“I’m keeping a vision in my head of donning a short white coat and diving head first into PA school.” That’s a quote from a blog I wrote in June of 2020, two weeks into my pre-med post-bac at Jefferson. I described that process as “Furiously trying to outrun a hungry lion, or trying to out-swim a tidal wave, and I am just barely staying ahead.” Just three years ago I was wrestling with general chemistry. And now in October of 2023, I’m about to finish my sixth week of PA School.
I’ve had 8 exams, seen 2 standardized patients, rotated in 1 ER, presented 1 patient to an attending (and messed it up badly), learned how to scrub into surgery, and can draw the brachial plexus from memory. I can tell you that A Fib. is irregularly irregular, show you how to flex your digitorum profundus, and ask you 2 questions from 14 different body systems. I can probably palpate your brachial pulse and definitely not palpate your popliteal pulse. I can also, with zero hesitation, tell you if you have infective endocarditis.
PA School so far is… kinda fun? I wore pajamas to school yesterday and drank water out of a Prego jar today (it’s Spirit Week). I mean, it’s definitely a lot of work and I know it’s going to get worse, but I’m not miserable. It sort of feels like I’ve been dropped onto another planet. It’s really sort of hard to explain. School and my life have become a single entity, and I don’t mean that in an unhealthy way. I’m a student again… and you really have to lean into that lifestyle. I feel very fortunate and lucky not to have to wake up and go to a 9-5 job every day. I’m in a 2 year break from the real world.
I realize that every hour of my day is valuable and I need to be very purposeful with how I spend my time. If you’re curious as to what six weeks of PA school look like, I’ve been keeping track.
Here’s my current process (so I can look back a year from now and compare). I wake up every morning at 5AM, and try to do the same on weekends. To help wake up in the morning, I created seven 3-song playlists that go off every morning at 4:55. Waking up to pop-punk music beats the hell out of an iPhone alarm. I go to sleep by 10PM every night. I am absolutely committed to sticking to that sleep schedule as long as possible. They told us that on average, students spend 4-5 hours a night studying. I don’t think that’s sustainable at all. I’m done class by 5PM at the latest (earlier some days) and I schedule myself “flex time” from 5-7PM. I use this time to run errands, drive home, take my dog for a walk, check up on social media, cook, eat dinner, and watch an episode of Parks & Rec. If I feel like I’m behind on studying, I will cut into that time a bit. I try to get some very focused studying done between 7-9PM every night, and rarely do I make it past 8:30 PM. If I’m struggling at night, hopping on a call with another student or two does wonders for keeping me engaged and motivated. I then try to do another hour or so in the morning before class starts and usually study during lunch. I take every Friday night off. I couldn’t study if I wanted to because I have zero energy left by the end of the week.
So what is studying? Studying for me right now revolves almost entirely around Anki which I started using the first week of school. The rumors about Anki are true, it’s incredibly powerful and super fun. I have an addon that makes studying seem like I’m playing Halo 3, awarding me medals for strings of questions I get correct in a row. And now I’ve connected a Nintendo Switch controller to my Mac to control my flash cards; I can even AirPlay to my TV. I’ve turned studying into as close to a video game as possible… and I actually look forward to studying. Anki makes studying incredibly organized and time efficient. It’s not just flash cards, it’s an entire study management system. And anything that can do even a fraction of thinking for you is a godsend.
I generate my flashcards in class. I read that taking notes in class isn’t super effective. So I figure I have two options. I can either pre-study and outline the slides and make flash cards and then go to class and fully engage in the lecture, or I can use the time in lecture to make flashcards in real time. The former is probably better, but I just can’t seem to find the time to do it. Plus, I don’t know how far we are going to get in lecture, and I don’t have the personalized touch of a professor to clue me into important concepts.
I study mostly alone, but mix it up with other classmates and small groups very often. I think it’s absolutely necessary to study with other people; it’s like crowdsourcing and very synergistic. You bring what you studied solo to the table, and then you bring home what you grabbed from the group. Often, other students will bring up the most obscure detail from one bullet point at the bottom of a slide… and without fail that’s usually an exam question. You have to find those people that have a knack for sorting through the hundreds of slides for what’s likely to be on the test. Once you find those people, hold onto them for dear life. Now, don’t get me wrong, group studying has downsides. Sometimes, actually very often, I find myself in a group and it seems that everyone is way ahead of me. That’s not necessarily a bad thing; just ask them to teach you. It’s infinitely more valuable to know what you don’t know, as overwhelming as that might be. Take that knowledge with you and then keep working on the concepts.
Reviewing 400+ PowerPoint slides is like sifting through mud, rocks, and dirt looking for anything of value. Is this important? Is this something? Should I hold onto this? I definitely don’t need this; they’ll never ask about that (oops). You simply can’t memorize everything. It’s just not feasible. They also can’t ask questions on everything. So you have to flip some coins and hedge your bets. The benefit of group studying is that you grind away and sort through your pile and then you review that with everybody else. And sometimes you have nothing but a bucket of dirt and an old shoe, and they have a truck full of gold. The magic is that everybody filters information differently. But now instead of just using what you went through for 10 hours, you’re adding 40 hours of work from 4 other students who went through the same information and picked up insights you thought were unimportant. And if 3/4 of them all picked up on something that you missed, there’s a good chance it’s going to be tested. And for this reason, it’s important to crowdsource your studying; it’s free real estate.
For one of my exams, I did start StoryNoting which I’ve found helpful so far (this is a concept where you type out notes in a very matter of fact way, like a stream of consciousness, in a way that’s meant to be read by someone else). It makes the flashcards have some more life and context and I find my mind navigating to the tables and charts I’ve made when I’m recalling information.
I’ve discovered something else that works incredibly well for studying. I call it a Matrix. Okay, it’s really not that impressive because it’s just Insert > Table in Google Docs. It utilizes spatial memory to recall information. I was trying to remember a detail about Atrial Septal Defects and remembered it was the first / far left column on the table I had made which helped me remember. One I made was for nine different secondary causes of headaches. And I found that what was even more powerful was including images and memes along with words. Okay, Archer (tinnitus) was next to the meme about bright lights. And I knew the middle of the Matrix was Pseudotumor Cerebri. There’s a certain safety to think of a specific location where you left some information, and then visit it in your head to retrieve it. It’s much less chaotic than just searching your brain at random for what the heck Lidocaine does for dysrhythmias. A Matrix is somewhere between just jotting down notes and a Memory Palace. It works.
The Matrices I have been making have expanded and I’ve been sharing them with other students. I’ve had multiple mention to me that they’ve been useful. It’s unreal how much that inspires me to keep pushing. You mean I can study, make silly mnemonics and charts and help other people? Whoa.
I think when you make content meant for other students, you find yourself presenting the information in a simple way. That’s a big part of the Feynman Technique. And to present something simply, you have to have a more complex understanding of it.
Do you know the most successful therapy for chronic venous insufficiency? It’s laser therapy. An exam I took just hours ago asked me that exact question. Do you want to know how I remembered it? I included a meme of Dr. Evil from Austin Powers talking about lasers in the table I made. I had the dumbest smirk on my face when I saw that question. It’s so stupid but it works so well.
I have used a few Memory Palaces so far. I made one for the 14 systems for a Review of Systems (I used the layout of my Planet Fitness) and another for the 5 major / 5 minor Duke criteria for Infective Endocarditis (I used my Aunt and Uncle’s lawn and house). Putting a clock on a tree that rang every 12 hours to signify persistently positive blood cultures got me another exam question this morning.
I also have plenty of acronym and acrostic mnemonics. I think the biggest memorization struggle so far are lists. There are so many lists for causes of things and at this point they’re all sort of arbitrary because I don’t know enough to make the lists obvious. Causes of Hypopnea? MAGO. Heart murmurs? PASS. Restrictive Cardiomyopathy? SSS. Kussmaul Respirations? DUMP. Brachial Plexus? MARMU. In my Room I do ARMS on TueSday (Rheumatic Fever causes Aortic Regurgitation, and Mitral/Tricuspid Stenosis). Causes of Apneustic Respirations? Red (stroke), White (brain damage [like white matter]), and Blue (hypoxia). Causes of Barrel Chest? PESCA (like shooting fish in a barrel).
And do you know what I don’t remember? Most things that I don’t have some type of mnemonic for. Do you know what I do remember? That Claud and Ray Migrate to get Burgers (triad for Buerger’s Disease); Spilled Salt? Please Lick Floor (Class I Antiarrhythmics). Churg-Strauss Syndrome? Strauss AVEnue (Asthma, Vasculitis, Eosinophilia). Can I tell you what Churg-Strauss Syndrome is other than those three things and that it’s an arterial vascular disease? Not really. Does it matter? Probably not. PA School is like jumping out of an airplane with a needle, thread, and an iPad with a 2 hour lecture on how to sew a parachute that you can watch at 2X speed… and you have 5 minutes before you hit the ground. Just survive… somehow.
Just last night I was studying with a small group and we were scratching our heads at the PERC criteria for ruling in/out pulmonary emboli. I suggested a Memory Palace and we made one together to memorize all eight criteria; it took all of 3 minutes. The topic was on the exam, and we all got that question right! I don’t think anyone understands the joy it brings me to share memory techniques with other people and for them to actually work!
PA School feels much different than pre-med studies because I’m finally learning the culmination of what I’ve been studying over the past three years. And not just that, but I’m learning about what I’ve seen in the ER. I honestly can’t stress how impactful my experience in the ER has been, even just six weeks in. The content in class, even though it’s a lot, all makes sense when you figure it all out. And it’s… useful. You go home and you feel proud that you can talk about the muscles in the back and arm now, or that you can talk about medications for hypertension. Everything so far is really logical and just makes sense. And you can use our own body to kind of provide grounding for what’s happening. That’s so much different than anything in pre-med.
If I’m making PA school sound easy, that’s definitely not the case. There have been plenty of struggles. After an exam, discussing questions afterward is a double edged sword. You feel great when your answer matched up with everyone else’s. When your study group developed some harebrained way to remember something and it shows up, or the concept you talked about seconds before the test shows up, it feels great to high-five the crew and build that camaraderie. But when everyone else said A and you said B, you feel stupid and embarrassed. You feel like you’re missing something and you feel like you’re falling behind. It’s not a great feeling and you start comparing yourself to other people. You hear a student explain a concept in such a matter of fact tone and there are times when you don’t even know what they’re talking about. And of course you think, “Wow, is everyone on the same page like that?” “Did people really think that exam was easy?” You start to bend your own truth: “Yea it wasn’t too bad,” when in your head you’re quietly screaming. Or you feel completely spent at the end of the day and overhear some other students who are going to keep studying for a few hours and wonder how they have the energy. Or you go to bed early to keep up on your sleep schedule but you lie awake for a bit thinking that most of the other students are staying up late to study. You feel guilty for taking a night off or taking it easy for a day. It’s a lot to handle and navigate mentally and emotionally. You’re already battling that early imposter syndrome and trying your best to stay confident in your own personal identity.
I think the important thing is to internalize all of this, reflect upon it, and make sure your own actions aren’t making the problem worse for other people. Here’s what I’ve learned. Never say an exam question or concept is easy. Easy is subjective and different for everybody. I think self awareness and humility aren’t just the two most important attributes for a student to have, but the two most important attributes in all of healthcare and probably life in general. If someone said they had trouble with a test question or exam and you thought it was easy, then lie and say you thought it was tricky also. I’m serious; straight up lie to them.
Okay, let me explain. You saying it was easy does two things: it boosts your ego and makes the other person feel like crap. Both of those are bad. So don’t do it. Match their energy and show empathy. Also, objectively, it probably was a tricky question but you just happened to study that concept more. Or you have some prior experience. Or you just grasped that concept better. Be self aware as to why you thought something was easy and how you got there because it wasn’t always easy for you. I think wrapping your head around this phenomenon isn’t too far removed from empathizing with your patients. Are you going through what your patient is going through? No, but you need to pretend like you are and put yourself in their shoes. So at the end of the day, you aren’t lying at all. You’re checking your ego, stepping down from your pedestal, and making a human connection. If you can master that (and I certainly haven’t), I think that’s huge.
I’d say pretty much every day here is a lesson in humility. I’m surrounded by brilliant minds that have been weeded through a wildly competitive and rigorous application process. And there’s not a day that goes by where at some point I feel stupid and inadequate. I’m not trying to be too self-deprecating here, but I think it’s important to address the lows. There are definitely times that I feel smart because I can explain a concept, or I knew an answer in class, or I remembered some obscure detail. But at the end of the day, it’s all sort of arbitrary. So I knew something and got a little hit of dopamine. Who cares?
What I did start doing is elevating other people around me: “Oh, wow, how did he/she know that? That’s awesome. Nice job!” Rather than think: “Shit, why don’t I know this?” Again, this isn’t easy to do but when I can, I pull out the old Uno-Reverse Card and it’s been working wonders for my mental health so far.
So yea, that’s six weeks of PA School in a nutshell. I don’t know how I’ll feel in another six weeks. If I’m being honest, the forecast looks busy and I’m sort of freaked out about it. We’ll see. I’ll see you in the next one.
Oh and P.S. I have my own white coat now! And a track jacket with my name on it. I’m one gray Patagonia fleece away from really being in the thick of it. It’s funny because I’ve been surrounded by white coats for a third of my life and at a certain point they kind of lose their meaning. But being handed my own short white coat… that’s pretty special.