LCE – Semester 1

Longitudinal Clinical Experience (LCE)

As part of the PA program at U of T, each student is required to do a minimum of 30 hours (max of 40hrs) of clinical experience per semester. These experiences are arranged by the student and are flexible, except that at least 10hrs have to be primary care. In the first semester, it is strongly recommended that we have allied health experiences (ie with healthcare professionals who aren’t MDs).

Why bother having small clinical experience when we are going to have clerkship rotations for all of second year? The answer is that earlier exposure to clinical settings & real life patient interactions better prepares you to make the most of your 2nd year rotations. These LCEs take care of all the “firsts” in clinical care; then in second year, you can jump right in and practice medicine! Also, it’s all fine & well to learn your anatomy, pathology and clinical skills, but having early opportunities to practice your knowledge & skills is extremely useful, especially in this program where a lot of the learning is online. It’s nice to get in a hands-on learning environment!

Between October-November, I have scheduled an average of 5-6hrs per week for an LCE. As with the McMaster equivalent of this LCE (called a Longitudinal Placement, LP), students are responsible for arranging these LCEs are their own. This gives you flexibility but is also a great deal of work. I’ve had great experiences and have fulfilled my requirement. I also built great MD-PA relationships so that hopefully I’ll be able to return to some of these places in 2nd year for clerkship.

I’ve had to write about my experiences as I go to be marked in school, so I have translated some of that here to give those interested an idea of what LCEs are like:

Primary Care – Family Medicine

This was my first LCE & it was with a local family physician in KW who has multiple practices. I joined him at his less-busy clinic, which I was grateful for since this was my very first day in a clinic as a PA student. The only other people in the office besides the patients were myself, the physician, the receptionist & a nurse – it was a very stress-free day. The physician I was with had hired/worked with a PA a few years ago (that PA ended up going to med school & is now an MD returning to become a partner with his old supervising physician!) so it was nice to not have to extensively explain PAs & my role. The nurse presented the patient’s brief history, vitals & reason for follow up to me & showed me how to use the electronic chart system, which helped me out a lot. There were no new patients but I was able practice history taking/interviwing & report to the physician.

What I Saw:

  • Congestive Heart Failure – measured JVP & listened to chest
  • Vasovagal syncope with sinus infection – took a thorough history & learned a lot from this case (I was unfamiliar with vasovagal)
  • Diabetic meds update & counseling – took history
  • 9 month well-baby checkup – observed
  • Lots of psych counseling & prescribing – observed
  • R supraspinatus tear secondary to trauma – read imaging report
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My essentials for my first day in FM

Primary Care – Walk-In

I was very fortunate to be taken on by a new physician in Waterloo who had just opened up a beautiful walk in clinic (soon to be converted to a family medicine practice). This clinic was in the heart of student housing, between the University of Waterloo and Laurier University. As such, a large portion of our population were students which means 4 main things – Strep throat, Mono, Birth control counseling and sick notes. However, there were also babies, children and older adults. I really enjoyed the diversity of patients and the physician was an amazing teacher who I look up to! I hope to be able to go back to this clinic in the future.

I was also able to share some of my knowledge & make a recommendation to the doc re: a 67 year old man with a foreign body sensation in the right eye. Since we did not have a slit lamp to assess him, the doc’s initial plan was to send the man to emerg, in order for the on-call ophthalmologist to assess him. However, since I have worked in ophthalmology, I knew that this would not be a quick process in this region. Since it wasn’t extremely emergent (he said it first started over 1 week ago), I knew it would be much quicker for him to be assessed by an optometrist, for which it would be covered (b.c hes older than 65) and for which there are very many optometrists in Waterloo (b.c UW has the only optometry school in the country). I’m a huge advocate for optometrists as primary clinicians for eye issues & even felt confident that if there was a foreign body, that the optometrist could easily manage it or refer to ophthalmology if needed (also, ophthals like referrals from optoms b.c they’ve already had a good look & reason for referral). Anyway, I was just glad I could help streamline the care for this patient & also provide this information to the doc who was new to Waterloo.

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I love clinics where scrubs is the attire!

Primary Care – Nurse Practitioner

As part of my learning of allied health care professions, I wanted to work with an NP to really be able to answer the question I get asked all the time: “What’s the difference between a PA and NP?”
After 1 day with a lovely NP, I was able to learn a lot about her role. This clinic also had PAs working as well so it was awesome to see the MD – NP – PA dynamic. At this clinic, when the NP and PA were in, the physician used EMR to bill for their service. This involved setting up a laptop or iPad & briefly consulting with the doc between patients. Although on this day, there were some internet difficulties so I was not able to actually see this process actually working.
The PA and NP each get their own list of patients to see and work independent of each other. Both were relatively autonomous clinicians who (usually) consulted the physician. Each of them would interview & assess patients, perform physical exams, order labs/tests, wrote referrals and prescriptions. Practically, both had the same responsibilities but some of the administrative details are what separated their roles.

*I will be doing an in-depth post on the differences between MD, PA and NP both clinically and legally. Stay tuned!

Respiratory Therapy – ICU

It was a wonderful learning experience to learn from a respiratory therapist. The main thing I learned: RTs are ventilator masters. In the ICU, the RTs are responsible for patients on ventilators (very complex), they are part of the intubation process and they also provide recommendations to the physician on how to proceed with the plan, based on their respiratory stats. In addition, the RTs are apart of a large interdisciplinary team that cares for the patients in ICU. These teams include a physician, residents, nurses, dieticians, RTs, social worker, pharmacist, physiotherapist who all round on patients together & formulate a plan for each patient – it’s truly amazing. So, in addition to learning about the role of an RT, I also learned about how many allied clinicians work together in interdisciplinary teams.

Psychiatry – Inpatient

I know I keep saying all of my preceptors are amazing, but that’s because they are! I have been so fortunate to have wonder physicians who are happy to teach me & treat me with respect – the same goes for the physician I worked with in the psychiatry ward at Grand River Hospital. Going into this LCE, I was nervous & did not know what to expect; but I ended up learning so much & loving this field. Much like the ICU, there were interdiscplinary teams involving the physician, nurses, social workers, CCAC workers & other professionals that help patients develop skills & make plans for how to manage their symptoms after they are discharged (usually a short list of places for them to go and numbers to call if they are feeling unsafe). What I loved most about psych was the relationship built with the patients & the care given to how their life will be after they’re discharged. It was an amazing experience that I hope to go back and do again in the future!

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Pathology – Coroner’s Autopsy

This was a very unique experience (to say the least). Since this semester there was an emphasis on primary care & allied health, one of my classmates, who was a former pathologist’s assistant, offered to arrange for anyone who wanted (almost everyone in my class did) an LCE at the coroner’s office where she used to work. Essentially, us as PA students (up to 4 of us at a time) would join pathologists, researchers, fellows, residents & medical students to observe autopsies for a day.

Definitions:

1. Coroner: medical doctors who have been through specialized death investigation training and have been appointed to investigate sudden deaths. A coroner is called to investigate a death that seems to be the result of unnatural causes or natural deaths that occur suddenly and unexpectedly.

2. Pathologist: medical doctors who are experts in disease and injury. May perform autopsies.

3. Forensic Pathologist: pathologists who are experts in disease and injury that result in death. Perform autopsies.

4. Medicolegal Autopsy: The coroner, usually in consultation with a forensic pathologist, will decide if an autopsy is needed. An autopsy (postmortem exam) is when a pathologist/forensic pathologist examines a decedent’s body to help determine cause of death.

The Morning:

  • 8:00am – Arrive, sign in, get badges, discuss the day, dress in lab coats & shoe covers
  • 8:30am – Rounds start. The whole team visits the gurney of each patient to plan the autopsy & discuss each case: the team included myself & 2 of my classmates, a few pathology fellows, a 2 pathologists, 2 clinical researchers, 1 PGY1 pathology resident, 1 medical student, many pathology assistants & case photographers
  • 9:30am – Autopsies begin. The team splits up into pathologists/pathology assistants; one team starts on one case, another starts on another & so forth. There are multiple autopsy stations (~10) set up in the room so that many can occur simultaneously. As learners, we could circulate between cases as we pleased.
  • 11:30am – First autopsy that I observed, completed. This one took longer than the others, because of many findings & difficult dissections. Head to another case.
  • 12:00pm – I left before the next case was done. I had enough for the day.

If I’m honest, I was terrified to do this LCE. I was in the 4th “round” of students to go & after hearing about everyone’s experiences, my fear only intensified. I was comfortable around cadavers but I was told (and now know) that the deceased are totally different from cadaveric specimens. A lot of my classmates witnessed homicide & suicide cases; many felt very traumatized. We spent a lot of time as peers discussing our experiences with each other, since it helped us overcome our sadness/fears/concerns/anxiety/distress. We were all very supportive of each other, which I am truly grateful for.

I felt lucky, in the sense that I did not experience any major traumatic cases. Other than rounds, I followed the same pathologist working on the same patient for the whole morning. I’m going to describe very briefly a run down of the case to give an idea of what we experienced.

*CAUTION, SENSITIVE/DISTURBING CONTENT WILL BE DESCRIBED. READ ON AT YOUR OWN DISCRETION. NO IMAGES WILL BE SHOWN*

  • 48 y/o paraplegic for 10 years (secondary to MVC) with recurrent osteomyelitis in the R hip (present on postmortem CT). I did not record/cannot remember other history about his initial ER presentation, previous surgical history etc.
  • Images were taken posteriorly & anteriorly of specific regions (by a specially trained pathology photographer)
  • R hip examined closely; bone samples taken; exterior examination (by pathologist assistant & pathologist)
  • Sternum/anterior rib removal. Bowel drainage & removal. (by pathologist assistant)
  • Peritonal & mediastinal organs removed. (by pathologist assistant)
  • Face/skin from skull retracted. Skull top removed to retrieve brain & associated features. (by pathologist assistant)
  • Heart dissected; R coronary artery thrombosis & atherosclerosis found. No signs of myocardium damage; likely no MI. Sample of artery & myocardium saved for microscopic exam. (by pathologist)
  • Spleen dissected; excessive spleenomegaly. Indicative of sepsis. Sample for microscopic exam. (by pathologist)
  • Lungs, trachea, esophagus, tongue, stomach, duodenum, gallbladder, liver dissected. Duodenal ulcers, fatty liver & esophageal petechiae found. Samples saved. (by pathologist)
  • Spinal nerve, brain, meninges dissected. Samples saved (by pathologist)
  • Organ remains placed in bag. Bag tied & placed into abdominal cavity. Abdomen sutured shut. Facial skin pulled back over skill & stitched.
  • Pending verdict for sepsis originating from R hip

What I found particularly interesting was the different roles of the pathologist and the pathology assistants.

Advantages & Challenges of LCE: Location?

The great thing about having a portion of this program distance-based, is that you can organize these clinical experiences wherever you want, including your home town. Not only is this spatially convenient, but it also allows you to build professional relationships with future employers in the city of your choice. (Eg. I would love to work in Waterloo someday so by having placements here, I’m building connections with possible employers & gaining a good understanding of the potential PA job market here!). You’re able to being to establish yourself in a place where there may not be a saturation of PAs (is there such thing in Canada?) or med students (competition is tough). The freedom also gives you the opportunity to have a wide variety of experiences, such as when I went to Toronto for the pathology day.

Personally, I have experienced some challenges with arranging my own LCEs. Although we have the freedom to arrange LCEs where we want, that isn’t to say that everywhere will take us. Competition with medical students and residents at teaching hospitals makes it hard to get in. However, with perseverance, an excellent recruitment speech/strategy and the right contacts, anything is possible.

Bonus: Ultrasound Skills at CHEST Conference

Although this was not an LCE, I learned the basics of ultrasonography that will help me in future LCE’s & clerkships.

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U of T PA Admissions

October of 2016 was the time I began preparing to apply to the U of T PA program. Since it’s that time of year again, I thought I’d share my admissions experience as well as some helpful tips! Some basic admissions stats: it was circulating on last year’s forum that there were ~650 applicants (not official) last year to the U of T PA program. Of those 600, 88 were invited to the MMI. And of those 88, 30 applicants were accepted for the class of 2019.

Admission

Step 1: Read & Evaluate

Before you put up your money & effort to apply to the program, make sure you know what you’re getting yourself into. This is the most important step. My #1 piece of advice for this step is to read. Get your hands on any/all info about the PA profession (Canada and other countries); what a PA does (or doesn’t do), what PA education entails, job opportunities for PAs etc. Read about other people’s opinions on PAs: get the positives and the negatives. Why do some physicians oppose while others praise PAs? What are other allied health care professional’s views on PAs? How do PAs work in interdisciplinary teams? What is the political, regulatory, financial state of PAs in Canada? All of these things you should be able to answer, even briefly, before you apply to a PA program. From this info, you should be able to rightly determine whether or not this is something that you want as a career. And then, you should be able to figure out whether or not you would be a great PA.

I also want to emphasize that the PA program is NOT intended to be a stepping stone to another profession (i.e medical school). The profession is working hard to lift off the ground & become established in Canada, and to do so, a strong body of PAs advocating for themselves is what is needed. So if you become a PA just to go to med school, you’re really just hurting the profession & it’s population. BTW this is something that the admissions committee screens for in applicants, since they do not want non-dedicated PA students!

Story-Time: How I Learned About PAs

In my 3rd year of undergrad, I took a healthcare systems class and we had to write an essay about a controversial healthcare topic. I thought this was a perfect opportunity to research the profession (and have it count for something other than my personal knowledge). As I continued my research, I quickly realized I wasn’t going to the get the full picture just from writing this essay. On my “undergrad bucket list” I wanted to be involved in a research project, so the next semester I found a professor to supervise me (she had done work with the midwifery profession) and set out to conduct a systematic literature review on PAs. My plan was for this to be a pilot study to orient me to the body of literature so that for my thesis in 4th year, I could do an actual study on PA regulation in Ontario (but I never made it to 4th year to do so). Anyways, during this literature review, I essentially read every single piece of academic literature on PAs in Ontario (and subsequently in other places, which I had to discard from my study, but still read them anyway). This was a conquerable goal for me as a 1 person research team as an undergrad because the body of literature on PAs in Ontario is not that big (still a lot to read for 1 person). So this was how I came to have a strong knowledge of the PA profession. You can still do this research on your own, without intending to publish it & follow a scientific method. GoogleScholar will be your best friend!

Other helpful resources that I used to become familiar with the profession:

Step 2: Requirements

Now that you have decided being a PA is your dream job & you know everything there is to know about PAs, you can start looking at applying to schools. The 3 civilian programs in Canada (McMaster, U of T, Manitoba) all have different admission requirements. Specifically for U of T you need:

  • Minimum 2 years of undergraduate study
  • Minimum GPA of 2.7 (although the average accepted GPA is much higher…)
    • GPA is cumulative (cGPA), not weighted
  • Minimum 910hours of healthcare experience (the more clinical, the better)
  • English language proficiency proof
  • Supplemental application (mandatory)

For U of T, there are also preferred admissions criteria (although I really think the course ones should be required because it would be really hard to do well in the program without them):

  • Full year course equivalent of Human Physiology, Anatomy & Chemistry
  • Ontario resident
  • Clinical experience that is recent, paid, & direct
  • Resident of Northern Ontario

More specific information can be found here: http://www.paconsortium.ca/admission-requirements

I will hopefully be able to survey my class to get insights into the demographics of who was accepted in our year (if I’m allowed!). So stay tuned for what our class GPA was, the type of experience & education everyone had!

If you meet all of the requirements, you make an application on OUAC (fee involved) & apply to your program of choice.

Step 3: Supplementary Application

This is the part of your application where you really get to show the admissions committee why you would be a great PA (fee involved). You need to show yourself off, brag about your accomplishments and skills. And you also need to not write this last minute in a short amount of time. Take your time with these questions; think them through; edit and re-edit your answers. Perfect them. I personally worked on mine with my career guidance counselor through my University’s career center. While she was not able to basically write my answers for me, she was able to help me take the answers I had written and edit them to be more articulate. I would highly recommend working with your institution’s career center (everyone I know who has been accepted to a professional program has done this).

This section is where you’ll also be able to use all of your knowledge of the PA profession and apply it to your answers. You’ll be able to fit together your experience/skills with what a great PA is.

Step 4: MMI

While it is a huge relief to receive an MMI invitation (competition just went from 649 people to only 87 people) the stakes are still high. ~65% of applicants at the MMI will still be cut. Not to scare you, this just means you gotta majorly prepare.

I heard many people on forums say to read some book called “Doing it Right” or something, but I personally never read it. I think some of my classmates did. However, I have a different piece of advice for those of you in your undergrad: take a variety of health courses. While knowing your biology and chemistry is important, they won’t help you in the MMI. What I found prepared me best, were the courses I took in undergrad including:

  • Social Determinants of Health (don’t bother going into medicine without knowledge on this subject, it changes your whole perspective)
  • Public Health/Health Promotion
  • Aging & Society
  • The Canadian Healthcare System
  • Philosophy
  • Medical Ethics
  • Sociology
  • Psychology etc.

If you’re out of school & have not taken these courses, this technology era is to your advantage: do some self-teaching & read about these topics online or find good textbooks. I recommend Social Determinants of Health 3rd Edition By Raphael for a good Canadian context.

Having a broad understanding of the non-biological aspects that impact human health will not only help you in the MMI but also in your medical career. Seriously, take these courses. Thank me later. These also helped me greatly with my supplemental application (*add to step 3*).

SDOHGraphic

In addition to building up your body of knowledge, I utilized my career centre for MMI preparation. At UW specifically, they had online modules regarding MMIs (basically a mini online course) & also practice sessions. I practiced with my career counselor individually & received feedback and also in a realistic mock MMI, which was basically what the real thing was actually like. I took notes on the modules & studied them right up until I walked into the Michener Institute for my interview. I prepared answers to typical medical school interview questions (although none were asked) to get a flow of how I would describe myself (it’s harder than you’d think).

Since I’m about a 2 hour drive from downtown Toronto, I stayed overnight in a hotel for the interview. I don’t have a car & my parents were out of town so I had no one to drive me. Plus I did not want the stress of Toronto traffic & parking. So staying overnight, the night before, worked well for me. I was able to be comfortable and in a stress-free state of mind going into the interview.

Other general MMI tips:

You’re In!

So there you have it: If you followed steps 1-5 correctly, you should be accepted to the PA program 🙂 (I am not liable if you do not). Just kidding, everyone does this process differently and this was just the way I went about it. I hope you found it helpful! I will go into more detail in another post about examples of clinical hours (since that’s always a HUGE question since the program doesn’t explicitly say what is considered good & bad). Stay tuned!

University of Toronto PA Program – Month 1

Preamble:

OK – I have sat down at my computer to write a post like this, over 10 times. I hesitated diving into this documentation of this program before writing a dedicated entry on what the PA profession is, since I still have a lot to learn about it. And that’s usually what I do when I’m stuck on something…I leave it, and leave it, and don’t touch it. But I decided to just get over the hurdle, ignore what I’m stuck on and start writing about the program itself. I would like to be able to document my journey through these next 2 crazy years for myself & for self-reflection, but also for those interested in the program to get a good understanding of what it entails – there’s no better time to write about your experiences than while they are happening! Before I knew it, my first month was done and I hadn’t written a thing, so I’m starting now and hope to continue all the way through! So here it is:

 

Physician Assistant Professional Degree Program

I will insert my “elevator speech” here as a brief primer on what a physician assistant is: “A Physician Assistant, PA (also called a Physician Associate in other countries), is a mid-level clinician who works under the license of a physician in any setting to practice medicine by extending physician tasks. Under medical directives, PAs are trained as generalists to perform all/any physician-delegated tasks, with room for on-the-job learning to increase their scope of practice. PAs can do most things a physician can do, and can practice in any area of medicine they can be hired into. They are NOT the physician’s assistant. They differ from Nurse Practitioners.”

So essentially, the PA program is a professional, second-entry undergraduate degree program under the faculty of Family & Community Medicine (at the University of Toronto). In Canada, there are 4 PA programs: University of Toronto, McMaster University, University of Manitoba, & the Canadian Armed Forces. Generally, the program is a full-time, 24-month long curriculum delivered non-stop for 2 years that merges didactic & clinical training. It’s really just a condensed version of medical school (PA = 24 months, Med = 32 months, Difference = 8 months). Each PA program is structured differently, and since I am enrolled at U of T, I will be describing the U of T format.

When you graduate from an accredited PA program in Canada, you are eligible to write the certification exam. Although you are not mandated to pass the exam to practice under a physician, the likelihood of being hired without a successful exam score is low. Once a PA is hired (by an institution, family health team or private physician), they start out on the job with similar competencies to a first year medical resident – they have a lower level of autonomy, are still learning/checking in the with supervising physician and are receiving income. As the PA continues to learn in their workplace, they gradually have more autonomy & have less direct physician supervision, the same way a medical resident would. The only difference is that there is no “official” graduation from non-autonomous, to autonomous practitioner. But while you are always legally working under a supervising physician, the autonomy you can gain can be very high. I will make another blog post regarding how PAs actually practice medicine.

The Consortium of PA Education – U of T, NOSM & Michener

Although I said I attend the program at U of T, the program is actually a consortium that includes NOSM (Northern Ontario School of Medicine) and the Michener Institute, but is centrally delivered through the U of T Faculty of Medicine. This program is unique in that it has a distance-education structure with a mission that focuses on “building a foundation of social accountability, particularly to rural, remote and underserved communities.”

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What does distance-education look like in medicine? The way this program is structured, students are required to be physically present in Toronto for learning clinical skills and other hands-on learning (such as Anatomy labs), which are combined into  a few consecutive weeks, called a Residential Block.  For this first year, residential blocks are as follows:

  • September 03 – 30, 2017
  • December 07 – 20, 2017
  • April 09 -27, 2018
  • ~July 23- Aug 20, 2018 (Not yet official)

During these Res Blocks, students are basically in class 8 hours/day learning things that you can’t learn online (how to listen to heart/bowel sounds, how to do a vaginal speculum exam, locating the phrenic nerve on a cadaveric specimen etc.). The December, April & August Res Blocks are also the time for final exams. (Aside: Midterm exams are held at proctored centres nearest to the student’s permanent residence).

FYI: Living accommodations for residential blocks are the responsibility of the student. AKA the program does not provide/pay for living accommodations. The majority of my class lived in/moved to Toronto. A few commuted daily from Mississauga and Brampton. Myself and a few others got AirBnB’s for the month. All others lived with friends/family in Toronto for the month.

Day 1: September 03, 2017

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This day was kind of a blur and was packed full of orientation information & attempts to remember names. There were lots of opportunities to introduce ourselves, and team building activities.

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The Marshmallow Challenge. Our group came 2nd!

We finished off this day of firsts with a beautiful Stethoscope ceremony. As a class, we had our family/supports come to the event and watch as each of us was decorated with our stethoscope, signifying our official entry to the PA program. There were many guest speakers, current/past PA students and faculty. The lovely event was put on by the 2nd year PA Student Association (PASA) and was much appreciated 🙂

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The Class of 2019!

September Residential Block

Here’s what the Res Block for September 2017 looked like for me:

Clinical Skills

Definitely the meat and potatoes of Res Block. Essentially, there were various topics that we had to learn regarding physical exams (Respiratory, Cardio, Abdomen & Pelvis). These were covered in 2 sessions:

  • Session A (4 hours) included a summarized lecture of the components of the exam:
    • Brief anatomy, questions to ask in the history, specific things to look for on observation, and physical exams to perform such as auscultation (listening with the stethoscope), percussion (sound vibrations for dullness), vaginal and/or rectal exams.
    • After lecture, we had the opportunity to go to different stations in groups and practice the exams on each other or on rubber/plastic “patients” (for obvious pelvic reasons)
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PSLs mandatory
  • Session B (4 hours) was the time to put everything you just learned to practice:
    • We were divided into small groups of 6 and went around to stations that had Standardized Patients/SP (patient actors) and a facilitator
    • There would be 1 student assigned to take a focused history and 1 student to perform relevant physical exams, as per the patient STEM (description of the “patient” and what you need to do)
    • The students and patients would act out their roles accordingly, and after the encounter, the student would get feedback from the SP, the facilitator and the peers in the room. It was very stressful but also rewarding when we all could see our own progress!
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First Session A: Vitals

We had up to 2 topics/week (meaning 16 hours/week of clinical skills) and there was a lot of reading to do. For example, for the abdominal topic, you couldn’t just show up to session A knowing nothing, you had to come prepared to practice what you had read! You had to read about relevant questions to ask in the history (OPQRST of abdominal pain), you needed to know the signs/symptoms of common differential diagnoses, you had to know what sort of physical exams to perform, how to perform them and when it was necessary to do so. Basically what I’m trying to get across, was that I spent most of my September preparing and practicing clinical skills. I definitely have learned a lot!

Anatomy

2 hour labs, 3x/week with cadaveric specimens. Online lectures & readings were expected to be done upon arrival to the lab. A lab manual was provided with focused topics and diagrams for labeling. On the last day of class, we had a Bellringer-style exam in the lab: ~30 stations set up with specimens that had pins/markers pointed to a specific part. Questions were asked about each pin such as “Identify; Name one branch off of the specified vessel; *on X-ray* Identify X, be specific” etc. Topics covered were Thorax, Abdomen, Head&Neck and Pelvis. It was interesting because although I had taken anatomy with cadaveric specimens in my undergrad, we had not cover face/neck or pelvis so I was able to learn many new muscles/arteries/bones! The TAs were great and labs were a lot of fun.

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Brought a piece of UW with me

Intro to the PA Role

During Res Block, we essentially just had a few lectures in person as an introduction to the course. There were 3 in-class quizzes and a few modules we had to do at home (work place safety stuff). This course is definitely important, but was not the focus of the Res Block since a lot of the learning can be done online.

Other Sessions

We had various sessions from guest speakers, which included:

  • Study strategies & Learning preferences
  • Canadian Association of Physician Assistants – Discussing the association & membership
  • Interprofessional education introduction
  • Various debriefing sessions with admin in the program – Discussing areas for improvement and areas of strength

Intro to Physiology

We had 2 in class lectures as a primer on physiology before we started the online course on October 02. The session was nice to meet the profs/TAs but was not that helpful honestly (since all lectures are videos that are posted for us to watch whenever).

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Ending our Res Block at Mill Street Brewery

Transition to Learning Online

The rest of the first year (October, November, January, February, March, May, June) is didactic (basically knowledge acquisition through traditional teaching) online. There are lectures/group discussions held via Webcast and there are recorded lectures/videos students to go through on their own time. There are few structured time sessions each week, meaning that you have the freedom to do your studying when you want…as long as you cover everything before the exams. There is a downfall in a short professional program/compressing med school, and it is that each class has ~7 hours of lecture/week (regular undergraduate class is 3 hours/week). So although you have freedom to arrange your schedule as wanted, it’s definitely not “easy” to do the work just because you’re home. It requires vigorous time management skills and discipline in order to succeed. I’m writing this post on my first day back home and already I feel like I’m behind! Here is my first semester online schedule:

  • Physiology: 51 recorded lecture sets, ~45mins/lecture, 1 hour live web-cast tutorials/week, ~11 weeks long, 6 quizzes, 2 midterms, 1 cumulative final exam December 07/2017.
  • Anatomy: 10 modules (1-4 done in September), 1 bell-ringer lab exam (completed in September), 1 midterm, 1 cumulative final exam December 08/2017.
  • Clinical Skills: Transitioned to electronic Problem Based Learning (ePBL) involving 6 case studies with various assignments throughout the term. Oral presentation done in September. Assessment of actual clinical skills learned in September (Cardio, Resp, Abdo, M/F Pelvis) will be assessed via simulation in December. There is also a written final exam in December regarding core competencies.
  • Intro to the PA Role: Various lectures, quizzes, essays, reflections & modules. No recorded lectures, just reading & live Webcast discussion-style lectures.
  • LCE: Longitudinal Clinical Experience … coming soon

I still have yet to navigate this part of the program (moved home 1 day ago) but will keep you updated on how it all goes! I definitely have a FULL schedule so I must get back to physiology. Stay tuned for more info on LCEs & my experiences.

 

 

 

OR 101

This past week, I was fortunate enough to have my first Operating Room (OR) experience. I have had many questions about how I got the opportunity, what I saw and what I experienced so I thought I could make a quick blog post to address these topics!

Disclaimer: All clinical explanations are very basic. Do more research at your own discretion. All images are from google.

How?

As many of you know, I currently work for an ophthalmologist (eye surgeon) and she was kind enough to invite me to one of her Strabismus OR days at Grand River Hospital. Since she doesn’t get many of these blocks, I immediately took up the offer and it was up to me to gain observatory privileges. The hospital doesn’t let just anyone into the OR to watch, so I had to find and fill out quite a lot of paper work beforehand. Luckily, since I have been working with the HELP program at GRH (read more here) I had many of the “tests” completed (this included the blood work, TB skin test, police check etc.) so it was fairly straight-forward to get OR access for me. The forms I had left to fill out included my personal information, the Dr.’s signature, type and date of surgery and other logistics.

Since working in a surgical specialty, I have been considering it as a potential career path and I was so glad to have the opportunity to see if surgery was for me, before applying/making any decisions. It was definitely not what I was expecting and it was not like Grey’s anatomy (mostly).  If any of you are interested in observing surgery or are considering it as a career path, I would recommend volunteering in the hospital or getting to know some surgeons. It’s definitely possible to observe without working for a surgeon, you just have to build connections (and ask nicely!).

What?

As mentioned, I was observing a Strabismus surgery. This surgery is done on the rectus muscles (side muscles) of the eye to change the muscle’s position, weaken or strengthen the muscle in order to make the eye straight. Patients receiving Strab surgery have one or both eyes turning inwards or outwards, obscuring their vision. If prism therapy (making them look through prisms in their glasses to adjust where they look), patching therapy or other non-surgical interventions are unsuccessful, strabismus surgery is recommended at a young age in order for the brain to adapt to/adjust the vision. The older you are, the less likely the surgery will be able to fix your vision (the actual eye will look straight, but your brain won’t interpret the vision and it will still seem like you are seeing cross-eyed). Strabismus surgery can still be done on adults, but mostly for cosmetic purposes.

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The surgeon can perform muscle resection (strengthen) or muscle recession (weaken) in order to turn the eye straight. All of the surgeries I observed were both eye, muscle recessions. Each surgery took about an hour (because all 4 patients were both eyes) and she performed recessions on medial (inner) and lateral (outer) rectus muscles – lateral is much easier since the bridge of the nose does not get in the way.

The eye is prepped with a lid speculum (to hold the lids back) and it must be held in place/fixated with forceps (since we need to get to the side of the eye). Then an incision is made in the outer “fascia-like tissue” called the conjunctiva of the eye. The incision can either be Limbal (less damage to tenon’s capsule, but also much more uncomfortable recovery) or a Fornix incision (less anterior segment blood supply damage, comfortable recovery). Dr. McAlister performed Fornix incisions since post-operative comfort is a large benefit and she doesn’t find that there is ever much difference in scarring of the tenon’s capsule either way.

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Once the conjunctiva is reflected, the muscle is isolated on a hook, cut appropriately and reinserted with absorbable stitches. The conjunctiva is then stitched up and that’s really it. The surgery is very straightforward in concept, but the most difficult part is placing the muscle at the exact measured distance and stitching it in place. The surgeon measures and remeasures multiple times to ensure that it is accurate. Also, since the muscles are so small, it’s very delicate work that takes concentration.

While preparing for the surgery, I watched videos on YouTube of the procedure and read my Ophthalmic textbook, and I have to say that it was not as bad in real life as in the video. I do get squeamish and it was difficult for me to watch the video, but somehow in-person it wasn’t so bad. It could be because I was prepared for what I was about to see, the Adrenalin in the excitement or how calm everyone in the OR was. Either way, I actually enjoyed the surgeries (I was worried I’d feel faint/nauseous) and I was able to stand right beside/behind the surgeon to get a great view.

Orthopedic Surgery Too?

Whilst talking with the incredibly nice staff and anesthesiologist in between and during procedures, they offered to talk to one of the practicing orthopedic surgeons to let me observe a knee replacement. Since everyone there is SO NICE, I was able to observe that surgery as well. The operating room was much bigger and there were 5+ tables of tools for the surgery (unlike the single tray in the strab surgery!) with much more people working in the room. Overall, the orthopedic surgery was much more intense and I stayed pretty far back, mostly because it was much more gruesome than I was anticipating. Drills, hammers and sheer force were all elements that I had not encountered during the eye surgery. I didn’t stay for the whole surgery for a few reasons: 1) I was getting pretty grossed out at all the flying bone material, drilling sounds and blood 2) I wasn’t read up on the surgery, so I didn’t really know what all they were doing and didn’t want to interrupt asking what the surgeon was doing all the time 3) it was very busy in the room so I was just glad to get out of everyone’s way.

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For some reason, I was worried that eye surgery would be much more difficult to watch because there is something so human about eyes. I thought if it was a limb or something else, I could easily de-humanize it as an object and not feel grossed out but that wasn’t the case. Especially since I had experience with cadaver prosection, (read more here) I thought I could handle ortho surgery, but there’s much more blood and the tissue is so alive, it made it harder for me to watch. It could’ve also been that I wasn’t prepared for what I was going to watch or the loud sounds… (sounded like construction work!). Either way, I’m glad I had the opportunity to experience it and I do not regret it at all.

My Experience

Unexpectedly, I learned a lot more about the OR than just surgical procedures. My day started at 6:30am when I woke up, to be at the hospital for 7:30am. I met the surgeon on the main floor and she showed me to the OR “department.” It’s like it’s own little section of the hospital that felt like it’s own building (very isolated). I got to the locker room (verrrry small and squished) where I had to change into the hospital’s scrubs and put on a hair net.

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Then we headed to the one of ten operating rooms, put on a surgical mask and scrubbed. But scrubbing isn’t how it is in Grey’s anatomy any more: The foot-peddle sinks to wash hands and arms are still outside of each OR but today, gel sanitizer is used instead. Similar to grey’s anatomy however, you do keep your hands up and don’t touch anything until you’re in the OR where the OR nurse puts on your gown and shoves gloves over your hands. One thing I wasn’t expecting, was how bright the OR actually is: Grey’s Anatomy always had a very dark OR but everything was actually well lit (Grey’s was my only OR reference before I got to do this!).

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Next, the surgeon and I talk to the family (the patient is usually a child) and have a “time-out.” A time-out is an official confirmation that we have the right patient and they’re getting the correct treatment: we get them to state all of this information out-loud and we confirm it. The anesthesiologist also meets the family with us and discusses the anesthetic briefly. Then, we take the child back to the OR, lay him/her down, reassure them, the anesthesiologist assistant (see what they do here) & the anesthesiologist start the IV, intubates the patient (tracheal tube) and sets up blood pressure/heart rate monitors. Something very interesting I learned, is that there a common parasympathetic reaction that occurs in children when the rectus muscles of the eyes are pulled. Their heart rate drops and it’s actually life-threatening. So before surgery, the anesthesiologist treats the patient with atropine, which increases their heart rate to avoid the parasympathetic reflex. (I thought that was pretty cool!)

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Once the patient is under general anesthesia, sterile gowns are placed all over the patient except for their face. Betadine (an iodine-based antiseptic) is spread across the face on all skin to disinfect the surgical field. Then the surgery is performed. About 5mins before the surgery is over, the surgeon tells the anesthesiologist the 5min mark and he/she begins to slow the patient off the antithetic. I found the anesthesia part particularly interesting; one of the patients kept unconsciously holding his breath every few minutes so the anesthesiologist had to keep a close eye on him and manually ventilate – The anesthesiologist does so much!

Another interesting thing about anesthesia is that there are different types. For the eye surgery, the patients were put under general anesthesia, putting them completely to sleep. However, in the knee replacement, the patient was given spinal anesthetic (similar to an epidural, just in a different location in the back) and laughing gas to make them sleepy, but not fully unconscious. This means that a “wall” needed to be put up to block the patient’s view of the surgery in case they were lucid enough to realize what they were seeing. One of the main complications during surgery is due to being put unconscious from the anesthetic so the less that can be used, the better so when it’s not necessary, it isn’t given.

After the surgery, the betadine (it’s like orange/brown looking) is cleaned off of the patients face, they are extubated (tube taken out), are transferred to a moving bed and are wheeled off into recovery. The surgeon then signs a bunch of papers and makes notes about how the surgery went and then goes to tell the family that everything went well (or not well depending).

And that’s pretty much what I experienced 4 times in a row! Now that I’ve finished explaining everything, I realize that I really did learn a lot in one day and I’m so thankful for the experience.

The Flu Shot: Making Your Immune System Stronger!

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To get more information on topics I don’t cover such as what’s in the flu vaccine, influenza symptoms vs. the common cold and additional ways to protect yourself from the flu, see Ontario’s Flu Facts!

Here’s Why

I thought I’d make a short blog post to spread the importance of getting your flu shot before the flu starts spreading itself! We are so privileged to have free and easy access to vaccinations like the flu shot every year that we as a community should do our part to keep our population safer. I could talk all day about the medicine behind vaccines and how they work and how there are no adverse effects, but it’s almost as useless as explaining why the sun rises everyday. So here are some reasons why you should get the flu shot, other than fearing you’ll get autism, and not all of them revolve around you! For more information on the medicine behind vaccines, see the Centre for Disease Control and Prevention’s vast evidence.

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“The Flu Shot Doesn’t Work”

While it’s true that the flu shot is not 100% effective, it can have enormous impacts on population-wide immunity. The only way you could still get the flu after receiving the flu shot is if you were already exposed to the virus beforehand, or if there is a new strain of the virus circulating.

People who get the flu shortly after receiving the vaccine often attribute the sickness to the vaccine itself, but this is a very common misconception. The flu vaccine takes several days to build up your immunity and if you were exposed to the virus before your immunity is built, you will still get sick. It is very important to note that in no way, shape or form can receiving the flu vaccine give you the flu. See here for more information on why. You can avoid getting sick before getting the flu shot by getting it early on in flu season and taking sanitary measures (washing hands thoroughly, not touching your eyes/mouth/nose excessively, etc.).avoid-flu

If a new flu virus evolves during flu season, the vaccine that you received will not protect you against it. But that isn’t to say that the vaccine hasn’t already protected you from the other strain that has been buzzing all around you! If you think of immunity as a protective wall around your body, why wouldn’t you take the free and accessible opportunity to add just one more brick to that wall?

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“I Don’t Need the Flu Shot, I Don’t Get Sick” (or “I Don’t Care If I Get Sick”)

While this may be “true” for some of you, chances are that you will eventually get the flu at some point in your life if you never receive the vaccination with the current population vaccination rates. If the healthcare system knows that many people do not get the flu without the flu shot, why would the public health system spend a huge chunk of valuable healthcare funding to advertise the flu shot and make it so accessible? Simple answer: They care about more than just YOU. Most of the time, the average, young, healthy adult can get the flu, be really sick and then recover in a few weeks. And while you may fall behind in work or school and feel terrible for a few weeks, by getting the flu you’ve actually increased the chances of getting other people sick in your community. These other people could include those who are at a higher-risk for developing complications from the flu that are life threatening.

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“Herd-Immunity” Would Rock

These high-risk individuals are those with cancer, diabetes, heart disease, lung disease, children under 5 and older adults over 65. If 70%of the population got vaccinated, anyone else in the population who didn’t/couldn’t get vaccinated would be protected, as per the herd immunity theory. And the high-risk populations who are prone to the vaccine not being as effective would also be protected. But even with the accessibility, the lack of financial requirement and wide variety of locations and times to get the vaccine, only 33% of Canadians receive the vaccine. If nothing else, you should get vaccinated to protect all of the babies in your community under 6months old who are not old enough to get the vaccine. Babies getting the flu is a serious matter that can result in numerous complications and if no one was sick with it, no babies would get sick with it. In addition, the more people infected with the virus, the more powerful and able to mutate the virus becomes, which is dangerous to everyone! It’s simple logic: If no one gets the flu virus, no one will spread the flu virus!

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Just Get the Shot!

As I’ll say one more time, we are SO lucky in Canada to have immediate and FREE access to the flu vaccine in all sorts of facilities and at all sorts of times – there really is no reason why you can’t make it out to a flu clinic! Even being one of the most healthcare-rich provinces in Canada, Ontario is actually seeing a decline in vaccination rates. So do your part for your province, your community and for yourself, and just get the shot! (Don’t be scared of a little needle).

Even though I would love to believe otherwise, I know there are people hoping to work in or have started working in the healthcare industry or with at-risk populations who still don’t get their flu shot. All in all, it’s just unethical that you would put your patient’s life at risk just because you won’t get the flu shot. So please, if you are working with children, older adults or anywhere in the health field, get your shot!

Where to Get the Flu Shot

Most family doctor practices, walk-in clinics and even local pharmacies offer flu clinics…for free.

There are also additional flu clinics set up large-scale in public areas such as recreation centres and schools during peak flu season (October-November).

University students can get free flu shots on campus (at University of Waterloo for sure) through health services!

You can even use this web-service to find flu clinics near you in Canada.

Keep an eye out for your local flu clinic postings!

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Summer 2016: All Eyes on the Clinic

 

ophthalmic-assistThis summer, I can confidently say that I have started on my path in healthcare. I have learned so much about many different aspects of healthcare and I’m eager to share my experiences! I was so fortunate to be hired at multiple places this summer, so I thought I’d share all the different things I’ve done at each practice.

Optometric Assistant

This is where I definitely got my foot in the door where healthcare is concerned. I went around to every Optometrist I could find in the area to apply and was lucky enough to be taken on by Dr. Linda Daniar. She is a very experienced and respected Optometrist, running her own practice along side an Optician to provide optimal eye care. After getting a lens prescription from her, you could turn the corner to see the optician to pick out frames to order your glasses right then and there.

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I got to try on a lot of glasses lol

Definitions:

  • Optometrist: An Ocular Doctor (OD) who studies eye care in a four-year long University post-graduate program. They mostly work with refraction, providing lens prescriptions to put in glasses to improve vision. They also work a lot with simple eye infections and can do diagnostic eye tests to refer to Ophthalmologists.
  • Ophthalmologist: An eye surgeon who focuses on eye pathologies with mostly surgical cases. To become an Ophthalmologist, you must attend 4 years of medical school and then 4-5 years of Ophthalmology residency.
  • Optician: An ocular technician who studies lenses and eye care in a two-year long College post-graduate program. They learn a lot about the physics of how glasses lenses work and how they are made and how to fit a person with the right lens and frame.

Working for Dr. Daniar is awesome. Since this was my first exposure to a medical practice, the most important thing I learned was the work flow of a medical office. I learned how the referral system works between doctors in different specialties, how to read/write consultations and referrals, OHIP billing, patient filing etc. Clinically, I learned the basics of auto refraction (a diagnostic machine that essentially gives a glasses prescription automatically). We did this test on children (who’s eyes change rapidly as they grow) and new patients. I learned what prescriptions (-1.00 vs. +3.00 vs. cylinder and axis) actually mean about the anatomy of the eye.

Having an Optician in the office was also an asset to what I was able to learn. I learned a lot about how to fit patients for bifocals (progressives and lines) and how to match the patient with the perfect type of lens for their needs. I learned how to take measurements for lens orders and helped so many people pick out their perfect frames.

Although I was loving my time with Dr. Daniar, I wasn’t able to get full-time hours, which is why I went job searching again.

Pharmacy Assistant

After diligently researching my way through the entire medical field, I found a job-listing for a pharmacy assistant at a Shopper’s Drug Mart. Upon being hired, I was SO excited! I was especially excited that everyone else who worked in the pharmacy had completed some sort of pharmacy program and that I was just going to march right in and start working without all the studying.

This job definitely challenged me the most with regards to all that I had to learn. I really had no idea how the pharmacy field operated and I felt really overwhelmed for the first few weeks. I felt especially overwhelmed since I was thrown into a position in the pharmacy that had way more responsibility than just filling prescriptions: I had two weeks to completely take over for the person in charge of blister packs.

Blister packs (also known as compliance packs) are for people who have lots of medications to take at different times during the day: They are essentially little plastic bubble containers with all of your pills in it for the week that you have to take at breakfast, lunch, dinner and bed time. (See the pic below, it’s hard to explain in words).

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A blister pack

So pretty much, I had to fill on average 10 prescriptions per person and then sort their pills into the correct time 1 week at a time – It is very easy to make mistakes and very important that there are no mistakes. So not only did I have to learn how to fill prescriptions (which includes learning the HealthWatch computer system, all of the medications, how to read prescriptions, how to charge drug plans etc.) but I had to it for 10x more medications than normal and then sort them perfectly by hour of the day. And since patients who require blister packs are often on medications that change frequently, I always had to keep track of when a prescription was cancelled, added or if the dose changed for each patient. And I had only 2 weeks to learn all this before the person who I was taking over for was leaving and then I was the sole person responsible for making these packs for over 150 patients.

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A very complex blister pack that took me a long time to complete. Very satisfying!

Luckily I learned very quickly and soon became a compliance pack queen and learned so much about pharmacy. I know a fair bit about many common medications for heart conditions, diabetes and various mental illnesses (there are a lot of meds). Becoming familiar with many medications has really helped me in other medical fields and I believe will be a huge advantage to me later on in my career. I also learned sooooooo much about how pharmacy in Ontario works in general and what retail Pharmacists do. For instance, I learned how important Pharmacists are in actual patient care: They don’t just get a prescription from a doctor and fill it, they are crucial in detecting possible drug interactions and altering your medications to avoid them as well as being able to prescribe generic drugs over brand name (if the Doctor ordered brand name) and making sure dosages are appropriate for patients. I learned about how drugs are distributed throughout provinces and what happens when the province over uses it’s supply. Pharmacy really is it’s own world in healthcare and is very difficult to understand until you are fully immersed in the system. I am very thankful to have gotten the opportunity to learn so much so early on in my career. Although this job was very educational, what I didn’t like about pharmacy was the idea of working for a corporation and the lack of clinical skills I was learning. I’d say that my role in pharmacy was secondary care (although pharmacists directly provide primary care) since my work was “behind the scenes” to the patient. I was more interested in pursuing medicine versus medication, which is why I went job hunting one last time…

Ophthalmic Technician

Since I knew I wanted a job that was more clinically focused, I searched the city for clinical jobs I could apply to that didn’t require a specific certification. With the help of many forums and google-searches, I applied to areas like Podiatry (feet), Physiotherapy, Chiropody and Ophthalmology (eye pathology and surgery). My experience in Optometry landed me the best job I’ve ever had: An Ophthalmic Technician for Dr. Chryssa McAlister, who I believe is one of the best doctors I’ve ever met.

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Although Dr. McAlister is paper-less, the other Dr.’s in the office have such pretty files!

 

Dr. McAlister is an Ophthalmologist who specializes in Cataract surgery, Glaucoma treatment with laser surgery, Strabismus surgery, Lucentis injections and many other ocular pathologies. She works in a practice with two other Ophthalmologists and the office atmosphere is amazing where I can learn so much every single day from many different people. I worked most closely with a fellow technician who is currently an Optometry student at the University of Waterloo. She knew a lot and taught me so much. It was really nice to be working along side another student since everyone else in the office was working there as their career. Whenever I had a question about anything, everyone was always very willing to help/teach me and I am still learning more every day.

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The textbook I use often to look up specific cases and how surgeries are performed.

Definitions:

  • Cataract Surgery: When the lens of your eye begins to build up calcified proteins, it clouds over and impedes light from entering your eye (you can’t see clearly). An Ophthalmologist can remove the lens and replace it with an artificial lens so that you can see clearly.
  • Glaucoma: Glaucoma is very complicated and is a set of diseases that essentially causes high pressure in the eye, which can damage your optic nerve. Ophthalmologists monitor and manage glaucoma and can use various laser treatments should eye drops and medications not be sufficient.
  • Strabismus: This is when the alignment of your eyes is off (one or both eyes are out to the side or turned in) causing your vision to also not line up producing double vision. This can be treated with prism in refractive treatment (glasses) or by surgery to adjust the origin or insertion of rectus muscles that move the eye.
  • Lucentis injections: This is a medication used to treat macular degeneration, macular edema, and other eye pathologies that requires the use of a hospital room. Not many Ophthalmologists in the area use this newer technology so I am so lucky I get so work under someone so innovative!
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Basic eye anatomy

For Dr. McAlister, I get to do so many clinical things that it literally blows my mind. In a typical clinic day, I do the work up for the patients based on what we are seeing them for. I generally examine the patient’s vision (eye charts), pressures (with a rebounder! More new technology.), medical history, pupil responses (always looking for afferent pupil defect where one pupil has optic nerve damage causing the opposite pupil to dilate instead of constrict!! Very cool). I also record a run down of the patient’s concerns, symptoms, medications and reason for referral. For new cataract cases and other retinal/back of the eye issues, I dilate their eyes with Mydriacyl and Mydfrin drops. For pediatric neurological cases, I dilate their eyes with Cyclogel 1% (if they haven’t already received atropine drops the night before). For Strabismus cases, I do a whole series of tests to examine their eye alignment including red/green light suppressing OD or OS at near or distance and their ability to see 3D. For Glaucoma and other neuro patients who have decreased vision, I do a visual fields test on them to assess their entire visual field. This is done on a big machine and takes about 7 mins per eye. It was really exciting to me at first but now they’re kind of a drag since they take so long! All of this and more happens in a typical clinic day. But that’s only 2 days a week (except this week when we are doing 5 days because she’s going on maternity leave next week!).

On OR days, Dr. McAlister is at St. Mary’s hospital or Grand River Hospital doing surgeries, lasers or injections. For cataract surgery days, she does surgeries from 8-4 while I’m in the office doing visual fields or clerical things (receiving/sending faxes, referrals, appointment bookings, consult responses, patient concerns etc.) and then all of the patients come to the office at the end of the day for a post-op check. 18 people all pile in at 4pm while I race to take their vision and pressure and asking if they are having any major issues after the surgery. I also write up the prescriptions for the drops Dr. McAlister prescribes for her cataract surgeries (vigamox and maxidex).

And then there are on-call weeks. All Ophthalmologists in Southern Ontario (I think), take turns being the on-call Ophthalmologist for all of the surrounding areas. So anyone with an emergent eye issue will be sent to us (or we see them at St. Mary’s) when we are on call. A few weeks ago we had one of the busiest on-call weeks there has been in a long time. We had multiple retinal detachments (symptoms are flashes and/or floaters), eye herpes, and high eye pressures…patients whom we had to add to our clinic days on top of our regular patients. It was absolutely crazy busy but I loved every second of it! I got to see such a large range of cases that I wouldn’t normally see outside of the emergency room. I even got to go to St. Mary’s and work in the eye clinic there with Dr. McAlister while she was on-call and do the work-ups there! It was seriously awesome. I’ll also be accompanying Dr. McAlister for her Lucentis injection day next week at St. Mary’s for pre-op checks. (Provided her baby doesn’t arrive early). I’m so excited!

I have learned so much working under Dr. McAlister and I am so blessed to have been able to be her technician. She is definitely what has made me feel confident in my passion for medicine and she supports and teaches me every day!

Volunteer Prosection Training Program

In addition to all of these jobs, I also had the amazing opportunity to work with the VPTP! After taking anatomy last year, I felt really lucky to have been able to have the resources of human cadavers in my anatomy lab. When the opportunity arose to be able to prepare these specimens for the Optometry school and the anatomy classes, I took it since it really is a once-in-a-life-time chance. In all medical post-graduate programs, students are required to study human specimens, which have been prepared for them to examine. It is so rare that you get the opportunity to prosect cadavers for examination so I’m so lucky! Essentially, the program involved prosection training and preparation of cadavers where we would remove skin, fat and connective tissue from human cadavers in order to expose and differentiate muscles, nerves and vessels. Since we were required to have been successful in the anatomy lab, we already knew a lot of the human anatomy and were taught how to use dissection tools like scalpels. We were also taught dissection techniques, which was a very unique opportunity. I worked in the beginning stages of the program mostly removing skin and fat from the chest and lower back. It is definitely a fine skill that takes practice since you must be careful not to cut any muscle tissue, which I found especially difficult on the neck! I will be working in the last rounds around the posterior leg and foot in the brand new anatomy lab! (SO EXCITED!!!!) Every round focused on a different area of the body and involved a study of the anatomically relevant features beforehand. This program was not only an amazing opportunity, but also kept my anatomy knowledge very sharp! (Get it? Scalpel? Sharp? lol)

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Image from http://www.uwstout.edu/news/articles/Cadaver-training-gives-rehab-providers-inside-look-at-human-body.cfm

In Addition

On top of all of these jobs this summer, I was also able to keep up my work with the Hospital Elder Life Program at Grand River Hospital (see my previous blog post for more info!), although I did take August off since I was so incredibly busy.

I also successfully completed my required philosophy credit in an online class at U Waterloo.

I was also able to pick up a few life guarding and daycare shifts to exercise those skills as well.

Irrelevantly, I was able to take an amazing trip to California with my family as well as spend some good relaxing time up in Muskoka. It truly has been a great summer and I’m excited for what is to come!

 

 

 

Hospital Elder Life Program (HELP)

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For the past year and a half, I have been fortunate enough to be apart of the Hospital Elder Life Program at Grand River Hospital. It is a program where volunteers are selected, intensively trained and sent out on the floor to directly interact with older patients for a non-geriatric approach to recovery.

What’s the big deal?

Usually when a person gets sick and requires hospital care, you would expect them to make a recovery and return home to live their life normally. However this is not the case with elderly people who stay in the hospital. The opposite actually occurs and elderly patients often experience a functional decline and often can’t go back to being fully functional or independent after a long stay in the hospital. Not only does this increase patient-stay times in the hospital (a huge financial burden) but it also increases morbidity and mortality (making life shorter and of lesser quality) and a greater likelihood of needing long-term care.

This is where the HELP program comes in: since nurses and physicians are so busy in the hospital, they often don’t have time to extensively check in on patients and keep them up and awake. Volunteers like myself will visit at-risk elderly patients and provide non-geriatric (aka, non-medicinal) treatments to maintain cognitive orientation and function, physical function, encouragement of independence, non-pharmacological sleep protocol, hearing/vision adaptations and a feeling of social support. All of these treatments significantly maintain the elder’s overall functioning resulting in a quicker and fuller recovery.

Volunteers make all the difference!

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Thank-you letters the volunteers received during this past International Volunteer Week

You may be shocked to learn how many people’s children have moved far away from their parents and the resulting lack of visitors a lot of elderly patients have. Majority of these elderly patients we visit are also widowed and usually don’t have much other family around to visit them. Although children and even grandchildren try their best to visit their elderly loved one as much as possible, it is definitely not easy to always be by their side. Loneliness in the hospital significantly increases the patient’s susceptibility to depression, which makes their health decline greatly and decreases the patient’s will to live. It is a very sad reality but we are lucky to have dedicated volunteers in our program that act as a genuine support system for these elders to brighten their day and not let them slip into depression.

A typical day for a HELP patient would look like this: a volunteer would visit after breakfast, after lunch and during/after dinner. The visit would be 30mins-an hour long and would consist of anything from range of motion exercises, cognitive-stimulating activities (cards, trivia, brain-teasers), meal-assistance, meditation, going for a walk or just talking about life (letting them remember/discuss their family and past). A lot of the time, without stimulation, many of these patients will sleep the days away: not moving more than a few inches causing their muscle mass to deteriorate and for them to be very confused/disoriented, which does not help their recovery process.

Being in the position of a HELP volunteer is truly a different experience: the patient sees us more as a friend than as a”scary” busy doctor and can open up to us about questions or concerns they’re having with their recovery. We can pass this information (that usually does not get brought up directly to the physician) on to our superiors who can work with physicians and nurses to better help the patient’s recovery process. It is an amazing experience to work with the HELP program and to see the difference it makes on so many patient’s recoveries and lives.

Delirium: A Main Target

One of the main focuses of this program is to prevent/decrease the incidence of delirium in elderly patients in the hospital.

What is delirium?

Delirium (or acute confusion) is a sudden change in mental status, or sudden confusion, which develops over hours or days. It is different from dementia, such as Alzheimer’s disease, which is a chronic state that progresses over time. The exact pathogenesis of delirium is still not understood. Delirium is most common in elderly patients who are on intense medications or have had a recent surgery.

What are the features of delirium?

Delirium makes paying attention or focusing difficult, and sometimes affects the ability to maintain awareness of one’s surroundings. Some people hallucinate or become paranoid because it becomes difficult to interpret their environment. Other symptoms include rambling speech and jumbled thoughts. These symptoms tend to come and go during the course of the day and can go unrecognized about 60% of the time. Confusion regarding day-to-day events, daily routines, and the roles of familiar people is common. Changes in personality can occur: Some persons become quiet and withdrawn while others become agitated or hyperactive. Normal patterns of sleeping and eating are often disrupted.

Why is delirium important?

Recent studies show that delirium is common for older persons in the hospital setting, with occurrence rates ranging from 29-64%. Delirium has serious complications associated with functional/cognitive decline, increased morbidity/mortality, increased rates of dementia and PTSD (post-traumatic stress disorder) and increased need of institutionalization. The main importance of delirium is that it is preventable: multi-component targeted interventions (like those used in the HELP program) have been the most effective treatments.

My experiences with delirium:

I have visited many patients that are suffering from delirium: often they are very confused as to where they are and even what year it is, and having a volunteer come in ~3x a day is very helpful to ensure they are oriented to time and place. Quite often these patients are sleeping a lot during the day and are awake at night and when I come in around 6 or 7pm their dinner is untouched on their table while they’re sleeping. Since nurses don’t have time to monitor the eating habits of every patient, a volunteer like myself coming in around meal times can wake the patient up and help them eat, improving their energy supply. The most severe cases I’ve seen are of intense paranoia and hallucinations: the patient may be very scared that there is a murderer in the washroom or a snake on the floor and the best we can do is acknowledge the fear and to reassure the patient that we will be taking care of it.

It is worth mentioning that the majority of the patients that I have seen do not suffer from delirium but it is a huge part of why the program is in place and also a large portion of the training you would receive due to it’s severity/importance.

Is the HELP Program Right for You?

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The HELP Program at GRH won an Award of Excellence – the first volunteer program to receive one!

If you are a student interested in gaining direct health care experience this program is an amazing way to learn patient care. Commitment wise, you’re looking at a one year minimum for about 3 hours a week (one shift=3hrs). If you have to miss a shift you are expected to make it up by picking up an extra shift one week or finding a different time slot. You will generally have a specific time slot that is YOUR shift: for example, I have been doing Wednesday evenings from 5-8pm exclusively except for some extra shifts that I have had to make up randomly. You will also be required to undergo about 20 hours of in-class training and another 12-15hrs of on-floor training one-on-one with an advanced volunteer before you are able to begin doing rounds yourself.

Even though this is a volunteer job, it is one of great responsibility and autonomy so if you don’t seem committed to patients or good for the job, you can get turned down. If patients or nurses report you as inappropriate, insufficient or you do something bad, you can be stripped of your position immediately – there is a long list of eager volunteers waiting to take your spot.

All of that being said, if you are fortunate to get a spot as a mature volunteer, do take the position seriously and commit to it fully. This position directly effects the quality of life of real people and if you’re just looking for hours to put on your medical school application, you should look somewhere else.

To end on a positive note, the impact you can have on these patient’s lives can leave you with a great sense of accomplishment and lots of great patient experience. Even if you aren’t interested in going in to healthcare, it’s still a great way to give back to your community, hear the amazing stories these people have to share and take good care of the elders who nurtured the generations before us.

To read more about the HELP program visit their official website: http://www.hospitalelderlifeprogram.org/

Undergrad 101

The first step to starting a career in health care is an undergraduate degree. Undergraduate degrees through universities prepare you to study at the post-graduate level to become doctors, pharmacists, optometrists etc. This post will purely focus on what factors to consider while choosing your undergraduate program. Also beware that if years of schooling isn’t for you, that you can absolutely pursue a health-focused career in a more direct learning environment such as a college program for nursing, paramedics etc. Just make sure you do your research and have the necessary prerequisites.

All of the factors I will talk about will focus on one main characteristic: balance. Having balance in your program will allow you to learn everything you need to, get good grades and have time to work, relax, socialize and volunteer. The main thing I want to stress is that you DO NOT to be in “biomedical sciences” or any science-specific program to be prepared to apply to post-graduate programs.

Choosing your undergraduate degree is a big step and certainly one you can mess up/regret if you don’t do your research. Thankfully it can be fairly easy to switch programs but it won’t come without a little annoyance and wasted time. If you do your research on these 3 main topics you should be able to find the perfect program for your health career!

1. Choosing a University: Consider Location

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Western University

If you are fortunate enough to live in a city with a university, it would be very wise both academically and financially to live at home. Being able to live with family will save you so much money and the stress of living on your own. You can benefit from possible meals cooked, laundry done and grocery shopping done for you. You may also have access to use your parent’s car or get rides to school in times when the bus is late or you slept through your alarm. The safety net of living at home can let you focus on your studies and not have so many stresses to make you the most prepared. At the end of the day, post-graduate schools like medical schools don’t care where you got your degree, as long as you  meet the proper course prerequisites and that you got really good grades.

If you live too far from any school or have to live on your own, consider choosing a program that isn’t crazy far from home so you can visit occasionally and not spend a lot of time or money commuting for visits. Sometimes you just need a good weekend at home with your family after a stressful week at school and being able to get home as easily as possible is key.

If you are really set on studying pharmacy or medicine in the states eventually, I would look into the prerequisites of the programs and if it would be worth it to study an undergraduate program there as well.

One thing I understand is that after high school you may feel like there’s nothing else you want than to move out and live on your own. But trust me the thrill wears off easily and the stress you can save living at home totally out-benefits the fun of living on your own. If you’re planning to go to a school in your home town but you still want to move out, you could stay in residence your first year or even just first term to get that feeling out of your system and to experience it. It’s also a great way to meet people in your first year and make friends without fully committing to living on your own!

Since you’re planning to be a doctor or pharmacist or something, I know you probably won’t pick a university just because it has good parties…If your friends go to “party schools” you can visit them during frosh week to have some fun but after that the partying will get old. The reality is that you’ll meet people no matter where you go and you’ll have fun if you want to…you don’t need to attend a specific school to have a good time.

A last thought…if you are wanting to go to a specific university for post-grad, doing your undergraduate degree at the same school will not increase your chances of getting in. For example, if your heart is set on U of T medical school, doing an undergraduate degree at U of T will not affect your chances of getting in. So definitely don’t make that a deciding factor!

2. Bachelors…They Matter

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University of Toronto

Before you can even look at programs, you need to get a general sense of what sort of prerequisites your desired career has. For example, the University of Waterloo’s optometry program has very specific course requirements that you should make sure you can take in your undergrad. You can find all of these requirements by visiting the university’s websites. Here’s the University of Waterloo Optometry Requirements if you were interested. Staying on Optometry, (a good topic because it is so specific) some post-grad programs require an undergraduate degree from a certain bachelor: UW’s Optometry program requires undergraduate studies in a Bachelor of Science (BSc). But some programs such as McMaster’s Medical School, requires undergraduate studies from no specific Bachelor. That means that as long as you’ve taken enough science courses to prepare you for the MCAT (the standardized medical school entry exam), you could study a bachelor of arts and still get in to McMaster Medical school!

Another thing to keep in mind is that the bachelor of the program with the same name varies between schools, and can make a huge difference. For example, the Health Studies program at Western  will earn you a BHSc (bachelor of health science) while the Health Studies program at Laurier Brantford will earn you a BA (bachelor of arts). That means that neither of those programs would qualify you to apply for the UW Optometry program. In contrast, the Health SCIENCE program at Laurier (main campus) will earn you a BSc and so will the Health STUDIES program at the University of Waterloo which would make you eligible for optometry. The bottom line here is that not everything is congruent and you’ll have to do your own research to find out what bachelor is right for you.

A really great website that they have probably showed you in high school is eINFO.ca where you can browse programs and the bachelor that they come with.

3. The Only Difference Between Programs? Courses.

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University of Waterloo

OK great. You’ve chosen a school and you discover you would like to study a bachelor of science…now all that’s left is to choose a program: Seems like the easiest step but it’s actually the toughest. At the University of Guelph alone, there are over 30 BSc Undergraduate programs to choose from. My advice? Choose the program with the most flexibility among courses.

Every program will have it’s own set of required courses in order for you to graduate with the specific degree and the required courses don’t always match up with the prerequisites you need to apply to post-grad. A lot of the time, there will be no perfect program: you may have to take extra courses you don’t need or you may have to add in courses as electives. Being in a program that is flexible gives you the most control over how balanced you can make your course loads every term, which is a fundamental factor in achieving a high GPA.

When looking at courses, see how many units of chemistry, biology and physics you are required to take and compare how many are extra or need to be added to apply for post-grad. For example, the University of Ottawa’s Medical School chemistry requirements state that you need a total of 4 courses in either general chem, organic chem OR biochem. This means you could do 2 general, 1 organic and 1 biochem; or 2 general, 2 organic; etc. But if you were taking University of Waterloo’s BioMedical undergraduate program, you’d be required to take 2 general, 2 organic, 2 biochem plus 2 physics and a lot of biology courses: therefore you may be overworked for what’s even required and taking extra really tough classes that may sacrifice your GPA.

It is really important to look at courses, even beyond first year because if you have your heart set on medical school and you end up in an environment program, you may not have the space in your time table to take all of the courses required to get in to post-grad. Another thing I look for in undergraduate programs is the number of electives: electives are beautiful and if you have a lot of them, you can spread out the tough, required courses and take some easy or interesting courses to have a balanced term. If your program is really strict and you have no room to make it your own, you can feel like its too hard and you won’t enjoy it. Having electives gives you the opportunity to spread out courses and dabble in courses that interest you oustide of sciences to make you a more well-rounded and cultured person! (Something that post-grad schools look for in applicants).

Aside from looking at courses within programs, you should check out which courses are required/recommended for writing post-grad admissions test like the MCAT (med school), OAT (optometry) and the DAT (dentistry). Even if Western’s Medical school has no specific course requirements, you still have to write the MCAT, which would require you to know some of all the chemistry, biology, physics and even psychology/sociology. Your score on these admissions tests is just as crucial as your GPA so make sure you choose a program where you can fit in all the courses you’ll need, while having a balanced work load.

Good Luck!

I hope you found this helpful and if you have any questions you can post them below! Good luck with all of your research.

The Big Picture

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Hi there! My name is Danielle and I am currently studying Health Sci at the University of Waterloo. I’m starting this blog in the hopes that it will be helpful for high school or incoming university students who are interested in a career in healthcare.

I’m hoping to make posts about the basics: degrees, courses, extra curricular activities etc. but I also hope to integrate some of the things I have learned about health that have impacted the way I live my life and will hopefully impact yours too!

Thanks for checking out my brand new blog and I hope you come back for some easy health-related reading.

Dani