When you begin PA school you learn to take it a day at a time and not worry about the job market until the second year. Time flies in this program and we are in the time of year where we are applying and interviewing and negotiating all while being on rotations and still studying for the boards exam. Yes it is stressful! I interviewed at a community hospital north of Pittsburgh and I loved the atmosphere. My fiancé and I are buying a house in the area now and taking our time moving while I am still on rotations. So, for anyone wondering yes this is early in the year, some places are in need of a PA ASAP and wont wait for you to graduate and others will wait for the right candidate. Keep that in mind that everyone will find jobs at their own pace, make different connections, and accept different offers depending on cost of living and the type of hospital. But do not sell yourself short and as our professors say, “KNOW YOUR WORTH”. You work hard so make sure you like the hospital, job requirements and can get a fair wage. Michelle and Justin helped me a lot with negotiating and understanding what I need because it isn’t all about the salary, we can negotiate for CME credits, employers paying for your boards exams and other benefits. This hospital is in an area that my fiancé and I dreamed of moving to in the future after retirement and it so happened the hospital in the area needed a PA now. Timing is everything and everything happens for a reason so relax, and keep working hard because it starts to pay off.
It’s been a while since I had time to write a blog, but I figured it’s time to give an update. St Clair was my first 6-week rotation, and it was the best. I got so many different specimens this community hospital and really felt like I was getting comfortable at the bench. The PAs were awesome and both WVU grads so they understood what I was going through. They were laid back and understood I was still learning and would make mistakes and always helped me with all my questions and taught me good ways to approach any specimen. They were PA’s that everyone respected from surgeons to pathologists, and they just really knew their stuff. I loved the environment, and I probably will tell my story of my first rotation and getting off to a great start in my career thanks to them. So, if you get to go to St. Clair, you are one of the lucky ones! You also get to do frozens if you want to so take advantage when they ask. My next rotation was autopsy at Presby, and I just finished week 5 out of 6. Autopsy was such a change from surg path but in a good way. There were already over 100 autopsies for the year, and it was only March, and that’s a number they don’t hit until later in the spring or summer usually. So, it was busy. The pathologist is in charge of you and a lot of the times they aren’t actually doing the autopsy with you, you eviscerate with a tech and prosect with a resident. If you have no autopsy background that is okay because that’s what you’re there for, to learn it. Working with a team was great because everyone brings different skills to the table. You start off just eviscerating and removing en block then eventually you prosect with the resident or the pathologist will come in and you will do the autopsy beside them and you will have to write a PAD. It was really great to see the organs in their relationships to eachother, for example doing the GI block and seeing there the pancreas sits in relationship to to duodenum and stomach will hopefully be helpful when orienting a whipple in the future. I got comfortable and there were some interesting cases here. I am doing a project on a Stevens-Johnson Syndrome case and I saw a Goodpasture disease case. I only thought I’d read about these diseases in Robbins so applying knowledge is a good feeling. Dr. Bartholow will also look over any slides you want with him so seeing the histo part of it has been great. I got lucky so far on my first 2 orations working with such great and knowledgable people. I go to Cleveland next for 3 weeks for the ME rotation. We’ve had 3 exams so far that have been difficult and studying after work has been rough. Having weekends off has been helpful but weekdays can be exhausting. I’ll update again soon. Goodluck to everyone interviewing soon!
Just like everything else these days, giving tours of our labs can now be online! Our class president took time to gather photos and explanations of our campus buildings to give you a feel for what WVU has to offer! The school is big, but our program has its own corner to make learning feel even more individualized. So, if you want to follow along through the pictures you’ll get a feel for what you’d see during interviews and what you’ll get to look forward to during didactic year!
Week one of rotations isn’t quite over yet, but it’s safe to say I survived. The two PA’s and 4 pathologists at my site have been amazing and welcoming. First thing to note is how different every site is. Michelle and Justin will teach you to dictate a certain way or gross something a certain way then your sites will all have their preferences so getting used to adjusting is good! So far I’ve been able to gross gallbladders, appendices, fallopian tubes and POC, a placenta many different types of biopsies and have gotten to see a ton of specimens the Pa’s gross. I’ve been getting my feet wet with the computer system and with speaking to transcriptionist to dictate. So far this rotation confirmed that I went into the right career. I’ve woken up looking forward to see what could end up on a gross room bench. I also have gotten my first round of the covid vaccine so i’m excited to be apart of these monumental times in science! Year 2 is going good so far just mustering up the energy at the end of each day to keep studying for class exams. Will keep updated soon!
Back in October we were given a rotation schedule. First question to answer is no, you do not choose where you go for rotations, Michelle and Justin place you. I have 9 different rotations, and most are 6 weeks long and a couple are 3 weeks long. Most are surgical pathology and a couple are hospital autopsy/medical examiner oriented. Only a few places provide housing, so the game plan is to book longer stay air bnbs out of pocket where it’s too far of a commute. Most of my classmates found a house to rent outside of the city of Pittsburgh and others will also find longer stay hotel/ air bnb type places. These are the types of finances to consider before signing up for your masters since there truly are a lot of expenses to consider along the way. When I say out of pocket, I mean I take out graduate plus loans from studentgov.org but others have different methods I’m sure that’s just my plan. You have an orientation early November and Justin gives you a student handbook for rotations. You should read through and pay close attention to your sites because there is overall paperwork then there is specific paperwork required by different sites but Beth Ann really helps you make sure all things are in order so now I get to just read through and make sure I understand what the handbook has before starting. Before finals week, I went and typed up a lot of my notes that were from AT such as the non-complex to moderately complex specimens and collected my CPT codes, CAP retention times and organ weights and put them into paper covers in a binder since you are allowed to have notes with you on rotations and I will probably use them a lot at the beginning especially. I got a $20 Robbins pocketbook too that I’m pretty excited about and asked for new scrubs and new hard top shoes for Christmas gifts from family members this year. It was a very PA styled Christmas I’d say:) I also bought a couple notebooks, big and little so I can remember to take notes to keep in my pocket and study from about protocols or things that I learn in each rotation. By finals in December, if I don’t know off the top of my head what sections to submit for a TAHBSO benign vs malignant or even a right total hemicolectomy well, then I shouldn’t have passed since these are the types of automatics that by the end of the year become second nature to just list if someone asked but there is a lot more than just sections. I’ve been reviewing differentials, for example what are the types of renal pathologies? Well, you could have a polycystic kidney, benign but nonfunctioning, RCC, oncocytomas, cortical adenomas, transitional cell carcinomas or even mets. Grossing will change your sections so understanding history, previous bx etc. is important to look over. However, it’s the little things you don’t want to forget such as skins biopsies, gallbladder sections, bone marrow bx and how long to fix something before decaling or what fixatives are needed for EM instead of light microscopy. There are basics that you should never forget no matter how complex the specimens become that you learn over a year! I also collected some example dictations as well to have in my binder in case, although everywhere has different methods. This break has been very refreshing, and I think we will all be ready to start another tough year after this much needed time for family, holidays and like a said a lot of Netflix. PS, no direction quite yet on Covid Vaccination requirements although I’m sure its coming soon. Hoping we can be apart of the movement towards Herd immunity this year as students in healthcare!
I finished my finals last week. A lot of naps, Netflix and family time has been going on. I slept about 12 hours the Wednesday night that finals were over no shame in admitting that. This was the light at the end of the tunnel we’d waited for all year. We start rotations hopefully on time third week of January but the rotation paperwork and keeping up on emails to prepare for the start keeps you somewhat busy. I’m going back to work part time for a little to make money over the holidays, so I am lucky to do that. Once clinicals start it’ll be another tough year, so I am enjoying time to myself. Covid is happening still so in Pittsburgh bars are closed again. I am forced to stay inside which I personally would’ve been doing anyways. The vaccine has made its way to the US and its being distributed. If there is a working vaccine, we probably will be needing it for rotations but just waiting to hear from everyone first for directions since it’s all so new. I’ve been gathering my notes together and putting a binder together that I can take onto my rotations which I hear we are allowed to have. I am excited to start and still a little scared. I will really be on my own without our professors with us so this year is all about growing and learning to work in the lab now not just showing what you can do on paper. 2021 will be the year of applying to jobs, finding out what state I’ll be in and my fiancé and I will be moving wherever my job takes us. Luckily, he is a CPA tax accountant so he will find work elsewhere if I don’t end up in my hometown of Pittsburgh. It’s going to be exciting and scary all at once but I’m ready! Hope everyone enjoys the holidays and stays healthy!
Whenever I signed up for this program, Covid wasn’t a thing. I graduated in May of 2019 and had been accepted into the program and knew the start date was 2020. I began working at a lab doing drug testing and making good money. I actually liked it, so I got a little comfortable even though I couldn’t see myself liking it in the long run. The fear I had and doubts about myself being able to survive this program crept in a lot. This program, I knew, was going to be hard, but I also knew how LUCKY I was to be accepted because of how many qualified people apply and this career is one of a kind. I just breached the surface of my learning in this first year and every day that I feel tired I stop and think there are people out there who don’t get the chance to be in a program and learn to be a PA. Looking back with covid, and people losing their jobs I could have been one of them in that lab. I trusted the timing and my gut to go back to school to do the harder route and let me tell you its rewarding and beyond cool the things we get to do in this job. We didn’t get a white coat ceremony yet and I have 3 more finals to take. The end is near but also the start of another tough year is ahead. I went to school in person for 8 weeks in the spring semester then full time online to finish spring and into the whole summer. You read a lot of Robbins textbook in the summer and take online quizzes. If you were in person you would also have those same readings, same quizzes. The difference is we did not get to have the hands-on labs which were made up and adjusted when we came back in the fall. Clinical path is a really helpful class also that matches nicely with Robbins chapters and learning more on clinical aspects of disease and this was delivered online in the summer. I came back to one lab and one class in person in the fall and the rest online still. Surg path is basically like a review of AT and Systemic Path so really understanding tumors and diseases from Robbins and how to use the techniques from AT all gets wrapped up and applied in Surg path which was the in-person lab and class this fall. So, a lot of online school seems like you’re learning alone but you have to study by yourself anyways. A couple hours of in person class doesn’t change that at all. Our professors adjusted in the middle of our class, so I believe they are prepared for whatever comes their way to deliver the material again for the future. Here I am, in the middle of a crazy time and did a lot of hard work and learned more than I could ever imagine. Not only did my class do it, we did it pretty well and we are excited to apply what we learned to rotations now. So, if fear of what could happen is stopping you from applying please still consider taking that career move because this is still the best thing I could have done even if it wasn’t what I “signed up for”, and if you do get accepted and the world isn’t fully back to normal and you can’t always be in person, just know 16 of us still took the same tests, same labs, struggled a lot and will still get the chance to learn a lot on the job during rotations just as any normal class did before us. Online or in person, this program gave us what we needed to move on to year 2, and I have 0 regrets. This incoming class starting in 2021 is jumping into a lot of unknowns too but at the end they are still going to come out pretty strong and resilient PA’s. So, with application time opening up in just a couple months I encourage people to take a look at my Break It Down for Me blog to see what classes come up in the springtime and Interview process. I will be on rotations through Pittsburgh and other hospitals in the area and look forward to sharing my journey. Thanks to all who tuned in this year. Best of luck to the new students.
Part of the duties of a PA is handling specimens that come for intraoperative consultation, which involves quickly making a slide to be reviewed under a microscope by a pathologist to determine how a surgeon should proceed with a patient in the middle of a surgery. If a specimen isn’t for frozen, PAs can take sections for permanent slides sent to histology to later be reviewed by the pathologist and doesn’t demand such a quick timeline for review. To explain why this would be needed it would be easier to talk about an example that we went over in class today. Imagine a patient is under for a surgery and a surgeon removes the uterus. We receive this specimen, but they need to know if this tumor is aggressive and if there is a need to remove lymph nodes while that patient is still there, so this tissue needs to be observed ASAP! Staging for endometrial carcinoma involves depth of invasion from inside of the uterus to the outer tissue. If the tumor is extending more than 50% into the muscle layer (myometrium) or has a higher-grade meaning an “uglier”, more aggressive tumor, this ups the stage and now there is more potential for invasion to other organs. The risk of spread is why nodes would need examined. If this tumor is extending further than 50% into the myometrium, the surgeon will remove the nodes before finishing the procedure. If the tumor isn’t so invasive and is staying in the uterus that was removed, they can finish knowing the information needed is in the already-removed uterus. Low grade or less invasive tumors aren’t going to up the cancer stage which is what the pathologist must determine. So, if you measure the thickness of the tissue and cannot tell grossly if the tumor is extending in or if the previous biopsies before the uterus was removed show signs of moving to a higher grade, the pathologist will ask for a frozen. The pathologist will then consult with the surgeon and let them know the next step to treat the patient and this all happens in about 20minutes. From the time the uterus is out, the time we take the section, make a slide and the pathologist gives a stage, this can’t take a very long time. Pictures below will help as I explain this procedure. If the PA takes a full thickness section of endomyometrium with tumor, they use a cryostat machine to make their slides. The cryostats here are brand new so we got lucky as a class to have new equipment! The little round disk is a chuck, and we put the chuck in the cryostat that keeps freezing cold temperatures. We squeeze a little bit of clear OCT gel onto the chuck and as the clear turns into a harder white consistency, we place the tissue onto the gel in the orientation that will give relationship to all the layers of the tissue. We use a metal tool called a heat sink to flatten that white gel as it turns into a hard, cutting medium to give an even surface. We take that chuck and adjust the blade so its barely touching when we move it up and down. The wheel to move the chuck up and down against the blade is on the side and as you turn the wheel it cranks out slices. At 20 microns (1micron=0.0001mm) we “face” into the tissue and cut away the top layers so that the extra OCT is away, and your tissue and cells are exposed. We then change the cutting section to give us even thinner 5micron sections that will be needed for the slide. This is the hard part because you have to grab with a paint brush and pull down onto the stage without tearing or folding this section. Once the section you want is ready you quickly grab the slide to touch it down to get you tissue to stick. You then put your slide through a series of stains, water and alcohol following the protocol that is written on a sheet. You can then coverslip your slide and check it under the microscope to make sure your section doesn’t have bubbles over the tissue and is good enough to give to the pathologist. Mistakes happen where tears occur and it happens more often than a permanent section done by a careful histology team, but if your section is showing the pathology and no bubbles from the coverslip are in the way, the pathologist can quickly tell the surgeon how to proceed with the patient still in the OR. This process happens not just for uterus of course, a lot of tissue in surgical pathology comes for frozen to check margin status, diagnose what type of cancer or if they need to do a regional lymph node dissection. “ENT”, or tissue of head and neck cancers come because surgeons like to make sure their margins in this region are clear. They want to conserve enough of the patient’s normal tissue since they don’t want to take away a lot of unnecessary tissue for reconstructive purposes. Sometimes in a lung case you can get sent tissue for frozen and you have to be careful because Tuberculosis is always a concern that can spread through air. You should never use freeze spray which helps the chuck cool off faster because you could breathe in the aerosolized bacteria. There are a lot of protocols to pay attention to and making sure you are careful and quick with this procedure! If you are a part of the program you do get graded in the fall on some frozen sections and your efficiency to help prepare you well for clinicals. Make sure you go on your own to practice, Taylor was a histotech so she helped demonstrate the procedure very easily here. If you come from a lab like her that already had you doing these, you’re way ahead of the game!
staging based on depth of invasion into the myometrium (photo from nature.com issues related to uterine pathology)tumors can extend from inside the endometrium to the outer serosa which poses a threat to invade surrounding organs such as the bladder or rectum making it a stage 4 cancer Taylor checking her slides for practice
We don’t have too many weeks left in Morgantown and today things sort of hit us all when we were given our rotation schedules. Finally when something you wait for and work towards in this program happens it’s a lot to take in. Didactic year is very short. Short amount of time for all the material you cover, even shorter when half the program was delivered online. I feel like we just got back because we did, as a group. It’s been crunch time getting practice in with specimens and labs to make the days go by so fast. Next year we will go our separate ways and to me, its bittersweet. I got comfortable with my friends and the environment that was created here and to the incoming first year students you’ll understand this soon. This past January moving by myself to West Virginia was scary not knowing anyone then quickly you realize there’s only a few people that know what you’re going through so you get comfortable again with your small class. Year 2 comes and that gets taken away. This career pushes you and doesn’t really let you get comfortable. You don’t walk into the gross room and have the same cases, same pathology everyday. You get to always keep learning and experiencing. I thought my professors were tough on us at times this year and push us to think for ourselves but I know its just to deal with whatever comes our way on rotations. I still have some weeks left and a lot of exams, and a lot more material to cover before the end but I can see a light at the end of the tunnel.
I remembered one of the first things I asked a second-year student…“Do you get to come up for air?” They said you might feel like you’re drowning in work and always studying but there are times you get to take that breather. West Virginia has a lot to offer and in the times I get to take a break, I take advantage. When you’re choosing a program, it needs to feel like home and a new adventure. School is the time to make some friends while you all work towards your common goals. My friends and I have explored some of the most beautiful places together. Morgantown has a ton of restaurants and the friendliest people. I will admit I take runs through the nice neighborhoods and admire that someday I could live in a cute house like these with the job I’m working towards (kind of a reminder to get back to studying). The nature views are by far the best. They aren’t called the mountaineers for nothing around here! So, if you plan a visit here, or commit to the program, check out some of the views and enjoy your time in Morgantown. As my year is coming to a close, before I leave for rotations, I’m trying to soak in a lot of the good things this school had to offer.
A couple of must-see nature views on the list:
Coopers Rock State Park (take Raven Rock Trail for a second overlook)
On the Right Path(ology) 