Busting Myths of Didactic Year in Physician Assistant School

There are multiple sayings, myths, and tropes that are associated with PA school so I wanted to unpack them a bit. All of what I’m about to share should be taken with a grain of salt. These observations are from my experience through didactic year of PA school as a 35 year old second-career student. Some of these tips might appear against the grain but that’s intentional. This is a list to make you rethink what it means to be a student. Your mileage may vary.

So without further adieu, and in no particular order:

You should go over what you learned in class when you get home.

So there’s this idea of being in class all day and then getting home and reviewing / studying everything you learned to help make it stick. On the worst days, you’re in class from 8-5. So what, you’re supposed to go home after and review an entire day’s worth of content? What does it even mean to “review?” Read it? Quiz yourself? Flashcards? You likely had 4-5 classes of differing, sometimes related, content. You’re supposed to go over all of it, regardless of when the next exam is?

Here’s my take. Likely you always have an exam coming up in the next couple of days, often multiple. So in my opinion your time is better spent on that content. Focus on short-term testable material that’s going to keep your GPA afloat. Besides, unless you’re planning to then review that same information from the day again at spaced intervals, it might not be worth your time to review content from earlier in the day because you’re probably going to forget most of it if the exam is more than seven days away. I think this is really critical to understand; there’s an illusion to feeling “caught up.”

Remember that you’re constantly battling the forgetting curve and when you start to fight that uphill battle matters. It might feel like you’re staying ahead, but you’re going to have to revisit information regardless. You might think, “Oh, but I’ll fall behind.” Well, welcome to PA School! You’re always behind, never catch up, and then you graduate. So in some instances, it’s actually to your benefit to delay when you start studying for an exam to maximize your memory and fight the forgetting curve. And when I say delay, I mean prioritize testable material that’s coming up sooner. For my big eight credit class, I would try to study a little bit every day, regardless of when the exam was, but it wasn’t in line with the class schedule. It was just my own personal pace which would then ramp up as the exam got closer. And a lot of that time I spent was just outlining, organizing concepts into tables, and creating Anki flashcards. That’s the stuff you want to have done ahead of time so that when it comes time for that crunch time 3-5 days before a massive exam, you have plenty of filtered content already to study from.

What you do in class also matters. For me, what was helpful in class was to be working and doing something active; not just passively listening and jotting down notes. That way I didn’t get home and felt like I had to get started. Read more about that here (Tip #3): https://anthonysorendino.com/blog/2024/8/27/p1-p2-amp-the-top-5-tips-for-surviving-didactic-year

Final verdict: If you have the time to go over content daily, certainly go for it, but plan to revisit the information again at spaced intervals. Your immediate time might be better spent studying for exams you have within the next few days. 

You should outline the PowerPoints before class.

I think outlines are valuable. Most of the time, however, I would outline in class because I simply didn’t have time (or energy) to do it beforehand. It’s important to not get slide fatigue. A quantity of 50, 100, 200 slides, etc. doesn’t really tell you much. You need to know what’s inside of them (I would actually use PowerPoint’s word count feature to see how dense the deck was). So make yourself a table of contents. How many “characters/diseases” are here? How many families of diseases/how do they relate? How can I organize all of this? Don’t just make an exact outline; make it work for you and organize it! Information is often presented in a linear fashion, with no real comparison or contrast to surrounding topics. 

An outline for me looked like this which I would then turn into a spatially-oriented table of highlights:

This is why tables/matrices are so valuable as you flesh out your notes. It’s about transforming a linear outline like the above into something more visual. The most important benefit of using a table like this is that your brain will remember where the information was. Oh! I know I wrote Group A Strep on the upper right and that was Guttate Psoriasis. Done.

The reason they say writing with pen and paper is better is misunderstood. It’s not because it slows you down, it’s because you can’t pinch to zoom on a piece of paper. Your brain remembers the scale and weight of information on a physical piece of media. You can zoom into a Google Doc table, but upper right will always be upper right; it’s a digital format that retains the benefit from a printed page. See the section “Enter The Matrix” here: https://anthonysorendino.com/blog/2024/1/1/studying-pa-school-the-tools-of-the-tradein

Final verdict: It’s good to get a glance at what’s upcoming and reorganize the content to your liking. Use tables!

Most students study 4-5 hours after class.

The “time” you spend studying isn’t a good metric at all; it’s how you study and whether it was focused or full of distractions. I think giving students time-based study goals can actually be detrimental because it traps students into thinking longer is better and that they should be staying up later and sacrificing sleep to hit an arbitrary benchmark. Two hours of laser-focused, spaced repetition, spatial-based memory studying beats 4-5 hours of unfocused, passive, interrupted studying every time. I’d also argue that the last thing your brain and body want to do after being in class all day is to study/learn even more. Efficiency of your time is important. How much are you really going to retain when you’re exhausted? I’d recommend waking up early and doing some solid studying before you even get to school. This allows you to take it easier when you get home and actually unwind and recharge your batteries so that you can get a full night’s sleep. I would try to study from 5AM-7AM every morning, seven days a week. When most of your family and friends are still sleeping, you’re not getting texts, you have no new Instagram messages coming in, etc., It’s much easier to lock in during the peaceful early morning hours.

I truly believe that how you study is the biggest oversight in academics because it’s simply not taught. Here’s the process I came up with: https://anthonysorendino.com/blog/2024/6/5/summer-semester-amp-the-problem-with-memorization-in-pa-school

Final verdict: Never measure your progress by time. “I spent 20 hours studying.” Okay, 20 hours studying…. how? Studying what? Quality beats quantity every time.

You have to lose sleep / pull all-nighters.

This one is easier said than done but it’s possible to never sacrifice sleep during your didactic year. Probably my greatest achievement in didactic year was that I was able to get a full night’s sleep for an entire year, including all three weeks of finals. Not a single all-nighter. Not a single late night. Never once did I have more than one cup of coffee per day. Rarely do I flex, but this is my nerdiest weird flex and I’m proud of it. My sacrifice in humility here is worth it to show you that it’s possible. My goal here isn’t to gloat, it’s to inspire. And for the record, I’m no savant. I’ve always been a pretty average student from grade school into undergrad. I was never an honor student, in a gifted class, nor have I ever won an academic achievement award. So if I can do it, so can you.

It’s not rocket science. Going into an exam on little sleep weakens and dilutes all of the hard work you did earlier that day and that week. It’s pretty well documented that quality sleep helps strengthen and build neurons overnight. Sure your all-nighter might have yielded you a passing score, but at what cost?

It’s important to note that sometimes lack of sleep is a deliberate choice and that’s okay. Maybe you had an important family event or a concert the night before an exam. Maybe it was your birthday last night. Striking a work-life balance comes with a price; you just have to decide on a budget. It’s certainly preferable to have a social life in PA school for your general well-being. I’m 35 and live alone with no children. My social life is slightly different than a 22 year old college student or a student supporting a family. Self awareness of the author giving you all of this advice matters; nothing I’m offering here is a one-size-fits-all approach. I’m fortunate for my situation, but I still think with discipline it’s possible to maintain a steady sleep schedule no matter what your situation is. It’s my #1 tip for surviving didactic year: https://anthonysorendino.com/blog/2024/8/27/p1-p2-amp-the-top-5-tips-for-surviving-didactic-year

Final verdict: It’s entirely possible to maintain a consistent and healthy sleep schedule in PA school and I believe sleep should be your #1 priority. 

PA School is like drinking from a fire hose with a straw.

Drinking from a fire hose with a straw means that inevitably most of the water is going to go… I don’t know, on the street and into the sewers, instead of into your straw. I always thought of this metaphor as “Okay, I drank as much as I could, I guess that’s good enough.” But the problem is, you need most of the water that spilled out onto the street so you have to get down and dirty and go sewer diving. I don’t know that there is a true metaphor for PA School. It’s sort of like juggling fruit and you have to pick and choose what you want to add into your juggle. A banana? Nah. An orange? Sure, I’ll take that. It’s about sacrifice of content that you don’t think is that important and understanding your limits. You have to let some fruit go and splatter on the pavement. Juggle enough fruit for an exam, finish your routine, and then start a new juggle. And often you need to split your focus and juggle with both hands and sometimes a foot.

Final verdict: This saying simply means “PA school is hard” and really isn’t useful. You already know it’s hard. 

PA School is all memorization / regurgitation onto an exam.

This one honestly isn’t far from the truth, but that’s far from a bad thing. I spent most of my later blog posts talking about memory so I won’t repeat everything here. Read more here: https://anthonysorendino.com/blog/2024/6/5/summer-semester-amp-the-problem-with-memorization-in-pa-school I think it’s important to trust the process. The PANCE and Arc-PA have created a giant PA-C creating machine, and you’re a part of that and you have to buckle up and enjoy the ride. You’re not just a student, you’re also a paying customer but in a business model that works.

Over time, the constant smattering of information means that things will begin to stick. You won’t necessarily need mnemonics or charts; you’ll just know it. Minutes after the exam, you start to forget information at an alarming rate. At times, you might not feel like you’re learning much at all. This is all okay. This is normal. Trust the PANCE rates of your program. Trust the numbers. Trust the process! Also, keep in mind that most of your training as a PA is going to depend on your specialty and is going to happen on the job, just like any other job. Your #1 goal is to simply get to that point and pass your exams. 

Final verdict: Mostly true, but there’s nothing wrong with that. Capitalizing on memory techniques is one of the most understated “hacks” of PA school.

Don’t triage your studying.

To advise future healthcare providers not to triage was always interesting to me as triaging is the lifeblood of an emergency room, the front door of every hospital. You absolutely should triage and play the numbers. See tip #4: https://anthonysorendino.com/blog/2024/8/27/p1-p2-amp-the-top-5-tips-for-surviving-didactic-year

Be okay not studying as much for the quiz tomorrow in the 1 credit class so that you can study more for the exam in the 4 credit class three days from now. Be okay not being perfect. You’re not going to be able to put a triage “green tag” on every single exam. Sometimes you have to be happy with a yellow and keep moving. Survive any way that you can and constantly re-prioritize based on what’s coming up in the next few days.

Final verdict: Prioritizing and triaging is an important skill in PA school and in life in general. Be okay making sacrifices and playing the numbers.

You should make your own study guides.

As someone who made study guides most of his personality in the first year, this is a spicy one. I think the actual value you get from the process of creating a study guide itself is overexaggerated. It’s the actual “studying,” the spaced repetition, the free-recall, the deep-dive, the using of said study-guide where you get the full benefit and start retaining information. I’d make 100+ page study guides with accompanying videos but still needed to “study” it to retain information. The creation process only got me maybe 15% of the way there. It’s not the short-term value of creating a study guide, but actually its long-term use that makes creating your own content a good idea. More on that in a bit.

I never used anyone else’s study materials for a few reasons. I was already putting so much effort into my own study materials, not just from a content perspective, but from a formatting perspective. I probably spent the same amount of time on color-coding, font-size, and finding that perfect emoji as I did with the actual content itself. I’m a stickler when it comes to format; I find that aesthetically pleasing content is much easier and more enjoyable to consume. Color-coding is incredibly slept on as a study tool. I can tell you gram positive from gram negative bugs in an instant because every time it’s mentioned in my notes, I color GPs purple and GNs pink (I also have them in very different memory palaces which make them impossible to forget). Penicillins are orange, macrolides are yellow, fluoroquinolones red. Even now when antibiotics or bugs are mentioned in clinical year, I can feel the color of the medication and instantly know the class. I’ve developed an entire custom color-palette that I carry over into every new Google Doc. Here are some of my proudest examples:

I also tend to have a higher-threshold for what’s important (meaning I would ignore a lot of information). I don’t mean that to sound pretentious. It’s a game to guess what’s going to be asked on the exam, and I feel like I got pretty good at playing. I ignored almost every single lab-based diagnostic workup, not because it’s not clinically relevant, but because it’s not high value for an exam. I cut a lot of corners and just focused on the big picture stuff, plus a few unique things that make a disease process stand out. If your study guides are an exact copy of the source material, just reorganized differently, that’s probably not the best use of your time. I’d really recommend paring it down and using your judgement to just take what’s important. The process of actively filtering out important information is a great way to actively learn. 

The value I’ve seen with creating my own study materials is that I constantly referenced them throughout the remainder of my first year and constantly reference them during my second year. It’s very rare that I actually open up a PowerPoint deck and check on the “source” material. To have something meticulously color-coded and filtered, in my own words is so nice to look back on. I also use my notes much more often than Up To Date when initially looking something up; I get the big picture from my own notes and can then dive into the recommendations on UTD or a hospital’s preset pathway.

With all of that said, if someone already painstakingly made a flashcard deck for the anatomy practical, by all means thank them for their service and use it. If someone made a nice chart of triads, use it. If someone made a 100-page fully color-coded study guide (ahem) go ahead and use it but try not to become completely reliant on the resources of others.

Final verdict: You can use any study material that you want, however there’s value as a long-term investment to creating your own content to your liking that you can utilize in the future.

This will be the most miserable year of your life.

I’ve heard this more than you might think and I’m sort of mystified by it. Sure there are times where you’re like “Man, this sucks” but I was never miserable. And that’s not even unique to me as an older student; everyone around me seemed to be pretty relaxed and having a great time throughout the entire year. PA school is only miserable if you let it get the best of you; it’s all about your mindset. You were vetted through one of the most competitive application processes in the country. You’re sitting in a seat that thousands in the country didn’t get to sit in. You’re surrounded by people who want you to succeed. You’re learning how to save lives. You’re learning practical, hands-on, skills. What’s remotely miserable about any of that!?

Final verdict: No shot.

You have to make social and personal sacrifices / won’t ever see your friends and family.

This is partly true but not nearly as dramatic as it sounds. I definitely had to make sacrifices like quitting video games, canceling concerts I had tickets to, etc. But I was still able to go to a couple of shows, still saw my family regularly, etc. It comes in waves though. Sometimes you have a crazy week coming up, so you really need that preceding weekend cleared. Then you get a few days to breathe and a weekend where you can squeeze some family time in. Your life certainly will revolve around school, but if you budget out your time, you can carve out time for yourself and others. This is another reason why efficiency in studying, not time spent, is important. Because I was efficient with my studying I was able to take multiple nights off per week.

The video games thing for me is interesting. They’re still one of my favorite pastimes but knew they would be a time-suck, so I cut them out completely during most of didactic year. I sort of rewired my brain by using video game-like addons for Anki and a Nintendo Switch controller for the Anki cards to make studying as close to gaming as possible. What’s funny is that when you don’t feel like studying, it doesn’t matter what distractions are around you, you’re just going to do something else if you’re really not feeling it. I realized instead of gaming, I’d just be doom-scrolling / brain-rotting on social media, which is much, much worse than a couple hours of Borderlands or Warcraft. So I actually started gaming again late in my last semester. I realized it made me much happier; I felt human again. 

Final verdict: Anything worth doing that’s going to create a great career for yourself will come with sacrifice. Carve out time for what matters most. Do what makes you feel like a human.

Your grades matter.

This one might be controversial so buckle up. Do you need to pass your program to graduate? Yes. Does it matter what your GPA is? Not at all (as long as it’s above your program’s requirement). Shoot for 90s and strike a balance between grades and being a human being. Patients don’t care about your GPA or grades if you don’t know how to relate to them on a human level. So don’t be a robot! Some of the most academically brilliant providers I’ve worked with over the past 10 years have a poor bedside manner, and poor relationships with the nursing staff and cost their organization time and money through patient complaints and poor reviews. So in the end, how much did their 4.0 GPA really help them in practice?

I actually think GPAs and awards for high ones are outdated and can be detrimental. Because it forces you to sacrifice to “achieve” a number that’s meaningless in clinical practice. Are we rewarding someone who made unnecessary sacrifices and holed up in their room for an entire year, just to achieve a relatively arbitrary score, one that has no relation to patient safety and satisfaction? It also makes those that didn’t receive an award feel sort of inferior. Does this mean I’m not going to be as good of a provider? (No).

At the end of the day, as long as you pass, you’re all going to be a PA-C. I constantly grapple with that personal reflection of “Am I lazy and doing the bare minimum, or am I striking that school-life balance?” And I don’t necessarily think that’s a bad place to be. I did really well in my didactic year and had a ton of fun while doing it. Am I going to win any GPA awards? Not a chance, and I’m perfectly happy with that.

Final verdict: Grades matter to no one else but yourself. Your grades and your patient safety and satisfaction scores have little correlation. Patients care about how you make them feel, not your GPA.

Final thoughts.

So that’s all I have for you! See you in the next one.

P1 ➡ P2 & The Top 5 Tips for Surviving Didactic Year

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.

Summer Semester, The Problem With Memorization, and What PA Students Can Learn From Memory Athletes

17 PowerPoint decks, 942 slides, and 39,273 words. That was the amount of content I was responsible for yesterday morning for my second exam of my final semester of didactic year of physician assistant school. It was an absolute monster of an exam, on the entirety of orthopedics and dermatology, including pathophysiology and pharmacology.

It got me thinking… how many words exactly is 39,273? Considering the content I was faced with, I thought it had to be at least the entire length of a Harry Potter book. But when I did the math, it was only 51% of the entirety of the shortest book, The Sorcerer’s Stone, right about at the part where Harry learns how to fly a broomstick for the first time. Especially as an adult reader, half of that book—isn’t really that much information. You could read half of that book in a day and I could ask you questions and you’d probably get most of the questions right without having to study. So why is learning the same amount of words, provided on PowerPoint slides, so much more difficult? Well, because a story is memorable, right? A story has a setting, and a plot, and characters, and humor. It has themes that connect to your life and is relatable, even if it’s a fantasy. The study of medicine often doesn’t have any of those things.

But what if it did? What if Multiple Myeloma, a Lisfranc joint injury, Paget’s Disease, and Dyshidrotic Eczema were as memorable as a fantasy novel? And what if you could be the author?

The Problem With Memorization

We’ll talk about storytelling in a second, but first we have to talk about memorization.

The problem with memorization is that we don’t talk about it enough. We don’t acknowledge that a strong memory is one of the most powerful skills during didactic year of PA school.

There’s a science to medicine and we spend our time in PA school focused on understanding pathophysiology, medication indications and side effects, but we don’t spend any time on how to tackle or retain that information. There’s a science to learning and I think we really overlook it.

I think we have to be comfortable with the fact that memorization is a big requirement for PA school, as well as many other disciplines. But that’s okay—memorizing is still a form of learning. And there are simply better ways to remember things. We shouldn’t be annoyed when we’re met with a list to memorize; actually we should celebrate because it’s a lot easier to memorize a list than most people realize.

There are many things that memorization doesn’t work great for, like complex pathologies, how osmolality works, the Renin–angiotensin system, how to read an EKG, etc. But the problem we students face is we can’t give those processes the time they require because we’re inundated with material that needs to be memorized. The best strategy is to fast-track what needs to be memorized so you can spend your time truly understanding those other processes.

I think there’s a misunderstanding that to memorize something, you just have to repeat it over and over again until it sticks. That works well for shooting three-pointers and hitting a fast ball, but PA school is a different ballgame. You don’t need muscle memory, you need memory… with muscle.

You can brute force rote memorize anything—but that takes a lot of time, and you’ll likely forget it in 24 hours. So why do it? And the bigger issue with rote memory techniques like flashcards is that they don’t battle interference. Sure you can recite that triad, but do you remember what disease process it belongs to? You know what Auspitz’s Sign is—but do you remember what skin condition you see it in?

The Memory Experts

Listen, in any other part of your life, who do you look to for advice? The experts. You’d go to a personal trainer for fitness advice, or a pro athlete to learn how to throw a football. But who are the experts of succeeding in PA School? There is no olympics of learning—or is there? To me, it’s critical to break down what the actual constituent parts of academic success are.

What is succeeding? Passing, graduating. Okay, so interview the top students in the class and those that graduated before you and see how they studied. You could do that, but class intelligence and performance are spread across a bell curve. Some students are just more gifted than others; some can read through a slide deck right before a test and do just fine. I’m not one of those people so it doesn’t make sense to compare myself and you shouldn’t either. So now what? Well what do you have to do to pass? Score well on an exam. And how do you score well on an exam? You have to remember the content from the lectures. Well how do you do that? You have to study that material. Well how do you study? Maybe you look at a flashcard and try to remember what’s on the other side. Well, how do you know if you studied effectively? Well, if you remember what you studied when you’re taking the exam. If what you studied… stuck. If Topic A doesn’t interfere with Topic C. If you remembered what belonged where.

And there it is. The core skill to passing an exam isn’t how you studied, or how long you studied, it’s simply what you remember.

And who knows the most about remembering—who are the experts of memory? They’re not medical students or law students; they’re not students at all actually. They’re the folks who who practice memory on a professional level at the USA Memory Championship. And yes, that’s a real thing. Things that we devote hours of our time studying, like a list of 16 diseases that cause rashes on the palms and soles, memory athletes can memorize in seconds, and they do it for fun.

And what strategy does every single memory champion use? It’s called the Memory Palace / Method of Loci / Roman Room and it entails harnessing spatial memory of locations you’re familiar with and mentally placing pieces of information in those locations. It’s easy to learn and will change your academic life. It’s certainly changed mine.

And no, the memory athletes aren’t savants; they actually all have average memories (as do I). I just finished reading a book called Moonwalking With Einstein, where a journalist who was writing an article on the USA Memory Championship learns the techniques and then wins the competition the following year. And I want to give you an idea of what this competition is like. One of the events is called Speed Cards. You’re given a full deck of 52 randomly shuffled cards. You have as much time as you’d like to memorize it, in order. When you’re done, hit your buzzer and then you have 2 minutes to put another deck of cards in that same exact order without looking at the first one. How long would it take you to memorize the sequential order of 52 cards? An hour? A day? Do you want to know what the world record is?

Under 14 seconds.

Do I have your attention? The Method of Loci is that powerful. And I now almost exclusively study using this method, replacing rewatching lectures, taking extensive notes in class, and using flashcards.

And it’s been an absolute game changer for me. It’s allowed me to maintain a consistent sleep schedule now for 10 months and I’ve yet to miss a single hour of sleep. It’s been a breath of fresh air and I truly think it can change the way we think about PA and medical school and academics in general. It’s by far the most powerful, efficient, and longest-lasting study technique I’ve ever encountered, and it’s not even close. And I think more people should consider using it.

Storytelling: My Current Study Process

I’ll walk you through exactly how I study and use this technique and narrate how and why this works.

The first step is to look at each slide deck and figure out who the players are. How many distinct “characters” or disease processes are here, especially those with distinct treatments? And also, how much weight, or how many slides does that process have? And that looks like this:

I try to put everything into groups, or families. It’s a simple outline—nothing groundbreaking. Then I put each “family” into a matrix, or table, that looks like this:

Then I fill the table in with all of the details I think are important. I usually do this in class, in real time. Sometimes I fall behind, which is fine. But I’ll sort of passively listen to my instructor and pick up on hints; sometimes they allude to important topics, or even more valuable, tell us which slides are just “fun facts.” If they say “You definitely need to know this” it goes in my chart. I use a combination of what they’re saying, and my own judgment for what I think is important, unique, or testable. I ask myself, “If I was writing this exam, what would I ask?” I leave a lot behind; most topics require less than 5 things to memorize. Oh this condition warrants a CMP and this one needs a BMP? This one has fatigue and dizziness, and this one just has fatigue? Is that important in practice? Maybe. But I’m not there yet. I’m just trying to pass an exam. Even if it’s tested on, it’s one question, so it’s not worth my time to memorize the labs and generic symptoms for 150 diseases to score .8 points higher on an exam. PA School is about playing the numbers and you have to be comfortable leaving things behind. Shoot for 90s, not 100s.

Anyway, sorry for the rant. You’ll notice I use numbers instead of bullet points in the table. I try to make every thing very singular: Concept 1, Concept 2, etc. These are the 7 things I want to remember? Perfect.

Once I repeat the above process for the entire content for the exam, I build a dashboard that looks like this:

Then I write a story, preferably using a real location, as all of the Memory Champions do. For the above, I used my school library. Each row, each unique disease process, gets a scene and it looks like this:

It’s silly, entertaining, and a tad crude, and that’s precisely the point, because that all makes this information infinitely more memorable. Forever, dyshidrotic eczema will be synonymous with my school library elevator and I wrote the scene you see above sitting right in front of it. I wrote 60 scenes for Dermatology, and 55 for Orthopedics. Some of them just have a couple of points to remember, others have 10. I don’t always go to the location in which I’m referring to; I use a lot of locations from my past like hospitals I used to work at.

So I write the scene, encoding each bullet from my table into it, then immediately look away from my computer and recite the entire thing back. Then I set a timer for 1 hour, and repeat it the scene again from memory, and then once more the following morning, after a full night’s sleep. That’s an important part of this. The science says that memory is improved by quality sleep, so it’s critical that you stick to your sleep schedule above all else. You’ll see those 1 hour and 1 day milestones in the dashboard; I use that to battle the forgetting curve; it’s simple spaced repetition. I audit what I remember each time to make sure I didn’t forget anything. And every now and then, I do. But I’d say I remember 95%+ of what I encode in a scene as long as I stick to my schedule. And after that third repetition the following morning, not only do I remember nearly all of the information word for word, I remember it for weeks to months after. Just today I was asked what the treatment was for Tinea Versicolor. I wrote a scene for it for my Infectious Disease exam 81 days ago using a park behind my apartment building. So all I did was think of that location and I saw my old neighbor Celine standing there who I wrote into the scene to help me remember the treatment: Selenium.

And I know what you’re thinking, “Oh I don’t have time for all that.” I would argue that, per minute of time, this is the most efficient way to study. Does this process take time? Of course. But it’s extremely time efficient because it encodes new information into the already existing long-term memory of locations. With a dashboard, you can statistically give each concept equal time and repeat it at spaced intervals. Every minute of studying becomes incredibly purposeful and, more importantly, trackable.

Here’s why this works. Think about your childhood home. Will you ever forget the exact layout and every piece of furniture there? Never. Spatial memory and those neurons that hold that information are incredibly long-lasting. A Memory Palace works by taking new information and just placing it next to rock-solid long term neurons that already exist rather than painstakingly try and build new ones. Imagine a bunch of “full” storage boxes in a closet. And you have five new items you need to store. Sure, you could purchase or put together a new box, place those five items in and then put the entire box in the closet, taking up a box-worth’s amount of space even though that box isn’t completely full. Or you could sift through your already existing boxes and find little cracks and crevices to store your new five items, using the boxes that have been inside for months or years. That’s the idea here.

I encoded all of the different types of eczema in one section of the library near the elevator. Then I moved to the back and encoded all of psoriasis in an area around a giant statue that looked like a dragon scale. Distinguishing buzzwords between the two, like “Silver Scale” or “Tapioca” became effortless because I’d never confuse an elevator in the middle of a library for a sculpture in the back of the library. The plague of interference, which can mean disaster on an exam, is eradicated.

This also works because I’m not studying just words on a page anymore. I’m making Bullous Pemphigoid and Ewing Sarcoma come to life. And I use cartoon characters, family members, Pokemon, and everything in between to make things stick. I convert medications and numbers to objects and people and just place them along the path of these memory palaces. It’s engaging, allows me to be creative, and makes me laugh. I’m making studying as close as possible to a fantasy novel—and it’s pretty magical.

Onward

At the end of the day, PA School of course isn’t just about memory. Like I mentioned before, there are tons of things that require you to understand them from the inside out, and memorization can’t help you there. But when you’re tasked with memorizing a list of 50 pediatric milestones, or the side effects of countless medications, or the DSM-5-TR criteria, those are tall orders and can take up an inordinate amount of your time. And I’m here to tell you I think there’s a way to get some of that time back.

I don’t memory palace everything. It works best when you’re flooded with either long lists or a lot of “buckets” of things you need to distinguish amongst. I’ll still use Anki for one-off concepts, definitions, and things like that.

After being at this for 10 months now, I think the ultimate triad of learning is:

1. The Method of Loci / The Memory Palace

2. Free Recall

3. Spaced Repetition

The process I use hits all three and I would simply never study in any other way. So if you’re looking to raise your GPA, study less, get more sleep, or are just looking for a new way to study, reach out. I’d be happy to teach this process to anybody.

I’ll see you in the next one.

Six Weeks In: Mnemonics, Medicine, & Mental Health

“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.