{"id":15157,"date":"2020-09-02T11:43:06","date_gmt":"2020-09-02T18:43:06","guid":{"rendered":"http:\/\/depts.washington.edu\/medex\/?p=15157"},"modified":"2021-09-29T06:21:07","modified_gmt":"2021-09-29T06:21:07","slug":"a-challenging-year-to-be-a-pa-student","status":"publish","type":"post","link":"https:\/\/familymedicine.uw.edu\/test\/a-challenging-year-to-be-a-pa-student\/","title":{"rendered":"A Challenging Year to be a PA Student"},"content":{"rendered":"\n<span class=\"dropcap\">\u201c<\/span><span style=\"font-size: 18pt\">2020 has been kind of crazy,\u201d<\/span> says Joesie Bowdish of MEDEX Seattle Class 52.\n\nShe may as well be speaking for all of us, with the widespread effects of COVID-19 and a U.S. Presidential election year. Nothing is as it was, especially for physician assistant students.\n\nWhen we first caught up with Joesie it was in January during the tail end of her 4-month family medicine preceptorship at <em>Kaiser Permanente<\/em> outside Seattle. A month-long surgery rotation at <em>Virginia Mason Clinic<\/em> followed. But by mid-March, her behavioral medicine rotation was interrupted when the University of Washington decided that all students should be pulled from their clinical environments out of an abundance of caution.\n\n<iframe loading=\"lazy\" title=\"Joesie Bowdish, MEDEX Seattle Class 52\" width=\"1020\" height=\"574\" src=\"https:\/\/www.youtube.com\/embed\/d2xt1Gci_dA?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe>\n\n\u201cI was sad,\u201d Joesie says. \u201cAs a student, you\u2019re in a groove, right in the middle of your clinical year with a daily routine of learning and studying. Having that interruption was unfortunate.\u201d\n\nWhile UW Medicine took the time needed to determine the safest course forward for all of their clinical students, the MEDEX leadership evaluated online education tools to keep their second-year students engaged and moving towards graduation. A programmatic decision was made to go with <em>i-Human Patients<\/em>, an online learning tool that simulated clinical patient encounters. For 12 weeks, Joesie and her cohort were required to shift their focus from actual patients under the guidance of a preceptor to working from home with virtual patient case studies.\n\nOnce UW determined the necessary precautions to safely return students to clinical rotations on June 22<sup>nd<\/sup>, MEDEX counted those 12 weeks of <em>i-Human<\/em> towards the students\u2019 education. The remaining rotations were shortened, allowing the 2020 students to graduate in early October instead of the customary August.\n\n\u201cI think MEDEX did a good job, given the circumstances, with keeping clinical year students engaged in learning, while also not delaying graduation too much,\u201d says Joesie. \u201cI definitely feel like it could have been a lot worse. I&#8217;m happy with the outcome and soon we can get started with our careers.\u201d\n\nJoesie Bowdish was born in Powell, Wyoming, but lived in the city of Laramie, WY located in the southeast corner of the state. She had connections to Washington State as well.\n\n\u201cMy grandparents and aunt Tina live here in Washington, which has been really nice. My grandparents live in the Olympic National Forest area and my aunt lives in Snohomish. Prior to PA school, my immediate family from Wyoming would frequently come to Washington to visit family during the summers.\u201d\n\nJoesie remembers both grandparents having health issues. Her grandfather is a cancer survivor and she recalls accompanying him to appointments when she was little, sitting in the waiting room.\n\n\u201cI made a lot of trips to the doctor\u2019s office with both of them as a child,\u201d she says. \u201cAnd, despite his fight with cancer, my grandpa is still alive and doing well. It was amazing to me that medicine could change his life in that way.\u201d\n\nAs a result, Joesie knew she wanted to do something in medicine. \u201cMedicine interested me, so I explored different fields.\u201d In turn, she worked to become a physical therapy technician, a certified nursing assistant, a pharmacy technician, and an emergency medicine technician. \u201cJust a large variety of experience,\u201d she says. \u201cI was trying to figure out what field of medicine was the best fit for me.\u201d\n\nAll that in the space of her 26 years.\n<div>[smartslider3 slider=264]<\/div>\n&nbsp;\n\n<span class=\"dropcap\">J<\/span><span style=\"font-size: 18pt\">oesie attended the University of Wyoming<\/span> for her undergraduate work. Initially, she entered the pre-pharmacy program at the University of Wyoming and worked as a volunteer pharmacy technician at the Downtown Clinic in Laramie, which provided pharmaceuticals and healthcare to the underserved population.\n\n\u201cMainly, I was counting pills and putting them in bottles,\u201d she says. \u201cI am a very social person and love to interact with people. I didn\u2019t enjoy this job as much because I wasn\u2019t getting to interact with patients. So, I decided that, regardless of what I do, I needed to get some hands-on patient experience.\u201d\n\nSo, Joesie obtained her Certified Nursing Assistant license, working for a couple of years at care centers in Laramie.\n\n\u201cWorking as a CNA was rewarding but very exhausting,\u201d she tells us. \u201cThis job is a lot of, what some would consider, grunt work. You\u2019re helping people do anything that they are unable to do themselves\u2014lifting them, feeding them, taking them to the toilet, etc. It was a great experience, but very physical and emotionally exhausting.\u201d\n\nAfter working at care centers, Joesie decided to venture into home health.\n\n\u201cI enjoyed working in home health because these patients have a little more autonomy. They&#8217;re able to do most of their necessary daily activities and may just need help with the shower, taking their medication, or they may just want someone to talk to.\u201d\n\n<figure id=\"attachment_15178\" aria-describedby=\"caption-attachment-15178\" style=\"width: 400px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-15178\" src=\"https:\/\/depts.washington.edu\/medex\/wp-content\/uploads\/Bowdish-VERT2-400x600.jpg\" alt=\"\" width=\"400\" height=\"600\"><figcaption id=\"caption-attachment-15178\" class=\"wp-caption-text\">Joesie Bowdish of Seattle Class 52<\/figcaption><\/figure>\n\nEventually, Joesie decided that she might want to go into the field of physical therapy.\n\nShe changed her major to Kinesiology and Health Promotion at the University of Wyoming. \u201cI wanted to go into physical therapy because I was fascinated by the human body and how it moves.\u201d Joesie did a summer PT internship in Lander, WY as a physical therapy technician.\n\n\u201cThis internship was great because I was able to work hands-on with patients. I was able to talk with them and get to know them as individuals, which is something that I love to do.\u201d\n\nBut physical therapy also highlighted aspects of patient care that were different.\n\n\u201cI just felt like there was some aspect of medicine that was missing for me. And I wasn&#8217;t quite sure what it was.\u201d\n\nAll of this was very stressful for Joesie. Yet she felt that she couldn\u2019t change her career path yet again.\n\n\u201cThe field of physical therapy is wonderful, don&#8217;t get me wrong,\u201d she reports. \u201cI guess I just felt restricted in some ways. I wanted to be able to prescribe. I wanted to be able to diagnose more than musculoskeletal conditions. I wanted to play a more comprehensive role in a patient\u2019s care.\u201d\n\nJoesie decided that either medical school or PA school would give her the kind of autonomy she hoped to get out of medicine, and to \u201cbe able to help people like the doctors and providers that helped my grandpa,\u201d she says.\n\nDuring this same period of time, Joesie had been working on the side as a home health aide for more experience. After her summer PT internship had concluded, she returned to CNA work for two years, while in school, before landing a job as an ER Tech in the emergency room at Ivinson Memorial Hospital in Laramie, WY.\n\nJoesie chose the physician assistant pathway because it was recommended to her by several providers. The flexibility afforded by the PA profession was a big draw too.\n\n\u201cAs a PA, you&#8217;re not restricted to one aspect of medicine, you can freely explore all of the fields that are available and find the best fit for you,\u201d she tells us.\n\nStill, there were big hurdles to overcome. PA school was notoriously competitive. Others told her not to expect to get in with her initial application. She was advised to get a job, apply, figure out what she could do better the next time, then reapply the following year.\n\n\u201cI was told that you don\u2019t get accepted your first time applying.\u201d\n<div>[smartslider3 slider=265]<\/div>\n<span class=\"dropcap\">F<\/span><span style=\"font-size: 18pt\">or Joesie, MEDEX in Washington State<\/span> was her number one choice. Partially because she had family who lived there, but also because she knew that MEDEX had a good reputation for its education and was a top-ranked PA program. Not willing to bet on one horse, she also applied to schools in California, Oregon, Florida and Arizona.\n\n\u201cI had interviews with all of them but was able to cancel the other interviews once I was accepted into MEDEX since it was my first choice for a PA school and also my earliest interview.\u201d she tells us.\n\nWhen Joesie received the acceptance call from Associate Professor Keren Wick of MEDEX, she was with a home health patient.\n\n\u201cI ran out into the hall to take the call. It was a really good feeling. I thought it was unlikely that I would be accepted at MEDEX, given how great of a school it is and how competitive their application process was. So, when I heard the news, I was really excited.\u201d\n\nWe asked Joesie why she believes MEDEX selected her for Seattle Class 52.\n\n\u201cI had a decent variety of patient experience,\u201d she says. \u201cI had good grades in undergrad and took a lot of challenging classes. I felt like my interview went well. I just tried to talk to the interviewers like I would with any other person.\u201d\n\nKaren Wick, Ph.D., Associate Professor, MEDEX Director of Research and Graduate Programs, recalls that same in-person interview session.\n\n\u201cJoesie was able to talk through that and present her genuine self,\u201d Keren explains. \u201cSome interviewees overcompensate and come across as a \u2018character\u2019. &nbsp;Joesie was able to articulate her life experience. &nbsp;The fact that she worked through different health professional options before landing on the PA field meant that she came to us with a pretty good idea of what she was getting herself into, which is very important to have a good fit. &nbsp;MEDEX also gives preference to our service region, which includes Wyoming. &nbsp;And the fact that she could describe healthcare needs of the rural and urban needs in Wyoming spoke to her fit with the MEDEX mission.\u201d\n\nJoesie concurs. \u201cI definitely came from a rural area and was able to see, firsthand, the need for family practice and primary care providers in these areas. I was able to talk about these experiences in my interview. I think that was probably helpful. I also know that MEDEX is big on diversity and I definitely come from a diverse background.\u201d\n\nJoesie\u2019s dad is African American and her mom is white.\n\n\u201cI have a unique background,\u201d she tells us. \u201cI didn&#8217;t know who my biological father was until I was 14.\u201d Joesie\u2019s adopted father, Wayne Graves, is also African American. \u201cHe and my mom met when I was two. He actually has a son who is eight days younger than me \u2013 Derek. So, Derek and I were raised together. It&#8217;s actually kind of crazy because Derek and I look identical despite having completely different biological parents. Wayne later adopted me, so that\u2019s my dad.\u201d\n\nJoesie recalls growing up in rural Wyoming with a biracial background.\n\n\u201cI didn\u2019t see a lot of people that looked like me or my dad,\u201d she says. \u201cIt never bothered me, and I never had any issues. I just remember when I was really little wondering, \u2018Why am I tanner than everyone else?\u2019 You know, you just don&#8217;t understand at that age.\u201d\n\nEven to this day, Joesie hears from friends that are doing their clinical rotations in Casper, Wyoming. \u201cAnd they see less diversity in terms of ethnicity and race, so I was definitely unique.\u201d\n\nWe ask about the specific healthcare needs of the people of Wyoming.\n\n\u201cThere&#8217;s just not enough providers,\u201d Joesie says. \u201cPeople will often go without healthcare or they will receive lower-quality care because many rural places are desperate to get help. Many times, rural clinics will take whoever that they can, to a certain extent. That could lead to lower-quality care. Even if they were able to recruit good providers\u2014let\u2019s say you have two or three of them for all of these patients\u2014that\u2019s going to lead to lower-quality care because there&#8217;s just not enough working hands for the situation.\u201d\n\nThen there are concerns about behavioral medicine.\n\n\u201cIt\u2019s a huge issue in Wyoming,\u201d Joesie says. \u201cMany people struggle with addiction. I&#8217;m actually writing my Capstone Project on the criminalization of mental illness in relation to rural and underserved areas.\u201d\n\nHer father, Wayne Graves, works in behavioral medicine for the National Guard and Veterans Affairs.\n\n\u201cI&#8217;ve just seen the lack of resources for these patients in the state. There&#8217;s a need in these communities and eventually, I would like to give back and contribute.\u201d\n<div>[smartslider3 slider=266]<\/div>\n<span class=\"dropcap\">W<\/span><span style=\"font-size: 18pt\">hen we first visited with Joesie<\/span> in January of 2020 she was finishing up her 4-month preceptorship under Dr. Amanda Brender at <em>Kaiser Permanente<\/em> in Factoria, WA just outside of Seattle. As reported earlier, much has happened since the start of her clinical year including an episode with COVID-19. She was able to trace this to a trip home to Wyoming.\n\n\u201cMy dad had just gotten back from a deployment in Kuwait so, I went to Wyoming in July to see him. Shortly after I got back from Wyoming, I started having minor symptoms,\u201d she tells us. On July 28<sup>th<\/sup> Joesie was tested and diagnosed with COVID-19.\n\nIn the intervening weeks, her recovery has gone very well.\n\n\u201cI feel very fortunate about my body&#8217;s response,\u201d she says. \u201cI had a majority of the symptoms associated with the virus, but my fianc\u00e9 was basically asymptomatic besides loss of smell. My sense of taste and smell have returned, and I was left with a bit of a cough and some shortness of breath. But I have asthma so that&#8217;s pretty typical for me after a viral infection.\u201d\n\n<figure id=\"attachment_15177\" aria-describedby=\"caption-attachment-15177\" style=\"width: 400px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-15177\" src=\"https:\/\/depts.washington.edu\/medex\/wp-content\/uploads\/Bowdish-VERT1-400x600.jpg\" alt=\"\" width=\"400\" height=\"600\"><figcaption id=\"caption-attachment-15177\" class=\"wp-caption-text\">Joesie Bowdish with preceptor Dr. Amanda Brender<\/figcaption><\/figure>\n\nDuring her recovery, Joesie continued her second-year clinical duties virtually. In August, she worked under Kelsey Wozniak, PA-C at the <em>Rehabilitation Institute of Washington<\/em>.\n\n\u201cKelsey is a MEDEX graduate so she gets it,\u201d says Joesie. Essentially, Kelsey allowed Joesie to join all patient sessions via telehealth to allow her to complete the clinical rotation requirements on schedule.\n\nOn August 8 Joesie was able to leave isolation. She was doing so well with telehealth that Kelsey decided to finish out the rehabilitation rotation in the same way. Next is an underserved rotation at <em>Harborview<\/em> with Dr. Ying Zhang, and then a behavioral medicine makeup rotation in Pasco, WA.\n\n\u201cI think that will be a virtual experience as well,\u201d Joesie says.\n\nPerhaps the most influential experience was the general surgery rotation under Neil Wiegand, PA-C at <em>Virginia Mason Clinic<\/em> back in February.\n\n\u201cIt was a great experience,\u201d she says. \u201cWe&#8217;re actually still in contact and good friends now. I learned a lot from Neil and the surgeons at VM. And the experience pushed me in the direction that I want to go into after school. Not general surgery, mind you. What I enjoyed the most was the inpatient rounding we did on surgical patients post-operatively. So, right now I\u2019m applying for fellowships in hospital medicine.\u201d\n\nSuch fellowships allow individuals entering the medical workforce to gain more experience. For Joesie, this is important especially after the two-month break and the resulting shortened rotations.\n\n\u201cI have applied to some really great fellowships, with my number one choice being in Colorado, given the close ties that I have to that area. However, I was selective in the fellowships that I applied to and I know each one of them would help me to achieve my goals. I do understand that the PA profession is one where you do a lot of learning on the job, but when wanting to go into a specialty field, I think furthering my education would allow me to be the best provider possible for my future patients.\u201d\n\nLooking back on the totality of her time at MEDEX, there have been challenges for sure. But Joesie is especially appreciative of the foundation provided during the didactic year in the classroom.\n\n\u201cD.J. hammered things into our brains, including many professional and life lessons that he shared with us.\u201d\n\nJoesie is referring to D.J. Smith, MCHS, PA-C, MEDEX faculty, and Assistant Director of Academic Affairs.\n\n\u201cHe changed the way that I would like to practice in the future, and I know he has had a similar impact on other students in my cohort. A lot of his lectures have stayed with me and I know they will stick with me in the years to come. I want to say thank you to DJ specifically because he takes so much time to make sure that students are learning and getting the most out of the didactic portion of the curriculum. But I also want to say thank you to the rest of the didactic and clinical year faculty. I want them all to know how much I appreciate their efforts and everything they&#8217;ve done for us.\u201d\n","protected":false},"excerpt":{"rendered":"<p>Joesie Bowdish of MEDEX Seattle Class 52 saw her clinical year begin near the start of the COVID-19 pandemic. As a result, there was a disruption in the school year as MEDEX Northwest and all PA programs worked to develop the path forward. Resilience was required throughout 2020, with Joesie and her cohort tested along the way. Now close to graduation, Joesie\u2019s familial ties, native intelligence and Wyoming roots have done much to see her through these challenges.<\/p>\n","protected":false},"author":1,"featured_media":15891,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8],"tags":[],"class_list":["post-15157","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical-experience"],"_links":{"self":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/posts\/15157","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/comments?post=15157"}],"version-history":[{"count":1,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/posts\/15157\/revisions"}],"predecessor-version":[{"id":15892,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/posts\/15157\/revisions\/15892"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/media\/15891"}],"wp:attachment":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/media?parent=15157"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/categories?post=15157"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/tags?post=15157"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}