was incredible. I’ve read just about every book there is that talks about the founding of Pixar, so I was delighted that there was a whole chapter devoted to Pixar. The details surrounding the Lucasfilm and Marvel acquisitions were equally fascinating. Here are some of my favorite passages from the book.

To this day, I wake nearly every morning at four-fifteen, though now I do it for selfish reasons: to have time to think and read and exercise before the demands of the day take over. Those hours aren’t for everyone, but however you find the time, it’s vital to create space in each day to let your thoughts wander beyond your immediate job responsibilities, to turn things over in your kind in a less pressured, more creative way than is possible once the daily triage kicks in. I’ve come to cherish that time alone each morning, and am certain I’d be less productive and less creative in my work if I didn’t also spend those first hours away from the emails and text messages and phone calls that require so much attention as the day goes on. 

Luckily, I’m a morning person. I can appreciate that quiet time each morning that he mentions here. I just wish I could pull it off on a consistent basis.

It was a big job, and a big title, but it wasn’t my life. My life was with Willow and my boys, with my girls back in New York, with my parents and my sister and my friends. All of this strain was ultimately still about a job, and I vowed to myself to try to keep that in perspective. 

This is a huge philosophy of mine and it’s inspiring to see Bob share the same one. I wrote earlier how this philosophy steered me toward PA over physician.

“A few solid pros are more powerful than dozens of cons,” Steve said. “So what should we do next?” Another lesson: Steve was great at weighing all sides of an issue and not allowing negatives to drown out positives, particularly for things he wanted to accomplish. It was a powerful quality of his.

Bob is quoting Steve Jobs here. They are talking about the Disney / Pixar merger. Throughout the book, Bob talks about some pretty intimate details about what it was like working with Steve throughout his career.

There’s a passage from Ed Catmull’s Creativity Inc. that I think pairs nicely:

When I advocate for protecting the new, then, I am using the word somewhat differently. I am saying that when someone hatches an original idea, it may be ungainly and poorly defined, but it is also the opposite of established and entrenched—and that is precisely what is most exciting about it. If, while in this vulnerable state, it is exposed to naysayers who fail to see its potential or lack the patience to let it evolve, it could be destroyed. Part of our job is to protect the new from people who don't understand that in order for greatness to emerge, there must be phases of not-so-greatness.

Here’s more from Iger:

...there’s not much to be gained from putting additional pressure on the people working on it. Projecting your anxiety into your team is counterproductive. It’s subtle but there’s a difference between communications that you share their stress—that you're in it with them—and communicating that you need them to deliver in order to alleviate your stress.

I’ve seen this countless times in my lifetime. Self-awareness is too important to have a manager without any.

All in all, The Ride of a Lifetime is an enlightening read outlining one of the most interesting careers of our lifetime. As far as leader and CEO, and overall human being, Bob Iger gets it right.

Should You Become a Physician Assistant or Doctor?

Delece Smith-Barrow and Ilana Kowarski, reporting for US News:

Jonathan E. Sobel, the current president of the AAPA and the chair of its board of directors, adds that PAs have the option of not only serving as health care providers but also as health care administrators. "In addition to practicing clinically, PAs are increasingly in leadership roles within hospitals and health systems, helping them meet quality metrics and improve care," he wrote in an email.

Something about this resonates with me. As ironic as it would be for me to go the great lengths to becoming a PA, just to end up in the long term back on the business side as an administrator, something about that seems to fit. I think a hybrid approach would suit me well. I don’t just want to practice medicine. I’d like to be a part of some decision making council that affects the work that I do. I enjoy innovation and process improvement.

Dr. Will Kirby – a dermatologist and the chief medical officer for the LaserAway aesthetic dermatology group, which employs many physician assistants – says one advantage of being a PA as opposed to a physician is the freedom to shift between medical specialties as your work-life balance needs change.

"Physician assistants however have much more flexibility when it comes to areas of specialization and a PA who starts out in a kinetic field in his or her early 20s, like emergency medicine for example, may decide that they want to start a family and that a slower-paced, more predictable field suits them better in their early 30s and can transition over to dermatology with very little effort."

Definitely some encouraging words and from a Big Brother alum!

Have You Missed Your Chance to Go to PA School?

Ryanne Coulson, PA-C, writing for Be a Physician Assistant (October, 2018):

Regardless of your age, you're better starting-PA material than you were five years ago. You've gotten better at relating to and interacting with others and have navigated more tricky situations than the younger version of you did.

PA schools care about this. A hot topic in PA education at the moment is how to assess the maturity level of PA school candidates as part of the application process.

The curriculum of PA programs is packed; there's no time to try to teach students how to behave in social situations or how to approach patients on a basic human level.

That last bit might point to the shortcomings of many health profession academic programs. As a patient advocate, I’m often shocked at the way some people talk to patients. I think 75% of empathy and humanity comes from within. You can only teach and refine that other 25%. If you don’t have an innate ability to connect with people, it’s impossible to make that fundamental change. We are who we are.

Some of the best PA students I've ever worked had a winding path to a PA career, and their training experience was heightened because of everything that came before it.

There's unlikely to be 80 students interviewing for your program who are just like you, so being a bit different is an advantage.

But this doesn't happen to new-grad PAs who are a bit older. Patients will automatically assume you've been practicing for a while and know what you are doing.

While that may be a bit scary for the first 6-12 months, it will give you confidence and the freedom to practice without worrying that patients are second-guessing you because you seem "too young" to be doing what you're doing.

If all goes according to plan, I’ll be 34-35 when I’m all finished school. There seems to be many benefits to entering the PA profession in your mid-30s. Patients will assume I know what I’m doing? Hey, I’ll take it.

On Being a PA

Paul Kubin, MS, MFT, PA-C, writing for Inside PA Training, 5 Reasons a Physician Assistant Career is Wrong for You:

Your interest in medicine is more about the science than about caring for patients. Don’t get me wrong – as a PA, you’ll need to know and work with plenty of science.  And PAs aren’t the only medical providers who care about their patients.  But as a PA, your patients are a larger focus.  Your communication with them and your ability to educate and counsel them about their health and treatment are your “magic bullets,” not your specialized knowledge of biochemical pathways or fluid dynamics.

This speaks to me. To be honest, I’m not the biggest fan of science. I wasn’t a science geek in grade school. I didn’t participate in the science fair. Don’t get me wrong: I respect science and can enjoy it. I actually look forward to learning biology and chemistry after having worked in healthcare for nearly ten years. I can finally see the application of it all. My end result though is exactly what Paul is talking about above. I’m all about people. And I’ve always enjoyed teaching; I’m just not knowledgeable enough on many subjects to get the ability to teach often. I’ve always enjoyed translating ideas into layman’s terms. I’ve always felt I’ve done a good job at not assuming any knowledge of an end user. Back when first learned Adobe Photoshop, I created a tutorial aptly titled So Easy a Caveman Can Do It. I had many comments on how easy it was to follow. You can still view it on my Deviant Art page 12 years later.

Stephen Pasquini, PA-C, writing for The Physician Assistant Life:

I honestly believe you can be better at compassion when you are more grounded. Having a life outside of work justifies life, it makes for a happy person which translates to better patient care.

I realized after quite a bit of soul-searching that I never really needed to be a Doctor, but I wanted to feel like one.

If you are on this journey to being a health care provider, just know that life exists beyond MD. It is a beautiful life, and it has fulfilled every single one of my dreams of being an excellent health care provider.

PA is the sweet spot! Where life and medicine meet in the middle.
— Stephen Pasquini, PA-C

Why PA School?

I’ve found myself in two situations in life where a career I’d never thought once about was introduced to me. Around 2010, I joined the Philadelphia Police Explorers, a youth program run by the Philadelphia Police Department, with assistance of the US Army, that taught discipline and hands on training. It was one of the most rewarding and enjoyable years of my life. Unfortunately, I aged out of the program because I joined when I was 20; I often wonder if my career path would have changed had I been allowed to continue. Through the program, we were trained by US Army drill sergeants, Philly police, and PA state police, to name a few. We learned how to conduct traffic stops, investigate and deescalate domestic disputes, handle firearms, how to march and drill, and much more. I had never seen the allure of a career in the military or law enforcement, but that mindset was quickly changed. I found all of it fascinating: marching as a unit, learning how to detain a suspect, entering into a building to find a criminal (actor) who was hiding inside. It was thrilling. The camaraderie, brotherhood, and sisterhood that I had with my fellow cadets was outstanding. I decided not to pursue such a career, but it’s always been in the back of mind even ten years later.

The second was in 2014 when I found myself in charge of the Undergraduate Medical Education (UGME) Program at Abington - Jefferson Health. I managed orientations for hundreds of medical and physician assistant students. Never once in my life had I considered a career in any aspect of medicine but now I was starting to see the appeal. I also worked alongside the Graduate Medical Education (GME) office. We had tons of foreign medical graduates coming to the US for the first time to complete their residencies. It was pretty inspiring to see. There were so many types of people coming through our doors. From the new batch of 50 residents per year to the 40 or so students per month that I was orienting, everyone had a story. They were all different ages. Many were married and had families. Many were older, non-traditional students who were non-science majors in undergrad. To add to this, I also assisted with Abington’s pre-med program. So from a college junior to a fifth year surgery resident, I was seeing the entire medical school journey unfold in front of me. There are medical students I’ve oriented who are now chief residents at the hospital, and others are practicing physicians.

In 2015, a close mentor of mine, one of the internal medicine physicians had said to me, “You know, you would make a great physician.” For the past few years people have been complimenting me on my people and customer service skills. And not just anyone; the former CEO of the hospital told me this in 2018. I’m not trying to sound pompous here; but when people like that compliment you, it’s incredibly meaningful. It’s these skills that landed me a job as a patient advocate in an emergency room. And that’s where I’ve been the past year and a half. I’ve been in hospital rooms. I’ve watched surgeries. I’ve shadowed physicians in the areas of family medicine, OB/GYN & internal medicine, even witnessed an autopsy; never though did one of those experiences make me say “Hey, THIS is what I want to do.” That all changed once I started working in an emergency room.

The camaraderie I found in the ER reminded me of my time in the Police Explorers. There was this way everyone blended into one big team; everyone had each other’s backs. The “always on” atmosphere of the ER is electric. Ever since it opened over 100 years ago, there has been a constant flow of patients. First responders, ambulances, traumas, it was all really exciting. I enjoyed spending time there and getting to know the staff but quickly I realized I wanted more. I wanted to be on the clinical side of things. As a patient advocate, you can only do so much. I realized I wanted to learn how to heal patients directly. The ER employed around 25 physician assistants. I was able to watch closely at how they worked, how they interacted with physicians and nurses. It seemed perfect for what I was looking for. They had ownership for their patients, but they weren’t at the top of of the ladder. They sat at a nice place in the hierarchy which I could appreciate.

I had never even heard of a physician assistant until 2014. It seemed like a pretty sweet gig. Two years of schooling to then have the freedom to go into whichever specialty that would take you. PA just sounded cool. I like interesting jobs that fit into special roles, and that seemed to be exactly what a PA was. It was a little bit mysterious. What exactly do they do?

Then there is the question… why not a physician? People have asked me that. I’ve heard of tales of PA students switching to medical school. I just can’t see myself as a doctor. I think visualization is an important part of life. There’s a certain level of pomp, glamour and stature that comes with being a physician and nothing about that seems appealing to me. Don’t get me wrong, I revere and respect physicians immensely. I often see though how intermingled life and career can become and that’s not something I’m looking for. I want to work to live, not live to work.

I like the idea of being a healer, but something a bit more involved than a nurse. I like the mechanics of making diagnoses and figuring out what is causing a patient’s problems. Waiting for lab results or radiology results to come back to find out what to do next is very exciting. I also like the “generalist / jack of all trades, master of none” dynamic that comes with emergency medicine or primary care. I can’t see myself getting into a specialty. But who knows? Life is full of surprises.

The Pomodoro Technique

My biggest concerns with going back to school are study technique, time management, work ethic, and procrastination. I feel like it’s worth looking into the science of studying; what are the most effective methods? I never thought twice about the efficiency nor effectiveness of studying in undergrad. It’s not often that we stop and think about the tasks we do every day. On numerous occasions I’ve taught my coworkers and managers shortcuts for Microsoft Office applications that would save them hours of time in the long term. So with that said, I’ve been looking into the science of studying.

The first thing I came across is something called the Pomodoro Technique, a time management method developed in the 1980s by Francesco Cirillo. Basically you break your workday into 25-minute chunks with 5-minute breaks in between. Here’s Kat Boogaard, writing for The Muse:

The idea behind the technique is that the timer instills a sense of urgency. Rather than feeling like you have endless time in the workday to get things done and then ultimately squandering those precious work hours on distractions, you know you only have 25 minutes to make as much progress on a task as possible.

Additionally, the forced breaks help to cure that frazzled, burnt-out feeling most of us experience toward the end of the day. It’s impossible to spend hours in front of your computer without even realizing it, as that ticking timer reminds you to get up and take a breather.

At first, working in such small increments felt unnatural. There were quite a few times—especially in the beginning—when I was tempted to ignore the timer and continue working. But, I forced myself to stick to the format.

After some time, the technique started to really gel with me. I was focused and insanely productive during my work time, as I was eager to get as much completed during that 25-minute interval as I could. I didn’t find myself mindlessly scrolling through Facebook or getting sucked in by those pesky clickbait articles. And, as a notorious multi-tasker, I noticed that I was totally zoned in on the one project at hand.

Because I was forced to get up and give myself a rest from staring at my laptop screen, I found that I actually did feel better at the end of each day. Not only did I feel like I had put in an honest day’s work, but I also felt less stressed, blurry-eyed, and cramped up.

It makes sense, right? It’s overwhelming cracking open your laptop with the entire day ahead of you, an amorphous blob of time. When do you start? When do you stop? I like how she was eager to get as much done as possible in that 25 minute stretch. It’s a manageable enough amount of time to not be overwhelming. It looks like a potential pitfall is continuing working when you’re in the zone. I’ve read that it takes a while to get back on track when you are interrupted, but if you are the one doing the interrupting, I suppose that makes a difference? This is definitely something I’m going to try.

Going Back to School in Your 30s is Easier -- and More Rewarding -- Than You Think

Tim Baker, writing for Thrillist (2016):

Unlike the first time around at college, staying home to read a book as an adult inspires neither guilt nor FOMO -- it's actually quite pleasant. This is one of the many advantages of being an older student. It’s actually been shown that more mature students do better in school. Researchers in Canada performed an extensive study of community college students, and their findings suggested that mature college students (those over 25) actually performed better on their final exams (on average six to seven points higher) than their younger counterparts.

This is promising. I remember the older and second career students when I was in undergraduate always being top performers. They were more focused and usually the leaders of any group projects.

One of the great things about heading back to college for a second degree or certificate is that the rewards are immediate and tangible. Your first time around, it’s not always clear what the long-term rewards of  struggling through statistics are. But when you know that the stats you learn may be the way to escape from a less-than-ideal work situation, it’s a lot easier to dedicate yourself to mastering the skills required.

This is something I’ve thought a lot about. When I was 20, I had no idea what I was working towards. I was taking random classes like economics, art history, management information systems, statistics, and microbiology with no clear end goal in mind. I was a business major. What did I need to ace microbiology for? Well, had I known that 10 years later that C in microbiology would affect my chances of getting into a post-bac and PA school, I would have tried a little harder.