Every Wonder What an ACO is?

I have been thinking about writing a blog entry on ACOs for a while now, but then I came across this great Health Affairs blog entry by Ron Klar called ACO 101:The Basics of Accountable Care and thought he did such a great job explaining it an easy-to-read fashion that I'm not going to try to re-invent the wheel.

"But I have come to realize during several recent conferences that most health care practitioners and administrators are more interested in information that is far more basic: just what is “accountable care” and what capabilities are necessary?  For example, when I asked the audience at one national ACO conference I recently spoke at how many had read the proposed rule — not a single paying participant raised their hand." 

-Excerpt from the Blog

The Physical Exam

Earlier this year, I recorded a full physical exam completed by our academic coordinator Rebecca Scott, Ph.D, PA-C and one of my classmates. It is up on YouTube in 3 sections due to the 10 min limit. Below are the links. I know Northeastern starts PA Boot Camp (what they call the 1st week of PA school) next week and having a video of a full PE is helpful. Hope it helps some other first years out!

PE #1
PE #2

PE#3

Student Leadership

Top 6 Ways to Become a Student Leader

1. Become your school’s Assembly of Representative (AOR) Rep

2. Be part of your program's student society

3. Apply for a national task force or work group through SAAAPA

4. Be a member of the AAPA (Knowledge breeds leadership!)

5. Be active in the community and get your classmates involved (PA Week, community service projects, visits/letters to political leaders)

6. Run for a spot on the SAAAPA Board or one of the appointed positions at the national conference

This is not an exhaustive list – just five suggestions to get your started. I truly enjoyed my time as an AOR rep last year and am currently enjoying my position as the Advocacy and Government Affairs Committee Rep. I've had the opportunity to meet with many leaders in our profession as well as work with other student leaders from all over the country. 

Above are links for all of the different positions. In addition, if you have any specific questions about any of the positions - feel free to contact me directly or the student who currently holds that position. We'd be happy to answer your questions!

Pediatric Rotation Resource

I just received my information packet for my first rotation - pediatrics- and as part of the "Preparation for your First Day" section...  The Harriet Lane Handbook 19th Ed. by Tschudy and Arcara was listed as a must-have for the first day. I just received the book in the mail and really like it - so I thought I'd share. It includes pediatric doses as well as many great diagrams and algorithms. It is thick, but could definitely fit in a white coat pocket.

Any other pediatric resource suggestions?

P!nk's Contribution to My PA Student Experience

As I hopped off the T this morning with headphones on and a coffee in hand and began the walk to my Medical Therapeutics final - I was feeling a bit stressed and unprepared. Medical Therapeutics is a class that culminates everything that you learn in PA school. It is a case-based class. You are given some information- you create a problem list and request labs/tests. You are given the test/lab results plus some more information - then you write out what your next step would be. This goes on and on until the final diagnosis and treatment are reached.  We have had cases that ranged from hematology to neurology and everything in between. The case for the exam could have been about anything. I was starting to feel anxious...  And then it happened... the iPod-God spoke to me. As I reached the front door of the building, my iPhone shuffled to Let's Get The Party Started by P!nk. (I never thought P!nk would contribute to my mental well-being as a PA student.) It was a mysterious sign that made me chuckle, but a sign nonetheless. I needed to stop stressing. I was ready to get this party started.

1 hour later: I came. I saw. I conquered. Although I didn't get every possible differential, I did gain an immense amount of confidence because all of the ones that I did come up with were well thought out - and at this point in my career, I am OK with that. Differentials will get better and more inclusive with time and experience. I am just amazed how much we have learned in one year and that in 3 weeks I will using my new skills to see real pint-sized patients.

Now... Only ACLS stands between me and my PA-S2.

4 Important ED Procedures

We just had the most amazing lab at Brigham and Women's Hospital on central lines, intubation, peripheral IVs, and lumbar punctures. I honestly had a blast (as did most of my classmates judging my all the Facebook comments!)

Here are some of the videos I watched in preparation. NEJM puts these amazing videos together, but you need a paid subscription to watch them. Enter... YouTube...

Chest Tube (part 1)

Chest Tube (part 2)

Lumbar Puncture

Central Line (Internal Jugular)

Intubation (part 1)

Intubation (part 2)

I have a headache.

I have a headache and, of course, my natural instinct is to run a differential in my head – an unfortunate side effect of PA school. Since headaches are a common patient complaint I thought I’d share my thought process…

Is it primary or secondary? (Note: Primary HA are non-life threatening.)

Primary = migraines, cluster, or tension

Secondary = think VOMIT

V = vascular (SAH, subdural hematoma, epidural hematoma, intraparenchymal hemorrhage, temporal arteritis)

O = other causes (malignant HTN, pseudomotor cerebri, post-LP, pheochromocytoma)

M = medication (drug related – nitrates, ETOH withdrawal, chronic analgesic use/abuse)

I = infection (meningitis, encephalitis, cerebral abscess, sinusitis, herpes zoster, fever)

T = tumor

Great Article and DDx Chart on Headaches (includes tests/treatments): 

Pitfalls in Management of Headaches in the Emergency Department

I may even add an “S”to the end – it will stand for studying student. I think I’m going to live.

Source: Step Up to Medicine  2^nd Ed.

Best Books to Study for the PANCE and the Reason Why

Just a quick resource post. The clinical coordinator at Northeastern, Rebecca Scott, Ph.D, PA-C recommended to us some resources to study for the PANCE. She recommended the following books over others that are out there because these books focus on using "test bank" questions, while the others do not guarantee this. The first 2 books have the essential points broken down by chapter and the 3rd book, I believe, just has questions. I have used the AAPA/PAEA as a study guide and it has been very helpful. All are about $40-50 new on Amazon.

1. AAPA/PAEA Comprehensive Review Book, ISBN-10: 1605477265 
2. Auth & Kerstein - Physician Assistant Review, ISBN-10: 0781783607

3. Miller - Lange Q & A, ISBN-10: 0071628282
Happy studying!


*Disclaimer: Rebecca Scott is the author of several chapters in the above books, but does not receive compensation for books purchased.

Pediatric Rotation Prep

As I have mentioned before, I have my pediatric rotation 1st.  Here are some of the things that I have found in prep books to get me ready...

What should I have in my pockets?
1-Stethoscope
2-Ophthalmoscope (unless you are in a pediatric clinic because they most likely will have it available - but it wouldn't hurt to have it on the first day just in case)
3-Otoscope with different sized tips (again, unless you are in a ped clinic)
4-pen light
5-tongue blade
6-calculator (or ped dosage calc app)
7-TOY for distraction (I picked up a toy otoscope)
8-Fun stickers (completely optional but I had great success bribing kids with stickers when I worked in pediatric O&P)

Some high yield topics to brush up on?
1-Otitis media vs otitis externa
2-Asthma
3-ADD/ADHD
4-Bronchiolitis
5-Fever management
6-Immunizations
7-Developmental milestones
8-Infant nutrition
9-Lead poisoning
10-Congenital heart dz
*By no means exhaustive but a good start- check with someone else who has already completed your rotation before and ask questions!  Is there a particular population or diagnoses that is typical of that rotation? For example, my preceptor is known for working with kids with behavioral problems so I will definitely be brushing up on ADD/ADHD treatments and risk factors.


General Pearls:
a-Crawling is NOT considered a developmental milestone because some babies skip this step
b-General rule - babies triple in wt and double in ht in the 1st year
c-Best trick that I've found to remember causes of cyanotic heart dz:

5 Major Causes of Cyanotic Heart Dz

(All T's - 5 fingers on your hand)

1 finger up - Truncus arteriosus (1 = 1 vessel)

2 fingers up - Transposition of the great vessels (2 = 2 vessels transposed)

3 fingers up - Tricuspid atresia (3 = Tri)

4 fingers up - Tetralogy of Fallot (4 = Tetra)

5 fingers up -Total anomalous pulmonary venous return (5 = 5 words)

Resource: First Aid for the Wards 4th ed, plus some others

Diabetes: Dawn Phenomenon Vs Somogyi Effect

What are 2 causes of AM hyperglycemia in diabetes mellitus? 
Dawn phenomenon and Somogyi Effect

What's the difference?
-The dawn phenomenon is likely due to an increase in nocturnal secretion of GH.

-The Somogyi effect is a rebound response to nocturnal hypOglycemia.

How do you figure out the difference clinically?
If AM hyperglycemia is present, check the glucose at 3AM...

If the glucose is ELEVATED, the pt has the dawn phenomenon, you should ELEVATE his/her evening insulin (this will provide extra coverage in the overnight hrs)

If the glucose is LOW, the pt has Somogyi effect, you should LOWER his/her evening insulin (this will avoid nocturnal hypOglycemia)

Resource: Step Up to Medicine 2nd Ed. Agabegi & Agabegi