Just minutes ago I finished my second to last exam for my entire first year of PA school. My last exam tomorrow isn’t worth much so, all things considered, I’ve completed my first year of PA school. It doesn’t feel too long ago when I was grinding away at general chemistry in my post-bac. And now here I am, halfway to being a physician assistant. Whoa.
I’m really curious to see what it’s like as a second year PA student. It’s finally time to see all of the things we’ve been learning. And obviously there’s that pervasive feeling that I still know so little. But I think the goal of P1 year is to know just enough to be a part of the conversation. It’s about “Hey, I remember learning about this and maybe I remember a thing or two, but let me go refresh my memory.” We know the basics of a new language and now it’s time for the immersion to make it all stick.
I think now is the time for a mindset change. This past year, patients really aren’t a driving force behind the why of everything you have to do to study and prepare for these exams. Coming up with wild mnemonics just to survive exams is a far-cry from real patient care and decision making. Now it’s time to change that and start to bridge that gap. I’m likely less than 18 months away from having a job as a licensed PA, responsible for the lives of other human beings. That’s a serious undertaking and a true privilege. It’s now about making things practical, being able to pick up on potentially life-threatening underlying conditions, and having those worst case scenarios in mind in case things go south.
P1 year was a lot of fun but I want to shift gears from student to professional. I think that’s the goal of P2 year. It’s going to be a lot of self-directed learning but if I’m honest, P1 year was also a lot of self-directed learning. But you had 3-5 exams per week to keep a healthy flame under your tail. Now I have just a single end of rotation exam (EOR) every 5 weeks so self discipline is going to be important.
The realm of healthcare isn’t new to me, but being on the clinical side of things, wearing a white coat, well that’s new to me. It used to be my job to be at the podium in an orientation classroom with a bunch of medical and PA students in front of me, on the first day of their rotation. Now I’ll be sitting in that classroom. That’s pretty wild. Here’s a photo of me (the only one not in a white coat) with a group of Drexel medical students I managed for 12 months during their 3rd year.
What’s cool is that I actually shot a video interviewing some of these students on tips to survive their clinical year. The fact that their tips now apply to me is pretty cool and I’m really grateful for that.
So the first year of PA School… How was it?
The First Year
I had an incoming student recently ask me “So how crazy is this going to be, really?” I think that’s a really tough question to answer. My experience at 34 (now 35) is going to be different than my colleagues completing a 3+2 program.
I will tell you that I felt more stressed in my pre-med post-bac than I ever did in PA School. My post-bac was a perfect storm of sorts, however:
In October of 2019 I was engaged, had a full-time well-paying job, and was a homeowner. Less than 6 months later, I was unemployed, living in my parent’s basement, single, and officially a full-time accelerated pre-med student taking classes online in the midst of a pandemic. All by choice, mind you. So it’s hard to compare just the academic portion of that without all of the environmental factors, to the academic load of PA School. But I would take any class in PA School over general chemistry, organic chemistry, biochemistry, etc. in a heartbeat. Classes in PA school are so much more useful and practical and less abstract. And the beautiful thing about PA school is that the pre-reqs are so rigorous; you’re not entering into it and learning things that are completely foreign. To go from a past career in business (albeit in healthcare, but still) into pre-med was a brutal learning curve. Despite my pre-med experience being so rough it really did give me the discipline and grit required to get through didactic year. Shout out to all of my colleagues in the Jefferson P4 program who were in the trenches with me.
Didactic year certainly isn’t easy, but it’s entirely manageable. Everyone around me, including myself, never seemed to be overly stressed or miserable. I’m sure we all had our moments behind closed doors, but we all kept such a positive attitude throughout the entire year.
Enough self reflection. Here are some practical tips to survive didactic year.
Top 5 Tips for Surviving Didactic Year of PA School
#1: Master your sleep schedule. Above all else, including eating healthy, exercising, and even how you study, a solid sleep schedule is the most important factor to a successful didactic year and I will die on that hill. You need to be able to sit in a classroom from 8-5PM, and still have as much focus at 4PM as you did at 8AM. No amount of caffeine can compete with a full night’s sleep. To maximize your sleep even further, go to sleep and wake up at the same time, 7 days a week. (+/- 2 or 3 hours is doable on the weekends if you want to stay up later). Waking up early on Sunday at 5AM to then wake up at Monday at 5AM makes for a very energizing Monday morning. I’ve historically been a student who has fallen asleep in class because my sleep hygiene was horrid. Because I’ve followed the strategy I’m outlining here, I haven’t nodded off in class a single time. A consistent sleep schedule has been a life-changing game changer for me.
Here are some other tips for better sleep:
Use Night Shift / Night Light on Apple / Android devices (removes the blue light from your screen). Set it up for 30-60 minutes before when you want to go to bed, or even longer.
iPhones have a “Wind Down / Sleep Focus” where you can limit notifications from only specific apps. I have this turn on 15 minutes before I plan on going to bed.
Don’t study where you sleep. That should help clear your head when it’s time to go to bed. If you have a studio apartment/dorm, try to have a dedicated desk / study space and only use it for studying. Don’t bring your studying into your bed! That way when you are in bed, your brain won’t try to think about studying and you should be able to fall asleep faster without your mind racing.
Using Sunrise Lamps / Hatch / Smart Lights to turn on 30 minutes before your alarm goes off will help you wake up. It’s peaceful waking up in the light instead of a dark room.
Instead of using an iPhone alarm to wake up, try an app with music. Or even better, if you have an Amazon Alexa device, you can set it up to play an Apple Music or Spotify playlist for you instead of a jarring alarm sound. Your favorite songs are infinitely more preferable to an instantaneous fight or flight response from an alarm. Oh, and use multiple devices for alarms. Never rely on a single device (your phone). And really you should have a battery-operated alarm in case your power goes out during the night. This is how I wake up:
My lights fade on with a warm light at 4:30AM
My Alexa plays a Spotify playlist at 4:55AM (I have a different playlist for every day of the week)
My iPhone alarm goes off at 5AM
On days where I have exams, I set an additional alarm on Alexa for 5:05AM
Charge your phone across the room so when you wake up you have to get out of bed. Don’t use the snooze function, ever, iPhone’s sleep schedule lets you disable snooze.
#2 Use a study management system / dashboard. The amount of information you’re going to be met with and responsible for is… insane. You need a system to manage and track everything. PA School is like suddenly being responsible for a start-up company. You need to manage payroll, employees, funding, or else you’ll go bankrupt. For me, this management system was a simple spaced repetition dashboard. It allowed me to take an “Exam” and convert it into 20-50+ topics and be able to see at a glance where I was from a 50,000 foot view. In PA School, when it’s effortless to become lost in the weeds, having a macro-view of what you’re up against is a godsend. Does it take extra time to manage your management system? Yes, of course but the organization and peace of mind it will offer you is invaluable. As the days approach closer to an exam it’s easy to enter into a frenzy/panic because you’re so overwhelmed. It’s always better to know what you don’t know so that you can triage and decide what topics are most worth your time. I’ve adopted my dashboard from Ali Abdaal; you can read about it here. Find the part that says “My ‘Magic’ Spaced Repetition Spreadsheet System.” Mine looks like this:
#3 Utilize the time you spend in class. Unless you plan on reviewing content before you enter class to then listen passively, I’d argue there’s almost zero reason to sit in class and just listen; that’s far too passive. I’d also argue that it’s a waste of time to take “notes.” Every test question is taken from the text on the slides. Extremely rarely a question will pop up that was only said out loud. The only reason to write anything down in class is when a professor says “This will or will not be on the exam” or just to add some extra context to a slide. So what should you do in class? I think the best way to spend time in class is to be working. Whether that’s making flash cards or organizing information into tables, it’s valuable to leave class with a resource you didn’t have when you walked in. For me, sitting and only participating in class meant I wasn’t really walking out with anything tangible. There’s so much information that I’d rarely remember what had occurred in class with the exam anywhere from 1-2 weeks away. I just don’t learn from listening. Even our Clinical Reasoning classes where we’re encouraged to close our laptops and participate, I just don’t retain much from a “live” session. With the exam weeks away and a host of exams in between that, there’s just no way to retain all of that. I have to sit down with content and manage it on my own time to be able to grasp it. So I might as well use my time in class to work on study materials. PowerPoint slides are easy to teach from but hard to learn from so sadly most of our time is used re-organizing information from those slides. That time isn’t always wasted, however. You should never just take all of the information from slides and transpose them to flash cards or tables. This is a tremendous waste of time and leads to the pitfall of overstudying. You have to use your judgment and just take what’s important; you should be using critical thinking to sift through what you think will be tested on. Your study material should be filtered so you aren’t overwhelmed. You retain some information just from that filtering. You never want to get home and have that feeling of “Okay, I need to get started on what was went over in class today.” You want to come home and already have material ready to go.
#4 Play the numbers. If it’s a low-credit class, don’t lose sleep over it if you got an 80. Take topics like the structures of the iliac arteries and be okay saying “Yea, I’ll pass.” Sometimes you don’t have time to learn everything, so you have to make some cuts. Is it worth 1-2 hours of time for 1 question on the exam? I mean, if you have the time, go for it. But if it’s between 1 question and 1-2 hours of sleep, take the sleep. The goal of P1 year isn’t to learn everything. It’s to pass exams. Period. I know that sounds sort of cold, but PA School is a business, you’re a customer, and you have to play along. If you feel good enough about that H&P exam which is 3 credits, but still have some content to go over for it, just move on. Your 8 credit exam is 10 days away so you better get a move on. Put your ego aside, take the 90, and put your time into something more valuable. Don’t overstudy! I often overlooked entire workups for diseases. My focus was: What does it look like? How do I treat it? What’s unique? Done, moving on. I talk a lot more about this here.
#5 Use your exam time wisely. As soon as the exam begins, feel free to write out some tables and mnemonics on your whiteboard. Yes, you don’t have to “start” the exam the same time as everyone else. I mean you have to see the first question, but it’s totally okay to go for your whiteboard and then memory dump. You’d be shocked at how powerful it is to have some resources to refer to as you’re taking the exam. During the exam, read the last sentence of the question, and read every answer. There are multiple times I’ve tunneled into an answer but saw that there was a better answer hiding in the choices. Use your highlighter! If you choose to review the questions again, seeing the highlights will save time and make your review far less painful. If you look at a question and literally shrug because you have no idea what they’re asking, think again. There’s something you’re missing. Why would they include this in the question? There’s a reason! Think outside of the box.
The time after your exam is some of the most important in your entire didactic year. My advice is to avoid people at all costs, find a quiet corner, and use the time you have left to look through and start highlighting what was tested on. Studying for finals begins the minute you walk out that door with your first ExamSoft green screen. Going over questions with classmates, for me, was very detrimental to my mental health so I chose not to do it. I got too often into that fight or flight mode, defending my answers. When you were between A or B and everyone else put C, that’s pretty disheartening and harmful to your mental health. You want to be that student that picked up on something that everyone else missed, but that’s so unhealthy for yourself and everyone around you. Don’t do that. I talk more about that in one of my first blogs of didactic year.
Test review was rarely a surprise for me because I had gone over all of the content to do highlights and had already reconciled most of the content I got wrong. It can take hours to pore over and highlight 12 decks, but it’s always time well spent because it makes studying for finals so much easier.
After you complete your first pass of the exam, go over it again. The room is more empty and you have a new environment to focus in. You’ve seen the entire exam so now you can look through it with a new lens. This also helps when you do your highlights after the exam because now you’ve seen every question twice, not just the ones you had flagged so this makes the content on the slide jump out: “Oh, yea they asked a question about this!” You spent hours of time studying, so you can put it an extra 30 minutes to protect your investment!
#6 Master your memory. Okay, there’s one more tip, and that’s to become a master of your memory. I’d put this at #1, but I feel this one isn’t as accessible to the masses. If you’d read up to this point and want to really know how to get an edge over didactic year, it’s mastering memory. Many of my past blogs are devoted to this topic, so start here: https://anthonysorendino.com/blog/2024/6/5/summer-semester-amp-the-problem-with-memorization-in-pa-school A great place to start would be to look up the Memory Palace / Method of Loci / Roman Room technique. It’s the single most powerful study tool I’ve ever used and it’s not even close. The process saved me hours of time and afforded me a level of confidence unmatched by other study techniques. Here’s a video of me using this process for a clinical skills checklist.
What’s Next
I have more to unpack from year one, including common myths and tropes, and also just general tips on how to study. So stay tuned for that!
I include songs at the end of each blog so I wanted to mention why I chose each song. “Aside” from The Weakerthans was the credits song from Wedding Crashers and it’s a perfect song to play over the credits for my first year.
I’ll see you in the next one.