Here’s a recipe that’s super quick and easy for all my busy med friends out there. For me, I’m likely to have all these ingredients for the most part, so it’s like an empty the pantry/fridge recipe. It’s vegetarian, but you can easily add meat if you want!

Ingredients:

• 1/4 large red onion
• 1/2 small red bell pepper
• 1 broccoli floret
• Asparagus (break off bottoms)
• Cherry tomatoes (cut into halves)
• Handful of spinach
• Garlic (5 cloves minced)
• Whole Wheat Penne
• Feta
• Cheddar cheese
• Splash of milk/almond milk
• Seasonings: Salt, pepper, basil, oregano, cilantro, thyme

Directions:

1. Prepare the veggies! In a large pan heat up some olive oil, add red onion, bell pepper, broccoli, asparagus and cook until translucent/softer. Season with salt and pepper. Add garlic, cherry tomatoes and spinach and cook for an additional minute or two (or when the garlic is fragrant, tomatoes and spinach are softer). Remove from heat and set to side.
2. Prepare pasta! In a saucepan boil water. Add 1/2 package of whole wheat penne pasta. Cook until al dente.
3. Strain the pasta and place back in saucepan. Drizzle some olive oil on the pasta to prevent it from sticking. Turn on low heat.
4. Add the veggies back to the pasta.
5. Add the cheese! Handful of feta, small handful of cheddar cheese and a splash of milk.
6. Add Seasonings to taste! Salt, pepper, basil, oregano, cilantro, thyme.
7. Garnish with additional cheese and seasonings if you want!

So making different types of burgers is actually one of my favorite things to cook because they’re so easy and filling! These burgers were seriously AMAAAZING with salsa and avocado, and THE BEST PART – they were super easy to make! You could also eat these on top of a salad or in a bowl with rice or quinoa!

Ingredients:

• 1 package Ground Chicken 93% lean
• 1/2 red onion chopped
• 1/4 cup Breadcrumbs
• 1 egg
• 1 4oz can diced green chiles (I didn’t use the whole can, I probably used about 3/4 can I saved some to mix into a sauce for the burgers)
• 1/4 cup chopped cilantro
• 1 tbsp lime juice
• 1 tbsp Cumin
• 1 tsp Paprika
• 1-2 cloves garlic minced
• Pinch of salt
• Optional: handful shredded cheddar cheese (I did it because you know you only live once!)

Toppings:

• Red Salsa
• Mix chopped cilantro, red onion, squeeze some lime juice
• Avocado
• Arugula
• Plain greek yogurt mixed with left over diced green chiles (kinda similar to a spicy mayo or aioli)
• Buns – I used Trader Joes Gluten Free Buns (didn’t realize they were Gluten free but they were actually really good)

Directions:

1. Mix all the ingredients together into a bowl. Make into 5-6 patties.
2. Refrigerate patties for 10 minutes.
3. Cook on grill pan or regular pan.
4. Plate with whatever toppings your heart desires! Definitely recommend with salsa and avocado!

ENJOY!

Pediatrics was definitely a rotation that surprised me! I was pretty hesitant going into it because I have never really worked around children and wasn’t sure how I would react to some overprotective parents, but I was pleasantly surprised by how fun this rotation ended up being! Many thanks to all the silly and equally entertaining little patients that entered through the doors each day!

I worked at an outpatient Pediatric clinic with multiple doctors and nurses on staff.  The schedule at this Peds clinic was seriously the most laidback that I have had throughout rotations so far! My doc had Wednesdays off and rotated on every couple of weekends. Days were typically 8:30am-5pm, except for Tuesday our late night which usually went until 7:30pm. I was so thankful to have more days off to recover from the illnesses I would acquire throughout my rotation. The staff here was also super friendly and amazing. I felt so at home and welcomed since day 1!

My duties mainly consisted of taking history and physicals and presenting a plan if I was able to come up with the diagnosis. Most of the visits were either acute care sick visits or well child checks! In regards to procedures, I didn’t really get to do any procedures during this rotation because there weren’t many complaints that required procedures. Also, most parents aren’t so keen on you trying something for the first time on their child which is understandable. I was pretty tempted to do some vaccinations, but after watching the nurses do a few, it was pretty hard to watch any more after that. Seeing babies get shots is seriously one of the hardest things to watch!

Another thing about Peds that surprised me was the wide range of patient complaints and types of pathology you encounter. For the most part it’s ear infections and well child checks, but we also had a good amount of interesting cases. And since very young children and infants are not able to express their complaints to you in words, it requires a greater amount of critical thinking to determine the source of the problem!

Resources:

• Objectives: PAEA Pediatrics Topic List, PAEA Pediatrics Exam Blueprint
• Books: 
  • Nelson’s Essentials of Pediatrics: This was a required book for Didactic. Many Pediatricians and Pediatric PAs use the full version of Nelson’s Pediatrics (which is two volumes) so this book is a simplified version. Overall, I though this book was just okay. I mainly disliked the organization and I felt like I had to flip back and forth between sections or conditions were not where I expected them to be.
  • Current Pediatrics: I would choose this book over Nelson’s. It’s more organized. It’s also easy to read and has everything from the objectives. I used this resource along with UpToDate the most. *If you are hesitant to buy an extra book (like myself), I was able to access it free online on AccessMedicine under my school’s library resources. You should definitely check to see if your school offers this too!
  • First Aid for Pediatrics: This book is more of a review/study guide with bullet points. It would be a good resource to add for additional studying, but I still like to read from a book first hand about conditions.
• Websites/Apps: 
  • UpToDate: I used UpToDate SO much during this rotation!
  • OnlineMedEd: I found the videos were extremely helpful especially the Neonatal Jaundice video.
• Podcasts: I didn’t listen to really any Podcasts during this rotation because I had difficulty finding any good ones that would pertain to PA topics. But one that I found Pedscases.com: Pediatrics for Medical Students has some good Podcasts. I didn’t really listen to more than a few, but they seemed pretty good if you want to give it a try!
• Practice Questions: The Point

Additional Recommendations/Tips:

Well Child Examination: Outside of the acute care visits, the Well Child Examination is THE STAPLE of the Pediatrics rotation! I definitely think that it is worthwhile to go into the rotation with a little bit of knowledge about this type of visit.

• Developmental Milestones: The developmental milestones were definitely something that I struggled with during this rotation. Especially, when I was asked to do Well Child Checks by myself! It was good to carry around a quick chart at clinic that I could reference between cases.
  • USMLE Developmental Milestones Chart
  • Developmental Milestones Chart: Here’s a Developmental Milestones chart that I made and carried in my white coat. It doesn’t include everything, but it includes milestones that I feel were the most commonly discussed. (Information from Up To Date).

• Newborn Exam: You’ll be seeing a lot of Newborns in Peds at very frequent intervals during their development. So you’ll have to learn how to do a pretty thorough Newborn Exam. You’ll be able to see how your preceptor does his/her exam which will be helpful, but here’s a few resources for if you’ve never done one before (like myself):
  • Newborn Exam Video 
  • Newborn Exam Printout: Here’s a little printout I made initially just to ensure I hit most of the things to lookout for on a newborn exam.

Otoscope Exam: Looking in little kids ears is possibly one of the most difficult things I have had to do in PA school so far. No JOKE! Props to all the Pediatric providers out there that tackle this challenge on a daily basis. Whenever (on the rare occasion), I was able to see a TM on a patient <1 year of age and accurately diagnose an ear infection, I felt like a million bucks. That being said be prepared to hold children down while simultaneously “trying to hit a moving target”. My preceptor taught me a way to hold the otoscope that stabilizes it against the child’s head, so that the otoscope also moves with their movements instead of lodging into the ear canal deeper. Here’s a video with some good tips: https://www.youtube.com/watch?v=pQbjNyZr0gc

Infection Control PSA: “YOU WILL GET SICK ON THIS ROTATION.” The words I heard so many times, but thought to myself “Hey, I haven’t gotten sick once throughout PA school perhaps I’ll be the lucky one.” WRONG! AND WRONG! Regardless of my religious hand washing/sanitizing on entering and leaving every patient room, I still wasn’t immune! I haven’t been this sick since I was a kid. At first, I had a never-ending cold that lasted 2 weeks. By the time I was starting to feel myself again, I was struck by the most debilitating stomach flu I have had since childhood. This is coming from someone who has had a case of gastroenteritis from Third World Nicaragua! Children carry new germs that you most likely (99% sure) will NOT be immune to. PROPHYLAX. SANITIZE. HAND-WASH. EMERGEN-C. DO WHAT YOU CAN TO SPARE YOURSELF!

…And my rant is over haha!

With all that being said, Peds is super fun and you will most likely enjoy your rotation! Everyone is super friendly in Pediatrics so you really don’t have anything to worry about. If you have an questions or comments, leave them below!

 

 

This Pinch of Yum inspired Banh Mi bowl was too good not to share!  Asian food is definitely one of my favorite types of food to cook AND eat so I am always down for trying something Asian inspired. For the most part, I make a lot of Thai and teriyaki dishes, but I haven’t tried anything Vietnamese! I’m glad I did because it came out so delicious… definitely more than just a “pinch of yum!” This was the first for Vietnamese, but I am sure it won’t be the last! 🙂

I didn’t have any Lemongrass paste or fish paste, which is what is called for in her recipe. Instead, I substituted and made my own Lemon flavored soy sauce and I also used the leftover sauce for my brussel sprouts. Here’s her original recipe if you’re interested in making hers too: http://pinchofyum.com/banh-mi-bowls

I will warn you in advance that this is a little bit more involved for a recipe, but you could possibly prepare some ingredients ahead to save yourself some time (if you want to). For example, if the quinoa was pre-made, the carrots had been pickled the day before, and the veggies had been pre-chopped, then making this would be a breeze!

Ingredients:

Pickled Carrots:

• Spiralize 4-6 carrots
• 1/2 cup rice wine vinegar
• 1/4 cup brown sugar
• 1 tsp salt

Banh Mi Pork Meatballs:

• 1 lb Ground Pork
• 4 cloves garlic
• 1/2 small onion chopped
• 1 tbsp chili paste
• 1 tbsp brown sugar
• 2 tsp cornstarch
• 1 tsp salt
• 2 tbsp Lemon Soy Sauce (see below)

Lemon Soy Sauce: 

• 1 tbsp lemon juice
• 2 tbsp soy sauce
• 1 tsp siracha
• 1 tsp maple syrup
• 1 clove garlic
• 1 tsp coconut oil

Asian Lemon Soy sauce roasted Brussel Sprouts:

• Half package of brussel sprouts halved
• Olive oil
• Rest of lemon soy sauce

Additional + Toppings:

• Cooked Quinoa
• Mini cucumbers
• Radishes
• Jalapeno
• Cilantro
• Siracha “Mayo” – Plain greek yogurt, water, and siracha (mix to your desired taste and consistency)

Directions:

1. Pickled Carrots: Combine all pickled carrots ingredients (rice wine vinegar, brown sugar, and salt) in a jar and then add carrots. Let carrots marinate in fridge while you prepare the rest.
2. Banh Mi Meatballs: Combine all ingredients in a bowl and mix. Make into meatballs and let meatballs sit in fridge for 10-20 minutes to take shape. Heat oil on pan and cook meatballs until they are cooked through. (In the meantime, I cooked my quinoa and brussel sprouts).
3. Brussel sprouts: Preheat oven to 400 degrees. Toss brussel sprouts in olive oil and bake for 20 minutes. Then mix with the left over lemon soy sauce and broil for a few minutes until desired crispiness.
4. Plate! I plated starting with my quinoa and adding the pickled carrots, meatballs, and all my veggies and toppings.

Surgery has been a rotation that has been on my mind since first starting PA school! I have always been fascinated by surgery since I was a child. In elementary school I used to come home after school and binge watch TLC surgery shows completely amazed by the capabilities and resiliency of the human body. To this day I still am!

However, without any actual surgical experience it’s hard to know for sure it’s where you want to be. I chose to have surgery early on in my clinical year to see if this is an area of medicine I could see myself working in and that way I would be able tailor some of my later rotations based on this. There’s so much to surgery that isn’t portrayed by the dramatization of TV or what you see on social media. Surgery and the OR is absolutely unlike any environment that I have ever worked in or experienced in my life!

About this Rotation:

I worked with a General Surgery group with two surgeons and two surgery PAs. We typically worked at one specific hospital, but also had some privileges at hospitals in the surrounding areas. The daily routine entirely varied based on what types of surgeries were set up for the day. I would say there wasn’t really any specific routine that I ever got used to, which made it a little bit difficult as a student.

Most of the surgeries we performed were GI related cases, which makes sense since 50% of the end of rotation exam is GI based. The most common surgery we performed was definitely the laparoscopic cholecystectomy as well as hernia repairs and bariatric surgeries since that was my main surgeon’s sub-specialty. We also did colon resections, appendectomies, breast cases, excisions, biopsies, etc. We even had a sigmoid volvulus which was seriously one of the coolest things I have EVER seen!

I also was able to get a good amount of exposure in different surgical specialties during this rotation. I observed some urologic robotic surgeries, a D&C, and participated in a bunch of orthopedic surgeries. I observed spine surgeries, scrubbed in and assisted on a good amount of total hip and knee replacements, foot and ankle surgeries, as well as rotator cuff arthroscopies and repairs. This was probably one of my favorite parts of this rotation!

In regards to my involvement on this rotation, I would say that it varied depending on what surgeon I worked with and the setting. I pretty much saw patients entirely on my own during pre-op and in clinic for the most part. For laparoscopic procedures, my involvement was a little less than in other surgeries. I retracted occasionally, drove the camera once, but I helped with closing every case and always was in the OR before and after to help position/move patients. Whenever I was involved in any of the ortho cases it was pretty hands-on. I typically retracted, often double retracted throughout the entire case (you need muscles NO JOKE to work in ortho) and I got to wear the infamous ortho “space suits!” It really depends on the surgeon and team at the time, and the amount of help that is needed!

A day in the life of General Surgery:

5am-6am: Wake up… and lie there for a good ten minutes. Not motivated to get up in the morning when it’s 7 degrees. Get ready and make breakfast. Leave by 6:15am.

6:30am: Arrive at hospital and change into scrubs. Either begin pre-ops or see if there are any inpatients that need to be rounded on. During this time I usually wrote the H&Ps for preop patients or wrote progress notes until the first case.

7:30 or 8:30am: First case was usually scheduled at 7-7:30am, but sometimes such as the day depicted in this picture our first case was at 8:30am.

Rest of the day: Usually cases were scheduled the rest of the day. About two days a week we had clinic scheduled for pre-op and post-op follow ups. So some days we had surgery scheduled in the morning and then clinic in the afternoon.

End of day: The end of the day varied and usually ended somewhere between 3:30-5pm depending on what was scheduled. I also came in late around 10pm for a specific case when my surgeon was on call.

Resources:

• Objectives: PAEA General Surgery Topic List, PAEA General Surgery Exam Blueprint
• Books: 
  • Current Surgery – (Highly recommend) By far this has been one of my favorite books so far in PA school! It gives a good amount of background information (including both anatomy and physiology), conditions, indications for surgeries, and surgical techniques. Also, easy to read and I think an excellent introduction for surgery.
  • Surgical Recall – (Highly recommend) This book is a great book to prepare yourself if you have a preceptor that pimps you! I liked to use this book after I had already read about a certain procedure or surgery in Current just to test my knowledge. Just FYI though the whole book is pretty much formatted as questions and answers which some people may dislike.
  • Netter’s Anatomy – If you’re in PA school then you probably already have this book. Definitely review your anatomy before your surgeries!
  • Blueprints Surgery – This was a resource that my preceptor let me borrow for a few weeks. It’s a very quick/brief guide on surgeries written in an easy way to understand. I wouldn’t say that this is a necessity for the surgery rotation, but I found it was helpful to carry around in between cases or pressed for time. It doesn’t cover every type of surgery but the main/most common surgeries that you will encounter.
• Websites and Apps: UptoDate, Medscape
• Videos: OnlineMedEd
• Podcasts: Surgery 101 – great resource for your commute!
• Practice Questions: The Point

Additional Recommendations/Tips:

Here are some tips that I wish I would have either known or spent more time with before starting my surgery rotation!

Clinical Skills: The clinical skills that I utilized the most during this rotation included urinary catheterization and subcuticular suturing. I would recommend watching a video online/tutorial on how to do both. However, in regards to suturing – watch with a grain of salt! Every surgery group will have their own specific way they like things done. They will usually teach you how exactly they want their sutures to be so if you don’t come close to mastering it before your rotation it isn’t a big deal. If you practice beforehand you’ll get a little bit of the muscle memory down before you start which might help you when they teach you their way. Most importantly, I would strongly suggest watching a scrubbing tutorial prior to your first day. This might be a skill they already expect you to know before you arrive. Here are some helpful videos:

• Surgical Scrubbing & Gowning
• Subcuticular Suture
• Urinary Catheterization

Some other students I have spoken with had the opportunity to do IVs and intubate at their sites so you may want to refresh on those skills as well.

OR Etiquette: One of the hardest things about surgery (at least for me) is there are A LOT of rules! Surgery is a very ordered and structured place where routine and consistency are of the utmost importance. Some key OR etiquette essentials:

• Entering the room: Always wear a mask when you enter the OR, write your name and what type of student you are on the board, assist the nurses and anesthesia whenever you can prior to surgery
• Sterility: Keep your hands within the sterile field AKA “nipples to navel” or on the patient, do not touch anything unless you are asked to do so, if you are asked to scrub back in don’t take offense
• Conversation and questions: There are specific times that it is okay to ask questions and there are a lot of times its best to hold off. I have found that most of the surgeons I worked with needed peace and quiet in order to focus during the surgery. This is hard when you have burning questions as a student, but often it’s bad timing! I was told by one surgeon that I asked too many questions which really made me second guess myself and hold back a lot. I would say the best time to ask questions are during the most routine parts of the procedure usually at the beginning and at closing.
• Closing: Hold your pickups like a pencil! I swear all surgery preceptors have a third eye and will be able to tell (even when you won’t notice) that you’re holding your pickups like tweezers and not a pencil HAHA!

Feedback:

Hopefully all of this information is able to help you in some way! Please feel free to comment below or contact me if you have any additional questions or content you would like to see. Best of luck to you in your surgery rotation!

Internal Medicine was kind of a doozy to take on as a first elective! It’s pretty much learn by fire, but it’s also a great way to see medicine from a general perspective and gain exposure to a wide variety of medical conditions as you’re just starting to enter the clinical world.

About this Rotation:

I worked in an outpatient Internal Medicine clinic with a group of Internal Medicine and Family Practice physicians, midlevel providers, and nurses. Since our clinic was attached to the main hospital, we also did inpatient rounds if any of our patient’s were admitted. Every single patient had a combination of chronic conditions and a laundry list of medications. The most common conditions that I saw were pretty much what you would expect to see in Internal Medicine: Hypertension, Diabetes, COPD, Coronary Artery Disease, CHF, GERD, Hypothyroidism, Osteoarthritis, and Dementia. I found that I had to become more efficient and stay focused during appointments because IM patient’s typically have many chief complaints and medications to review in a limited period of time.

I also lived in a hospital room during this rotation which was surprisingly much better than I thought it was going to be! I had my own room and bathroom, and there was a common area with a kitchen and laundry. The only disappointment was that someone stole my spice rack on the first day. (HAHA I am fully aware that I am probably the only person in the history of all Medical/PA/Nursing/etc students to bring a spice rack to a rotation site!)

Highlights:

One thing that I really enjoyed during this rotation was the hospital and clinic that I worked at. Everyone was so friendly and welcoming that I instantly felt at home. I was in a smaller town so I was able to see the same faces throughout the hospital and floors, and people remembered who I was despite me being just a student. I also saw many patient’s more than once and was able to develop some patient relationships since they often required frequent follow up.

I also loved being able to see both inpatient and outpatient. I would often round on my patient’s in the morning before my preceptor so that I could be more hands-on and assess them on my own.

My preceptor also performed all of his own colonoscopies and stress tests, so I was also able to shadow him while he performed these tests.

Resources:

Here are the resources that I used to prepare for the End of Rotation (EOR) Exam:

• Book: A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants
• Websites and Apps: UptoDate, Medscape
• Videos: OnlineMedEd
• Podcasts: Physician Assistant Exam Review, PA Boards
• Practice Tests: The Point, Exam Master
• PAEA Internal Medicine Blueprint
• PAEA Internal Medicine EOC Topic List

I could not be happier with my choice of Infectious Disease for an elective. I would highly recommend it to anyone with any interest in ID. A little fun fact background info for you all, I spent a year prior to PA school working in ID in antibiotic resistance research so everything is SO COOL to me!

About this Rotation:

I worked with a group of Infectious Disease consultants who cover a majority of the hospitals within the surrounding area. We were asked to consult a variety of inpatient cases and as long as the case was infection related we were allowed to be involved! We saw anything from bacteremia, non-healing infected wounds and ulcers, pneumonias, intractable fevers, peritonitis, bowel perforations, HIV, TB… you name it – we did it! We typically rotated through several hospitals a day, usually throughout the different floors and the ICU. We also worked a few days in an outpatient clinic to follow up with patients once they were discharged from the hospital.

My preceptor was also AWESOME and let me be as hands-on as I wanted. She let me see the patient’s on my own, write my own notes, make phone calls, help dress wounds, remove PICC lines, and pack wounds and abscesses.

Another thing that has made this rotation entirely invaluable was learning how and when to use the right antimicrobials. It was definitely challenging, but I feel so much better about my antibiotics now! I feel that this is an excellent rotation option if this is something that you struggle with.

Highlights:

Some interesting cases that I had the privilege to be involved in include recurrent brain abscess, pulmonary artery pseudoaneurysm, multiple epidural abscesses, rare bacteremia infections, new HIV diagnosis, facial abscess, hidradenitis suppurativa, and bacterial meningitis. I was also able to scrub into surgery for what we originally thought was necrotizing fasciitis, and I was able to follow my patient throughout their treatment course even after discharge.

 

Image 1: Brain Abscess. Image 2: Epidural Abscess. Note: These images are from google and not of actual patients. They are very similar to cases that we encountered. Click on the images to bring up more information regarding these conditions.

Resources:

Since it was an elective I slacked a bit in the studying department and focused more on studying topics that interested me, but here are some resources that I have found were helpful during this rotation:

• Book: A Comprehensive Review for Certification and Recertification Examinations for Physician Assistants by Claire Babcock O’Connell, Pance Prep Pearls by Dwayne C Williams
• Antimicrobial Resource: The Sanford Guide To Antimicrobial Therapy
• Apps and Websites: UptoDate, Medscape
• Notes from school (PSA to take good notes in class haha)
• Antibiotic Classes Sheet
• Antibiotic Coverage Chart
• White Coat Essentials *Coming soon

And of course I can never go without making a chart. A quick guide to carry in your pocket if you need to determine what antibiotic to use *Coming soon