“There are two things that people from Philly love: the Birds, and being weirdly aggressive,” Hot Mulligan singer Tades Sanville explained to the sold out crowd from the stage of Philly’s Fillmore. I was in that crowd and felt lucky to be there. The rigors of PA school have made my favorite hobby of attending shows few and far between. Luckily this one fell on a Friday and I wasn’t going to miss it, even with two brutal exams just on the other side of the weekend. Even at 34 there’s almost nowhere I’d rather be than in a pit full of strangers shoving each other as Heart Attack Man plays “Like a Kennedy,” my #1 song this year according to Spotify Wrapped.
PA school is all about sacrifice. I had to miss out on quite a few shows this semester because I’ve been so busy. There’s really not much time for anything else. I took my 23rd exam just this morning, and that doesn’t count 3 quizzes and 5 practicals this semester. Final exams are in a week and a half. So what have the first 100 days of PA school been like? Let’s talk.
Let’s walk through the anatomy of the night before an exam. This morning’s exam was particularly grueling and my head is still spinning. We call the class CMPP; it’s three classes in one, 8 credits altogether of Clinical Medicine, Pharmacology, and Pathophysiology. It’s the bread and butter and meat and potatoes of PA school. This exam was the beefiest to date, clocking in at nine PowerPoints and 580 slides. The content was entirely GI related and relied on my ability to the tell the difference between Alcoholic Fatty Liver Disease, Alcoholic Hepatitis, Acute Liver Failure, Viral Hepatitis (A through E, mind you), Ischemic Hepatitis, Cirrhosis… and the list goes on. And that’s barely a third of the content! I wrote a 67 page study-guide, went through 621 flashcards, listened to Cram the Pance, rewatched lectures, studied alone, studied as a group, AND recorded over two hours of YouTube videos… for one exam!
I think one of the biggest problems with material like this is that you start to forget what goes where. You memorize entire clinical vignettes… but forget the name of the actual disease process. You recite a triad, but forget the name of it, or what it’s even related to. I know you run a Lille score on day 7 to continue treatment… wait but for what? Which one can have an elevated INR? Wait but which one needs an elevated INR to be called this? I had to spend a lot of time with studying just reminding myself what PowerPoint I was even in and what was the name of what I was studying. It’s hard to put a face to the disease processes you’re studying.
This exam was unique for me because I ran out of study time. Usually my study group will set aside at least an entire night to review, but the night before, there were entire presentations some of us hadn’t even looked at yet. I had gone through 7/9 of them (also, “gone through” does not = master), the exam was in 14 hours, and I was still missing nearly 30% of the entire exam’s content. I ended up skipping a two hour class to make up some time.
Then I had a decision to make… do I go home and just grind Anki, or do I do some group study. I decided to do some group study and go over things I was familiar with. I sat down and a few of us just talked through things, one topic at a time. In the back of my head I was thinking “I shouldn’t be reviewing what I already know.” However, the power of group study continues to show it’s strength. When recalling information on the exam, what’s most memorable, time and time again, are the words of a fellow student. There were multiple nuances that I had overlooked as not important, but other students thought they were important and lo and behold, they were exam questions. It happens every time.
PA school is sifting through hundreds of slides of soil and dirt just looking for something that you think might be valuable. Don’t do it alone. Sometimes one student’s weeds are another student’s treasure.
After the group study, I went home, still with two entire slide decks that were foreign to me. So I made a plan: I’d tackle one at night, and the other the next morning, without losing any sleep in between. I’m determined that losing sleep is the most detrimental thing to my academics. I hadn’t lost an hour yet and wasn’t going to start then. Whatever material I didn’t get to, I didn’t get to. It’s not the end of the world. I did have a brief period of panic, but I took a deep breath and kept grinding.
There were two topics in particular: Primary Sclerosing Cholangitis (PSC), and Primary Biliary Cholangitis (PBC) that I needed to tackle. These two were like a master class in compare and contrast. One is more common in men, the other women. One has negative antibodies, the other positive. One has a buzz word histology finding, the other has a buzzword medication. You don’t hear the word Primary Sclerosing Cholangitis every day so just familiarizing myself with the words in front of me was difficult.
So I made a table, what I call a matrix, comparing and contrasting Primary Sclerosing Cholangitis (PSC) and Primary Biliary Cholangitis (PBC). I made PSC blue (more common in men) and PBC pink (more common in women). I put a big 90s 6-line letter “S” on the left. If you’re in my age bracket and have ever held a #2 pencil, you’ve drawn this. I put a big letter “B” that had a woman’s face in it on the right. And then I just dumped everything that had to do with each in their respective columns; it was either left or right, entirely binary. I think there were at least 7 or 8 questions in total on these topics, and I felt confident for every single one. Every time there was a question, the table would appear in my head. And when I read a buzzword like “Ulcerative Colitis” I could just feel that it belonged on the left, because that’s where I last left that information. That’s where it was literally sitting inside of my brain. And I knew the left side was blue, and had a huge S, so the answer was PSC. Then “T cells” came up. And I knew I had left that on the right side. “Ursodiol?” I left a picture of Ursa Major on the right side, so it’s PBC. Of the bajillion topics on this exam, PSC and PBC were what I spent the least time with, yet I felt the most confident with them. And yea, maybe because I reviewed them not long before the exam, I remembered them more, but I recall almost every facet about both now as I edit this blog now days after the exam. Spatial memory has become such a powerful tool for recall.
One of the funny things with this exam was a question regarding Alcoholic Hepatitis. I made a very elaborate mnemonic story set in the Harry Potter Universe: Mad Eye Moody (Maddrey) & Lilly Potter are setting out to help people with alcoholic hepatitis. Mad Eye is like, hey, Billy Rubin needs some Physical Therapy (Maddrey’s Function measures total bilirubin and PT). Then, McGonagall and five of her clean feline friends (PENT-OXI-FYLLINE, like five clean felines = Pentoxifylline (Trental). Lilly is like, I’m going to come back for book 7 (run a Lille score on day 7).
This med, pentoxifylline, had never been mentioned before, so it had to be a question, or so I thought. Upon reviewing this mnemonic with another student, I realized you could use either pentoxifylline or a steroid. I wrote it out on the white board and made a point of mentioning the steroid. If I hadn’t done that, I would have gotten the answer incorrect, and my entire elaborate mnemonic would have led me astray. Again, group study saved me.
So finals are around the corner. My strategy is just to do what I’ve been doing: transcribe the slide decks into plain language, make mnemonics that make me laugh, use spatial memory and memory palaces where needed, trust Anki, and lean on and rely on the bright minds around me. Am I going to go back and painstakingly review 23 exams-worth of content? No shot, bro. Finals in PA school are a numbers game. Both graduates of the program and my own professors have said to focus on new content, and that’s exactly what I’m going to do. If I don’t get to something, I don’t get to it. It’s not worth panicking or losing sleep over.
That’s it for now. Back to studying for finals. I’ll see you in the next one… after having finished my first semester as a physician assistant student.