{"id":9159,"date":"2016-08-02T09:30:18","date_gmt":"2016-08-02T16:30:18","guid":{"rendered":"http:\/\/depts.washington.edu\/medex\/?p=9159"},"modified":"2016-08-02T09:30:18","modified_gmt":"2016-08-02T16:30:18","slug":"a-year-of-confidence-breaking-then-making","status":"publish","type":"post","link":"https:\/\/familymedicine.uw.edu\/test\/a-year-of-confidence-breaking-then-making\/","title":{"rendered":"A Year Of Confidence Breaking, Then Making"},"content":{"rendered":"

S<\/span>arah Kopke is rounding the bend<\/span><\/strong>, ever closer to graduation from MEDEX Northwest and her new career as a physician assistant. There\u2019ve been some obstacles along the way, most notably two knee surgeries that will delay receiving her diploma by three months. At the time of our visit, Sarah is fulfilling her family medicine preceptorship\u2014a 4-month long preceptorship under John Melgaard, PA-C at Family Health Associates in Coeur D\u2019Alene, ID.<\/p>\n

This placement follows a rigorous series of six 1-month rotations designed to expose her to a wide range of medicine. Before that was a full year spent studying in the classroom. Still, her entry into the clinical rotations came as a shock to the system.<\/p>\n

\u201cI came in having studied really hard for multiple years, and then it didn’t feel like I knew anything at first,\u201d she tells us. \u201cNow of course, I do know something, but the things you don’t know tend to kind of outweigh the things you do know, or at least outshine them.\u201d<\/p>\n

Ah, the familiar terror of entering the clinical year. How obviously does my ignorance show through? Will I break the patient? Through it all, Sarah would hear her teachers say, “Trust in the process. Trust in the process! It will happen! You’ll get confidence, you’ll get skills, just give it time.”<\/p>\n

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Still, in contrast to the didactic year, this is much closer to where Sarah wants to be.<\/p>\n

\u201cAfter the first year of just being buried in a book and choosing to kind of ignore a lot of joy in life, the second year has been awesome. It’s been amazing to actually put into practice what I studied so hard for. And then it’s been a year of confidence-breaking, and breaking, and breaking, and then making, making, making. If you’re looking for a pat on the back, don’t look for it in clinical year.\u201d<\/p>\n

\u201cAfter the first year of just being buried in a book and choosing to kind of ignore a lot of joy in life, the second year has been awesome. It’s been amazing to actually put into practice what I studied so hard for. And then it’s been a year of confidence-breaking, and breaking, and breaking, and then making, making, making. If you’re looking for a pat on the back, don’t look for it in clinical year.\u201d<\/p><\/blockquote>\n

Prospective PA students, take notice. The work of physician assistant education can be challenging and ego deflating.<\/p>\n

Sarah Kopke came to the MEDEX program after seven years as a physical therapist assistant. Her first rotation at MEDEX was in Sports Medicine at UW, so you\u2019d think there\u2019d be a lot of familiarity. \u201cEven with my years of orthopedic experience, I still felt like a fish out of water,\u201d she says. \u201cOnce in a while, there was a moment of, \u2018Ooh, phew, I knew that!\u2019 But that was my first introduction to flipping the roles, where I was the one asking questions, and the patient was presenting acutely, instead of running the show in a rehab setting.\u201d<\/p>\n

B<\/span>y her fourth rotation<\/span><\/strong>, this one in cardiothoracic surgery, Sarah was beginning to find her footing. It was at Rockwood Heart and Vascular Center where she worked under three preceptors: Dr. Hassan Tehrani and his two PAs, Torey Vail and Ted Banstetter. \u201cThis was very serious surgery,\u201d she says. \u201cVery engaging\u2014you have to stay focused all the time.\u201d<\/p>\n

Dr. Tehrani and his team were extremely courteous and excellent examples of professionals. \u201cThey were always respectful of what I did or didn\u2019t know,\u201d she recounts. The team always encouraged questions, and gently pushed her to participate more in surgery.<\/p>\n

\u201cIt was just a fantastic rotation,\u201d she says. \u201cIt was incredible. It provided the transition that I’d been looking for to bring me from student to this PA professional. From there on out, that rotation was benchmark of a confidence-maker.\u201d<\/p>\n

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An Internal Medicine rotation followed at Kootenai Health in Coeur D\u2019Alene, Idaho. \u201cThat was another eye-opener,\u201d Sarah tells us. \u201cHospitalists are really intelligent people, and as a student, you don’t feel intelligent on a daily basis.\u201d She explained what it\u2019s like to go into a room to examine the patient, to come out, present the case to your preceptor, and just totally mess up the case presentation. \u201cIt’s so messy as a student. First, you\u2019re fixed on your case presentation, and then you have to interpret labs, present labs, and you don’t even know what that lab means to begin with!\u201d<\/p>\n

There\u2019s a lot of research that goes into that kind of rotation. \u201cThere are moments where you really feel stupid, and acquire a big list of things to look up and learn when you go home that night. But once again, those little things you look up over time become a lot of stuff learned.\u201d<\/p>\n

Those two rotations\u2014the cardiothoracic surgery and internal med\u2014were back-to-back for Sarah. \u201cThey were my two most intense rotations, and the biggest periods of growth for me. Kind of roller-coasters, but necessary roller-coasters.\u201d<\/p>\n

\u201cThey were my two most intense rotations, and the biggest periods of growth for me. Kind of roller-coasters, but necessary roller-coasters.\u201d<\/p><\/blockquote>\n

Logistically, these 1-month rotations have their inherent challenges as well. During the first week the student gets to know the facility\u2019s system. \u201cYou scramble around a little bit, learn people\u2019s names, and refine your patient exam skills,\u201d Sarah says. \u201cSecond week, you think, \u2018Okay, I’ve got this a little bit.\u2019 But then inevitably, it’s like, \u2018What? What does that person have?\u2019 Or, \u2018What is that medication?\u2019 Or, \u2018What is going on here?\u2019 The third week, you really know people, you feel a little more confident. The fourth week, you’re golden and finally confident again, usually. And then you leave to start the process all over again somewhere else.\u201d<\/p>\n

E<\/span>xpectations are different<\/span><\/strong> as she enters her 4-month preceptorship with John Melgaard, PA-C at Family Health Associates. For one thing, it\u2019s longer. \u201cJust when you get rolling, you can keep rolling and build on it, and build on it, and build on it,\u201d she says. \u201cAnd not just build on your confidence, but build on the skills, build on your medication knowledge, and your exposure to different pathologies and personalities.\u201d<\/p>\n

\"Vertical-Sarah<\/a>
Sarah Kopke of MEDEX Spokane Class 18 with John Melgaard, PA-C of Family Health Associates<\/figcaption><\/figure>\n

All of this marks progress concerning Sarah\u2019s abilities to assess and think critically, and she is reassured. This is just the beginning, she knows. She started a medical career once before as a PTA (physical therapist assistant). \u201cThree months out of school, I was freaking out, thinking, \u2018I have to go back to school, I don’t know anything!\u2019 I hope that’s how I feel when I get out of MEDEX, because if you come out of school thinking you know everything\u2014or at any point in life if you think you know everything\u2014that is ridiculous.\u201d<\/p>\n

Early in her clinical year Sarah took part in a Global Health elective rotation that brought her to Laos for a month. There, she assisted the teaching faculty of the US-based NGO, Health Leadership International. Her topic of instruction and research, \u2018Treatment and Prevention of Mortality from Common, Non-parasitic Causes of Diarrhea in Children Under-five Years in Southeast Asia and the Lao PDR,\u2019 became the subject of her Capstone Project. This is a long-term investigative project and presentation that is a requirement of Sarah\u2019s graduation from the MEDEX Masters program. \u201cMy formal education would not be complete without that Global Health rotation. I know I\u2019m not the only one who feels that way about international rotations.\u201d<\/p>\n

You can read more about Sarah and her fellow MEDEX students\u2019 Global Health rotation in Laos at https:\/\/depts.washington.edu\/medex\/magazine\/physician-assistants-taking-lead-global-health-education\/<\/a><\/p>\n

\"Sarah<\/a>
Sarah at the right with students from the College of Health Sciences in Luang Prabang, Laos. In November 2015 she traveled to Laos with Health Leadership International as part of a Global Health elective rotation for MEDEX.<\/figcaption><\/figure>\n

Because of the knee surgeries, Sarah will finish her family medicine preceptorship in October, a few months after her cohorts of Spokane Class 18. After graduation she will be participating in an emergency medicine training program for one year in her home state of Maine. \u201cMEDEX has been so supportive,\u201d she says. \u201cThey want to graduate you, obviously. They’ve been supportive not only through two different knee surgeries during this past year, but also in finding the right clinical situations for me. I also have to say a big thanks to Patty Hahn, RN, MN, ARNP, a Spokane instructor who was always a little bird in the back of my mind telling me I could do emergency medicine if I wanted to.\u201d<\/p>\n

Looking back, she speaks with great fondness of her cohorts from Spokane Class 18. \u201cA class can be totally divided, or can really come together,\u201d she says. \u201cI feel like we are the latter. There’s a lot of buddies in my class, a lot of lifelong friends. Some of my best friends in life I\u2019ve made through school situations. You’re thrown into these brain-boggling moments together, and frustrated that you don’t have a life, and sometimes you have to study this thing you’re not interested in but at least you can do that together. I definitely feel lucky to have the classmates I do, and look forward to continuing to see them in real life<\/em> after school.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

After a year of classroom study, Sarah Kopke discovers how little she actually knows when working with patients. Closing in on her graduation from MEDEX Spokane Class 18, Sarah speaks eloquently about the ego-breaking aspects of physician assistant education during the clinical year. But from this comes new growth and refined skills. Sarah has the makings of an outstanding PA committed to lifelong learning. <\/p>\n","protected":false},"author":1,"featured_media":9171,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8],"tags":[],"class_list":["post-9159","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\/9159","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=9159"}],"version-history":[{"count":0,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/posts\/9159\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/media?parent=9159"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/categories?post=9159"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/tags?post=9159"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}