By LaurMG. (Cropped from “File:Frustrated man at a desk.jpg".) [CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons
STUDY TIPS FOR PA SCHOOL (PHYSICIAN ASSISTANT PROGRAM)
As a professor for both clinical and didactic year at 2 PA schools for 12 years, I have seen a lot of students come and go. PA school is one of the hardest things I have done in my life, but if I had a better roadmap when I was a student, the task would not have been as daunting. I started undergrad with 4.0 average and upon starting PA school, I quickly learned that what I did to get the 4.0 had to be DRASTICALLY remodeled for PA school or I would have kept drowning. Here are some tips to help new PA students stay afloat and survive the medical monsoon that is PA school. Before jumping into tips, one must have a complete understanding of the unique problems of PA school…
POINT 1: PA SCHOOL IS NOTHING LIKE COLLEGE!!!
COME TO TERMS WITH IT!!! Many people can cram, study and just regurgitate memorized material & many other skills to get a 4.0 in undergrad however, won’t get MOST people far in PA school because:
- You a learning A TON OF INFORMATION IN A SMALL AMOUNT OF TIME. You are constantly learning new material while being tested on old material – there isn’t just one focus on one area.
- You have more time & less material in undergrad so it didn’t require a lot to get a lot (in terms of good grades).
- MOST of PA school is application learning:
Classes like anatomy may be heavy on memorization but many core classes require learning how to apply the information in a clinical scenario, not just pure memorizing the material. This requires a much deeper understanding of the material compared to undergrad.
4. THE CLASS SCHEDULE IS USUALLY NOT STATIC: Classes easily change day to day & week to week so you must adapt more often to changes and lengths of class.
5. There isn’t much FREE TIME:
- Schedules are hectic with little breaks. Sometimes have multiple in exams in the same week while learning new material.
- You can easily fall behind & hard to catch up. Many students have the false notion that, like undergrad, it will be easy to catch up to speed with a little hard work. Once you fall behind it becomes harder and harder to catch back up without compromising learning and retaining new material.
- A lot of the material is CUMULATIVE: Unlike undergrad, it is not about learning for an exam and then forgetting it. You have to maintain a working knowledge and retention of the diseases . “Old" material is never “old" disease processes or diseases will come back in other classes = what I call the OVERLAP phenomenon.
I hope by now that I convinced you that PA school is different. But chances are if you are already in PA school, you have already learned the hard way. Now that you realize it is different, MOST of you will have to approach it DIFFERENT than you did in undergrad. Again, what you did to get a 4.0 in undergrad often will not work (or may not be enough to get a great grade in PA school). So how do you alter or rearrange your once useful or semi-useful techniques to make you a stellar PA student??
- The most fundamental principle of efficient studying – the best use of your limited time – requires ACTIVE not passive learning.
- ACTIVE LEARNING: requires MAKING ACTIVE, INTUITIVE DECISIONS about the material. Questions you must ask yourself is:
- “WHERE have I seen this before?? (to make connections with things you have learned before).
- “Where does this fit into the ‘BIG PICTURE?" How to organize material?
- “WHY Is this important?"
- “What is the BIG PICTURE?"
What is the LITTLE PICTURE ?"
UNDERSTAND THE “LITTLE PICTURE" .
The LITTLE PICTURE are the necessary components and details of a disease or group of disease. This requires:
- Understanding basic anatomy & physiology: STUDENT MYTH: IF I AM NOT STUDYING FOR AN ANATOMY OR PHYSIOLOGY TEST AND IT IS CLINICAL MEDICINE, I CAN SKIP THIS BECAUSE IT’S “NOT NECESSARY." REALITY: This is a critical mistake PA students make in an attempt to figure out when studying what should the focus on and what can fall by the wayside. Now, I am not saying to remember every single page of anatomy and physiology from the book but you do need to know the basics of that to apply to the disease. This is because when you understand the basic anatomy and physiology. You can make sense of the pathophysiology of the disease. Understanding the pathophysiology often will explain clinical manifestations and (9 times out of 10) the medications used to treat the disease, the mechanism of action of the medications as well as some of the side effects of the medications used or why some medications are first line for a disease where it isn’t in other diseases that it may be used for. For example: understanding that heart failure is a condition where the body tries to compensate for the failing heart by stimulating the renin angiotensin system, which over time leads to decompensation and heart failure. ACE inhibitors are first line for heart failure because they directly inhibit the effects of the renin angiotensin system. Side effects of ACE inhibitors are they can cause hyperkalemia (because from physio you remember that if you block aldosterone, you get rid of sodium but you hold onto potassium and hydrogen ions – which also explains another possible side effect of ACE inhibitors, metabolic acidosis). Understanding this also helps you to understand other disorders. For example, the disease hyperaldosteronism (meaning that too much aldosterone action is occurring) will present with hypertension, hypokalemia (since aldosterone holds onto sodium in exchange for potassium and hydrogen ions) and metabolic alkalosis (since you are getting rid of hydrogen ions). And why patients with Addison’s disease (a condition that you don’t produce enough aldosterone) will have hypotension and hyperkalemia as presenting symptoms. Again different diseases with the same connecting principle. Often students learn these thoughts in isolation and focus on these little details because in getting the little picture (of the details) they miss the big picture – but I am getting ahead of myself! Back to the little picture: Understanding the basics takes a little more time initially but the pay off is when you understand it, the other details make more sense and you don’t have to memorize as much because you can talk it out as to what is going to happen so it is easier to retain. The more you understand, the less you have to memorize! This means that you don’t have to study as much and the time that you do use to study is used more efficiently!
- Also understand the basic terminology used: I can’t tell you how many students can tell me that they see Kussmaul’s sign in certain diseases but when I ask them to describe it they can’t. Often on exams, they may either write out the name of the terminology or describe it, so it is good to be able to understand the terminology you are using in a disease. If you don’t know it, make sure to look it up!
- STUDENT MYTH: " IF I UNDERSTAND ALL THE LITTLE DETAILS THEN I WILL MASTER THE TOPIC". Wrong! There is no little picture if you can’t see the big picture!!!
UNDERSTAND THE “BIG PICTURE"!
The BIG PICTURE is making the connections of all the little details to see the underlying theme of that disorder and how that concept can apply to other disorders. This is the one of the hardest part for students because they concentrate so much on memorizing the little details they can’t pick their head up to see the connections, so they learn everything in an isolated bubble. It is like driving to a destination. if you just look at the road of the highway without looking at the signs, you will eventually get lost. The big picture is like the GPS. it tells you how the little roads that you learn are connected to get you to the destination. Rather than aimlessly drive and ending up in detours, you take the fastest route to the end destination while maximizing your retention. Why is the big picture Important??? Funny you should ask, well I am here to tell you!
- Knowing the big picture helps to understand the little details more! For most students this concept seems counterintuitive. But when you understand the big picture, you understand the purpose and the principles of all the details you learned
- Knowing the big picture helps you to relate other diseases to a common theme: For example Sinusitis (sinus openings get blocked and the flora that is already there along with the mucus builds up, leading to an infection), Appendicitis (fecalith blocks the appendix leading to infection/inflammation), Cholecystitis (stone blocks the cystic duct, leading to infection/inflammation), Diverticulitis (fecalith blocks the diverticulum leading to inflammation/infection), Saliolithiasis (salivary stone…well you get the picture now). Also other diseases that have the same processes are connected. For example: atherosclerotic disease in the coronary arteries happen throughout other arteries in the body not just the coronary. Whenever there is decreased blood flow we call it ischemia, when there is death due to prolonged ischemia, we call it infarction. Ischemia in the coronary artery is called angina, cell death is called a myocardial infarction. Atherosclerosis in the carotid arteries of the neck can lead to brain ischemia (TIA – Transient Ischemic Attack) or brain cell death (Cerebrovascular accident/Stroke). Atherosclerosis in the arteries that supply the leg can lead to ischemic leg pain (claudication) or cell death (gangrene). Atherosclerosis in the arteries of the GI tract can lead to ischemia (Chronic mesenteric ischemia often called intestinal angina) or acute ischemia that can lead to bowel gangrene, etc.
- Finding the “big picture" will help keep you on track during the lecture. This is a fine tune skill that not all students will subscribe to because they will say that they don’t have time. But if you read a lecture a few 5 minutes before class, it won’t be the first time you are hearing the material and then you can begin to formulate questions to ask your professor during the lecture of the material which is needed to effectively learn the lateral.
- Knowing the big picture can maximize your study of the material later while reducing the time you have to study for it to make it stick: it helps you to rewrite your notes in an outline form (which is very helpful for a quick study especially before an exam. So is creating flow charts, lists or diagrams that organize the needed material in a visual way. Not all of us are visual learners but you will be surprise that you remember that some information you needed to answer a question was in the upper left section of your chart or you can visualize your simplified chart in determining which way to go to treat the person. Actively memorizing these flow charts are a quick way to review the material and then when you add the little picture to your big picture, you can see the work of art you created.
Here is an example of the big picture study strategy and how it helps you understand the disease better. Click on this for a sample: BIG PICTURE.
Now that you have created your work of art, how do you know study it?
STUDENT TECHNIQUES TO USE ONCE YOUR MATERIAL IS ORGANIZED
1. MEMORIZATION: Some things need to be memorized and most students handle that part okay. Difficult things that you need to memorize can sometimes be made simple with a mnemonic. For example, I tell my students that Multiple
Myeloma is the main hematological malignancy that directly affects the bone. So I teach them Bones “BREAK" with multiple myeloma to help them remember the cardinal findings in patients with Multiple Myeloma.
Bone pain – due to calcium remodeling. This also helps them to remember the “punched out" lesions of the bone on the skull in patients with Multiple Myeloma
Recurrent Infections – the plasma cells that make up the malignancy crowd out the bone marrow that the marrow can’t make other cell lines such as red blood cells
Elevated Calcium – Hypercalcemia due to bone remodeling
Anemia – the plasma cells that make up the malignancy crowd out the bone marrow that the marrow can’t make other cell lines such as red blood cells
Kidney Failure – due to increased protein excretion damaging the glomerulus. This also helps them to remember to look for Bence Jones Proteins in the urine
- Don’t put off memorizing material until just before the exam! NOOOOOO CRAMMING!!! Remember that tactic helped us in undergrad but it won’t help us here because you can’t commit things you cram into long term memory and remember medicine isn’t about forgetting what you learned and moving on, it is cumulative knowledge. You won’t remember everything but you have to remember a lot of it or be able to recall it from your long term memory. If you cram the night before, you won’t remember it in a week.
- Frequent review of the material leads to more retention. The more you review a packet over and over again, the more things will start sticking or making sense and you get an idea of what you know and what you don’t know.
2. TIME MANAGEMENT
Another Student MYTH: “I JUST DON’T HAVE ENOUGH TIME TO GET IT RIGHT". I get it. The hours are long, there isn’t much time to study, you need to sleep… yada yada….(insert violin player and sad woe-is-me music). But this is what you signed up for. You can’t learn all of medicine in a couple of years without time and sacrifice. It is all about maximizing the little time you do have. A few tips on how to do so…….
- Set aside adequate time for studying: Even with study tips, they are tips to help you STUDY (the operative word here). You have to put in the time.
- BREAK UP THE STUDY WITH SOME BREAKS! Another big mistake students make (especially those who found themselves in that deep dark place of academic issues) is they study for hours on end, thinking that the chunk of time will allow them to learn it. I sometimes teach my students for 7 hours straight. The first 45 minutes they are into the lecture and then close to the hour, they begin to nod their heads, look at me with puppy dog eyes to have mercy on their souls, some snore loudly, some snore silently but drool a lot, and their brain starts shutting down etc. So I give them a break every hour and I do activities where they move around or do case studies or presentations just to get the brain to learn a different way and to give the brain a rest. You won’t learn if you are completely tired or if you don’t give yourself a break! Students fail to realize those breaks make those 45 minutes in between much more efficient. For example, lets say you have those 6 hours as above and you are studying for Pharmacology, Infectious Disease, Anatomy and Pathology (the dreaded test you didn’t do well on the first one and there are only two for that course) and you are one of the ones whose brains are fresh in the beginning. then your study should look like this:
- Pathology 12p -1p (break 1:15-1:30p)
- Pathology 1:30 – 2:30 (break 2:30 – 2:45p)
- Pharmacology 2:45p- 3:45p (break 3:45p-4:00p)
- Infectious Disease 4p- 5p (break 5p – 5:15)
- Anatomy 5:15-6:15p
- PRIORITIZE AND ORGANIZE TO MAXIMIZE the time you have by using it more efficiently. In other words if you decide you have 6 hours of study time (I know I know how often does that happen) and you have 4 exams that week and you are going to study every day, do 2 hours of the exam coming first and then an hour for the other exams. As the exam passes and you have new material, then always re prioritize which should get more of your time. A big mistake students make is using all 6 hours to study all the material in one exam and that will hurt your scores in the other exam. Some people prefer to set aside the most important topics in the beginning when the brain is freshest or some at the end (because they retain what they look at last better). You have to figure out which type you are to maximize the learning. Now you didn’t hear this from me, but for those who are caught in a hairy predicament. the have fallen behind and you have 4 exams this week but 3 of them counts for the same class and you have lets say 6 exams in that course that count to your final grade but the 4th exam you have that week is for a course that only has 2 exams and you didn’t do well on the first one (and if you don’t pass the second one, you will have to take a remedial or fail the course), then you need to prioritize that exam so that in the long run you are in better academic standing. If you don’t do as well on an exam where getting a bad grade in the long run won’t affect your overall score then you have to think about the long-term. Again you didn’t hear it from me and if you did all the things that I mentioned before, you wouldn’t find yourself in that dark, dark place.
And when you take a break, walk away from the study area, take a walk, catch up on your social website, pet your dog, cat or pet tiger, listen to music, call and cry to a fellow student that I am making you study for 6 hours. But do something to temporarily take your mind off the material and that is relaxing.
- GET SOME ZZZ’S TO GET SOME AAA’S: Another big mistake students make is to study all through the night and go to the exam with only 2 hours of sleep. While this strategy may work for very few and far between, fatigue means you are more likely to make smaller mistakes and your brain won’t function at its peak when you are sleepy. Do you want a sleep bus driver driving you to PA school??? Probably not (unless you want to use the excuse the bus accident delayed you from taking the exam). You should be well rested so you can perform at your best on the exam.
- STUDY GROUPS ARE NOT THE TIME TO STUDY…WELL SORT OF: Study groups are not for everyone. Many people do better studying on their own. But if you decide that study groups are good for you (which many are, you also have to maximize what you get out of that. Though it is called a study group, most of your studying should have been done before you go to the group. You want to be able to contribute to the group and if someone doesn’t understand a concept, you may be able to explain it in a way that they can get it. in you explaining it, you reinforce that concept in your head. Also since you studied, you know which issues you need help with to pinpoint your focus in the group. And no one likes that person who is slowing down the group because they are trying to write down everything being said because they have no clue what is going on. Make sure the socializing is limited. It is a study group not a social group. No talking about TV or who is hottest guy or girl in the PA class etc. That cuts into study time. Quiz each other, break up tasks areas and assign each person so they can tackle a subject and quiz each other make up some scenarios to apply the information you learned clinically. When a question is answered wrong, try to help explain why it was wrong to help each other learn. Sometimes you think you understand a topic until you get a question wrong sand you realize that you may not have totally understood a key concept that you thought. Plus, students discussing topics may have made you realize there was key area that you missed but them discussing it brings your attention to that detail.
FINAL THOUGHTS FOR THE FINALS
- Not all technique works for all people – find which ones works for you
- If you try a technique and it works, use it
- If it doesn’t work, assess if it needs to be utilized better, altered or changed
- Don’t become too discouraged, it takes time to get an effective
With this information you can cruise and soar above the waves instead of sinking into the deep abyss! And have a blast learning medicine at the same time!
Great Studies to you!!!!
Dwayne A Williams is a clinical professor at two PA programs and the author of Pance Prep Pearls, a study guide for the PANCE and PANRE available on amazon.com. For more information, visit http://www.pancepreppearls.com