Reunited in Japan

It's been a long year and a half, but it's good to finally be reunited with my fiancee, Hanako. Deciding to go to graduate school and work hard and study hard for two years is well enough on its own. However, it's also because of the goals and experiences that we want to attain outside of school and work that we do our best. Being able to achieve our professional goals in many cases helps us to achieve so many other goals in life. For me, being together with Hanako again is one such example.

January 1st will bring a close to the year 2012. In reflection, there are so many things that my classmates and I were able to accomplish this year, but there are still many goals and achievements yet to be made in 2013.

May the New Year find you all a little closer to achieving your goals!

Pass!

It has been a very busy past couple of days with last minute studying, unpacking, cleaning and organizing. But, perhaps the most important news is that I can now be considered a ASCP certified pathologists' assistant. It is great to have the burden of the exam lifted from off of my shoulders. I will still be very busy with cleaning and organizing all the way up until my trip to Japan. I still have to deal with the headache of USCIS and their frustrating immigration process, but it's good to be able to tackle different tasks one at a time.

I still have much work and meeting of family and old friends left to go, so this post will remain short. Thank you everyone for all of your steadfast support. The pages of these two years have turned and now what remains is the real meat of the story that is left to be written.

Last Day of Rotation and Specimen Log for 2012

One could say that today, Friday, December 14th, 2012 is the day on which the Pathologists’ Assistant Program for 2012 has officially completed. My classmate and I said our farewells to the hardworking and instructive PAs and staff at UPMC Shadyside Hospital and we headed to our home for perhaps the last time. Eight weeks ago I had very little experience with prostates, bladders, knees and hips, but now I feel much more comfortable handling those specimens.

From here on out, it will be packing and organizing my luggage before my flight on Tuesday. We have already discontinued our internet service, so I will need to walk to the local library to connect to the internet. Replying to any comments may be a little slow for a short while until I arrive back in California.

Of note for your viewing pleasure is a log of all of the specimens that I have done during this year. You could say that it is one years’ worth of grossing for this PA student. Any future students can look at this and get a general feel for what they can expect to gross during their own rotations. You will notice that I unfortunately did not get the chance to perform a whipple or a laryngectomy. During my rotation at UPMC Presbyterian Hospital, on the second to last week there were plenty that were coming in nearly every day. I watched other PAs gross these specimens in preparation for performing those ones the following week. Then, as luck would have it, hardly a trickle came in. Take it as a warning to be very proactive in obtaining certain specimens because the blowing of the wind can change direction at a moment’s notice. I am still confident that I can perform these two specimen types with the help of my future colleagues and my previous knowledge of the specimens from both observation and having studied the texts.

Overall, I am very pleased with both the range and volume of specimens that I was able to work with. The true range of specimens that I was able to gross is actually broader, but adding too many categories would make it difficult to fit it all onto just one page. Therefore, I combined all of the odd-one-outs into the “soft tissue, nos” category.

In addition to packing I will be studying hard for the last and final test. Time to put on the study cap.

Graduation!

Graduation day has come! Being able to see all of my classmates and the professors who made this program possible again was very satisfying.  Despite the rain nothing could dampen our spirits.

Our day was actually broken up into two parts. In the morning, we arrived at the alumni center for our convocation brunch. There we had the chance to meet the family members of many of our classmates and our professors. There was a variety of breakfast foods and the preparations and arrangements were beautiful. When I first arrived in Morgantown two years ago, I had the opportunity to attend the convocation brunch for the class of 2010 and I was glad to see that things hadn’t changed. After eating brunch our program director, Cheryl Germain, started with a few words about our accomplishments. There were many of us who were recognized for our awards and other achievements. In fact, our class has had an exceptionally large number of students who have been recognized at the national level, much more than would be expected for our class size. It is a testament that the efforts and hard work that Cheryl and all of the other coordinators and professors have labored for us has been fruitful. Pictures were taken, gifts were exchanged, and then it was off to the coliseum.

The coliseum was where not just our class, but all of the students from the various schools and departments at WVU were recognized. We put on our cap and gowns and walked in. There were a few speeches by a number of directors and each of us walked up to accept our certificates of recognition. Our actual diplomas will be mailed to us a number of weeks from now, but I thought that the ceremony simulated an actual graduation almost exactly. It was good to see all of us new professionals in our attire ready to enter into the workforce.

Which reminds me, virtually all of us have found jobs before graduating! In general, it is good to apply early to a few places that you are interested in, but as graduation is in December, if you apply in May or June you may get a reply saying that the lab can’t wait that long to employ you. I would say that by September, about half of us had found employment. By December, nearly all of us had. It’s great news not just for our class, but it’s also great news for our program at West Virginia University. It’s really exciting seeing our friends and classmates find work in a city that they love and how well things worked out in the end. It reminds me of one of those game shows on TV where they drop a ping pong ball down through a board filled with pegs. The ball bounces down all around on the pegs but eventually ends up in a final hole at the bottom. You can’t ever tell what path the ball will take as it falls down, but they all end up at their final destination. I’m really happy for all of my classmates and am glad to have had them by my side throughout this program.

All is not over however! We have one last week to complete at our hospital rotations before we can reunite with our families. Our last day is on Friday, December 14th. My ticket to return to Fresno, California is on the Tuesday, December 18th, and then I’ll take my ASCP Certification Exam in Fresno on Thursday, December 20th. A few days of relaxation and then I’m off to reunite with my fiancée in Japan on Friday, December 28th. I’ll be returning to California on Tuesday, January 15th and after a few days of rest I’ll be able to start my employment at Pathology Associates in Clovis. I can’t wait!

Although I’ll soon be graduating from this wonderful program here at WVU, I plan to keep up this blog for posterity and for all of the future potential students who are interested into entering Pathologists’ Assistant School. I believe that time will permit and if so I will continue with updates while working. My future blog plans are tentative, but I would eventually like to create a lot of guides on how to gross specific specimens. I’ll need to get permission from Pathology Associates and of course keep strict adherence to the rules for HIPAA.

So, despite graduation, this is not the end if there’s anything I can do to help it! I’m very fortunate to have a program director who has been able to get the information and advice found in this blog out to such a wide audience of students and young health professionals.

Rather than post pictures of our graduation directly onto this blog, I will post a link to our program’s website where the pictures can be viewed directly as soon as they are uploaded.

Thank you everyone for all of your support these past two years! We couldn’t have made it this far without your help.

Status post graduation.

Last Test at School!

I have been remiss in writing a blog post, but I’m happy to say that finally our last test at WVU is over and finished! It’s good to know that the only remaining test is the ASCP certification exam. I’m still registered to take it back in Fresno, California six days after the last day of our rotation. I’m feeling confident that I can pass it right now if I were to take it.

This latest test has been good in reminding me certain areas that I should be focusing more time on. I did very well, but I have been neglecting studying forensic pathology and histology/stains. It’s not uncommon for people in this field to focus on one subject to the exclusion of all else. My pathology and anatomy are down pretty well pat.

Still I haven’t heard any word from USCIS and our application for the K-1 visa. It has been over 7 months now which is very unusual to say it lightly. I have called, but the only answer that I get is that the processing center is still very busy and has yet to reach our application. It’s a big kink in our future plans, but I have only one option and that is to wait.

The days in Pittsburgh have been growing colder and colder and for a person who is ill-adjusted to cold weather, many of my conversations with those around me at work are about the harrowing adventures trying to get to work. The weather and the road conditions can play a surprisingly large role in your mood for the rest of the day. In the morning, if the roads are really clogged, then we’ll know that our specimen load is going to be really heavy. Likewise, if there’s little traffic, then the workload for the day will more than likely be lighter. It’s got to be more than just a coincidence.

With only two more weeks to go it has come time to pack up some of our belongings and get organized for our last big move of the year. We are giving away or throwing out furniture that we will no longer need. I plan on going to Goodwill and seeing how much from us that they will take.

I’ll try and get some good pictures of our graduation ceremony and convocation brunch for your viewing pleasure. It’s all coming to a finale!

One Year Ago

I can still remember how life was just one year ago. Finals were coming up and I was studying furiously while trying to juggle future living arrangements for Pittsburgh. Stress levels were high and I couldn’t wait to put down the books for once and use my hands. So how does life during the first year compare with this year?

   

I can say on behalf of all my classmates that not having three tests every week was a very welcome change. Whereas before I would spend a number of hours every day studying, this year I study according to my own schedule. For self-motivated students, being able to study when you want provides convenience and comfort. I can remember last year before many tests I would try and find a good studying spot. Many times that meant that I had to get bundled up in heavy winter clothes and brave the elements by walking to school or hopping onto the PRT to get to the library. This was all while freezing rain or snow was pelting my umbrella and body. I had to keep myself moving before the biting winds of the arctic tundra froze me in place. Now, our once monthly tests feel like a divine respite. With fewer tests we are at our leisure to study an hour here and there for the first and second weeks and then we ramp up our studying as the test date nears. It feels like a steady jog rather than an all-out long distance sprint. Stress from tests has definitely decreased during this second year compared to our first.

There are some other stresses that fill the stress meter, but they generally aren’t to the same degree as last year. There are times where work can be stressful such as when you are bombarded with specimens and you are rushing to complete them all on time before they have to go on the processors. But, generally, the stresses encountered at work can be left behind at work. At home, it is great to not have to worry about what may happen the next day until the next day actually arrives. Like in my first year, when I had one test coming up on Thursday and another test coming up on Friday, there was no way to truly relax from Monday to Wednesday, even at home.

This year, moving around from town to town was admittedly a bit of a pain, but after one day of packing and one day of settling in life would resume as normal. This year I moved a total of seven times between Morgantown, Pittsburgh and Charleston. That was more moves than all of my previous life. But, as I said before, once you have your place of stay all planned out, the moving step itself is not too troublesome. I knew that I’d be moving a lot so I purposefully packed light and all of my possessions can fit into two suitcases and a backpack.

Speaking of moving, one of the more stressful parts of last year was trying to find a place to stay in Pittsburgh. Each location has their own strengths and weaknesses whether they are related to price, distance from rotation sites, local crime, access to supermarkets and so forth. I was fortunate to be able to move together with a classmate to share the burden of rent and utilities. We decided on a place just outside of the downtown area and just west of the river. Our apartment complex has a couple of good things going for it. The price is relatively cheap compared to living downtown ($695 rent + utilities with free heating), there are supermarkets located nearby and the neighborhood is low crime. Commuting is a bit difficult for getting to Shadyside, but the other rotation sites are accessible. As I’ve mentioned earlier, I don’t drive in Pittsburgh so I carpool with my classmate and we save money by paying half and half for gas.

As the year has gone on, I have admittedly been feeling the pinch of tightening money supply. Debt only builds up the longer that one is in this program, so by the end, I have found myself doing silly things to save money. If there is free food offered at a conference for example I will fill my plate up as much as possible to save money on dinner. The bus system in Pittsburgh is unfortunately very expensive and so I don’t take trips to downtown, even though I would like to explore it. There is a great supermarket called Aldi’s where I go to buy groceries, even though it is farther away than the more convenient Giant Eagle. Admittedly, I do go to the occasional restaurant, but only for cheap buffets where I can eat a whole day’s worth of food in one meal. When new clothes are needed, Gabriel Brothers and sometimes K-Mart  are cheap places to go and shop. It’s necessary to micromanage your finances to alleviate the cost of living as the year progresses.

The amount of free time for relaxation and recreation that I’ve had this year has varied depending on each rotation site. On average, I would come home at around 5:00 PM and have the rest of the evening to do as I please. During the first year, classes may have sometimes finished by 2:00 PM or 3:00 PM, but with the amount of studying done after school the amount of time for relaxing was actually less than this year. This year, on some of my longer rotation sites when I came home at 6:30 PM or so I’d be too tired to do much so I would just make dinner, take a shower and head to bed. Still, in general I’ve had more time to relax and take life easier this year than last year.

Compared to last year, of course, I’ve become much more competent as a future pathologists’ assistant. The movements of grossing have almost become second nature, now. One interesting thing that I’ve noticed is that I’ve become much more ambidextrous than at any other time in my life. For example, I used to only be comfortable holding a scalpel and forceps in my left hand, but now, it’s just more convenient to work with a scalpel in my left and forceps in my right. Sometimes I even work with a scalpel in my right and forceps in my left. There has been a kind of rewiring in my brain such that the tools that I use are becoming extensions of my fingers. I’m sure that everyone else in my cohort is experiencing something similar.

A lot has happened this past year, but with good planning everything has gone relatively well without any major problems. Enjoying the second year in PA school isn’t hard to do. All it takes is to try your best at work, learn as much as you can from your PA mentors, don’t bring home with you stress from work and do some logistical planning in finding living arrangements. One year ago things were looking up, and I’m happy to say that things are still looking up.

Bureaucracy...

...if studying for the final fate-defining ASCP certification exam wasn't stressful enough, you can always count on our love for bureaucracy to make sure those catecholamines stay pumping. Lately, I've been stressed, not so much from studying, but because of my frustrations with paperwork and how sluggish some administrations are.

As many of you long time readers may know, for the past year, I have been in the process of getting Hanako's K1 visa requirements and forms completed. The K1 visa is required so that we can finally live together and marry after having been separated for more than 2 years. My forms from my initial application are currently being looked over by the Vermont Service Center. In fact, they've been looking them over for more than 6 months. While they look over the forms they perform a number of other different things such as background checks and if further forms are required then they will notify you. The average processing time for this form (I129F) at their facility is 5.6 months, so already our application is taking longer than average. It is frustrating to check on their website everyday only to see that our status is still stuck in the ever unchanging stasis of "Initial Review". I had incorrectly assumed that our application would be completed close to the average time and thus had already bought a plane ticket to go to Japan in December. Our plan was to then come back together on the same flight in mid January while using the K1 visa for her to enter into the US. Then our lives would be grand and you could stamp "happily ever after" at the end of our passports. Returning back together to the US at the same time is important because at the immigration window they are going to be very aggressive (speaking in brusk English) in asking her why she's coming to the US, who she's staying with, where she's staying and so forth. Previously, they were so rude that they brought her to tears. I won't let that happen again if there's anything I can do about it.

It looks like since I can't control how fast the USCIS processes our application, I'm going to have to return to the US in mid January alone and leave her in Japan until they get up to speed. When the application is finally complete, I'll have to fly back to Japan to meet her and then we can come back together as it should be. On top of it all, I get to pay thousands of dollars that I don't have for the pleasure of processing these forms. However, the responsibility is ultimately mine. I was naive to think that an organization of this size would be able to stick to their projected completion times that they publish. A part of me wishes that we could go back to the immigration efficiency once seen at places like Ellis Island.

In an unrelated but similar example of why I can't understand some aspects of bureaucracy is actually one of the requirements of the Pearson Vue testing center. Today, I was glad to receive a letter in the mail from the ASCP saying that I am now eligible to register a date on which I will take the PA certification exam. But, one of the strange things is that the testing center requires that when you go to the exam you must bring with you two IDs, both of which must contain your signature. Most people will use their driver's license for the first, but some people will have a hard time coming up with the second. How many people out there actually have two forms of ID with signatures on them? It makes me wonder if the testing center has had problems in the past with people faking driver's licenses so now they require two forms of identification. Perhaps one state derived ID is insufficient after all. I am fortunate in that I have a passport, but most Americans actually don't have passports. I'm curious as to what other forms of ID have signatures on them.

I had originally planned on taking the ASCP PA Certification Exam here in Pittsburgh before I returned home, but since my passport is back in California I have decided that it would be safer to wait until I got back. I can't risk mailing my passport to here because even if in the remotest chance that it got lost my life would be turned upside down. I certainly wouldn't be able to make it to Japan in time to meet Hanako and her family after all this time and anticipation. "It would be a disappointment" is a very big understatement. Taking the exam in Fresno, CA is no problem for me. It's just that there is a feeling of helplessness in not being able to follow through with the plans that you've already made. So many things are out of our control and we can't decide for ourselves when and where and how to plan for the future. I'm the type of person who avoids problems down the road by planning ahead of time. If there's something that can be done now, then I complete it and get it done. Unfortunately, it seems that no matter how well one plans, life has other plans for you.

That is perhaps the moral lesson of this all. You can't plan for the unexpected. Stay as flexible as possible and don't stress over the wrenches. Stressing never solved any problem. Stepping back I can see how silly this all is, now. I need to stop being so serious.

Week One at UPMC Shadyside Hospital

Our big monthly test for October has come and gone and it has been a heavy load lifted from our shoulders. This test was the last test on which we had specific reading assignments. The questions for our next test will come from any of the material that we've learned so far throughout this program. I believe that most of us are feeling confident now and we are prepared for most of what will come our way. To cram now for our next test would be an impossible task due to the amount of material that we've covered. Of course, I'll still be studying the material on some of my weaker areas, but rather than focusing on the specifics I'll be focusing on the general. Honestly, if I had the option to take our next monthly test as well as the ASCP certification exam tomorrow, I would go ahead and do it.

This last week at Shadyside I got the opportunity to handle many of the "gross-only" specimens that Shadyside gets. The ones that stick out the most in my mind are the femoral heads and knees, although there are many other smaller specimens as well. When doing many similar specimens over and over, the usefulness of templates cannot be overstated. What would be a 15 minutes job by free dictation is cut down into nearly 5 minutes. Each gross-only case is reviewed by the pathologist before being signed out, but it's up to the PAs to create not just the gross description, but also the final diagnosis and any comments that are needed. So long as my microphone doesn't mess up or my computer doesn't suddenly restart things should be smooth sailing.

Shadyside primarily handles two organ systems; genitourinary and bone/soft tissue. For the next three weeks I will be assigned to one and then the following three weeks I'll be assigned to the other. Shadyside Hospital is well known among the UPMC system for their entire examination of every prostatectomy. One of the special things that they perform is to strip the prostate capsule and examine it entirely for any tumor invasion. It ends up being a lot of blocks that need cutting, however you can't get any more thorough than examining the entire prostate. If ever I develop a malignancy in my prostate (which I hope not) then I might highly consider flying to Pittsburgh to get it taken out.

It's unfortunate that the apartment that I'm currently living in is on the other side of town from Shadyside. The commute to get there is the longest of all of my rotations. It will cut into my studying time but I'm sure I can make it work. A storm is coming in which is going to make traffic horrendous. If all goes well our car won't be blown off the bridge during our commute.

Book Review: Most Useful Textbook Award

Well loved and well worn.

A few minor adjustments.

Time and time again, ever since the beginning of the summer pathology course to even now, I have found myself coming back to reference and study from this textbook. It’s the BRS Pathology 4^th edition by Schneider and Szanto. It can be thought of as a condensed version of Robbins which removes a lot of the side content and tells you the main points behind each individual pathology. In fact, I find studying from this bullet-point style book much easier than having to wade through paragraphs and paragraphs to get to the bottom of my answer in Robbins. The information is presented with as little flair as possible which leaves just the delicious tenderloin meat of pathology left over. What would take me a whole day in reviewing an organ system takes me no more than 2 hours.

This book not only serves for me as a quick reference and study guide, but also as a practice review. The end of each chapter is filled with up to several dozen practice questions that hit the main pathologies from each section. The questions are in multiple-choice, which also helps us to review for our board exam once we graduate. The questions cover a good variety of topics, but the difficulty could admittedly be a little tougher. After having reviewed the entire book over and over and over, one gets to the point where just by reading the first sentence you already know that the answer is C.

As a book which condenses pathology into understandable bite-sized portions there are some pathologies which are glossed over or omitted entirely. It does a fine job at introducing most of the pathologies, but for the successful pathologists’ assistant, only knowing “most of the pathologies” is not going to cut it. You can see that I have made some “improvements” and have written my own notes within the book. Whenever I have come across a pathology that needed more elaboration or was not included in the book, I write it in myself in the appropriate chapter. Over this past year and a half it has become a much more personalized item and if there’s an entry I need to look up I know from my own memory the approximate page it’s going to be in. It has also been useful for me to write in non-pathology notes in the pages, for example explanations of different surgical procedures or surgical hardware/tools.

The last minor irk that I have with this book is that it’s not made from titanium. I’m afraid one day it’s going to disintegrate into dust and be blown away by a strong gust of wind. It’s only because I love this book so much that it is falling into disrepair. 

I think that many of my classmates will agree that this book has helped them immensely throughout both years of this program. As for myself, it will continue to be of use even after the completion of this program.

Getting the Bigger Specimens

It's both a good and sad thing that the end of this rotation here at UPMC Presbyterian is nearing. There are still a lot of specimens left that I would like to see and it's always a pleasure to be under the direction of the PAs here. As time is running short these next two weeks I expect to perform only on larger specimens, which is precisely the practice and experience that I am looking for.

Recently, I had the opportunity to gross my first lung case. As it was my first time, as always, I prepared beforehand by reading up in the texts on how to approach the specimen. It's nice when you are still a student and have the leisure to double check on the different procedures, but in the working world there is no such room for brushing up. It seems that no matter how long one studies the texts at home, without the hands on experience the material doesn't stick. I'm sure that there must be research out there confirming that most people learn better with hands-on work over reading.

In any case, I am still working on my speed as much as possible. I know one thing that is holding me back is that I stumble when trying to say a description. I often try to describe exactly what I see and without a "word bank" of important words that pathologists and PAs like to hear, it can become cumbersome. Also, I find myself backtracking sometimes to insert additional words that make the sentence more descriptive, but it still ends up eating my time. For example, I might say something like, "the external surface is tan-red, roughened and displays numerous adhesions" but I forget to mention that there is soft tissue attached or that there is a focal area of granularity so I have to go back and edit the sentence. Fortunately, I am fairly proficient at moving around using voice commands, but each command takes about 1 second for the computer to register, and even that takes up time when you aggregate all of the commands that you sometimes need to make. The best thing to do is to not omit anything the first time so you make fewer commands and save time.

Studying is continuing as usual. Many of my classmates and I have already applied to take the ASCP PA certification exam as soon as we graduate. The fee this year is $515. I had always thought it to be ironic for someone to pay to take a test. The demand however is such that the organization can charge this much and still attract willing PA students. Supply and demand. I wonder if there are any other certifying organizations besides the ASCP for pathologist assistants. I tend to usually view competition as a good thing. Election time is nearing and it's probably all getting to my head now. Another few more months of focusing on school and then it will be time to worry about other matters. It will be a welcome change.

Accepted!

This weekend has been a pleasant yet busy life changing experience. Although my interview was to be held on Monday morning I had Saturday afternoon and all of Sunday to spend some much needed time with my family in Clovis.

It is interesting to come home after being away for so long and to see all of the changes that have happened around the house. My mom and dad are always working on the house despite being retired and I could see the fruits of their labor. The house was getting new shingles and the kitchen had a new microwave, refrigerator and toaster oven. Some more striking changes were outside though. A small twister had come through in the spring and wiped out a whole bunch of things such as the arch to our driveway, a few old eucalyptus trees, and a gigantic old tree which fell over and squashed a whole row of bushes along the side of our house. My father had been busy chopping up all of the wood and the place just seemed a little empty without all of those trees. The most striking change for me, however, was to discover that my younger brother had invaded my room! What was once neat and tidy was now chaos with posters on the walls, my desk filled with his items and a floor that was in desperate need of some cleaning.

I was looking forward to the interview on Monday, but I didn’t know what to really expect so I prepared for any interview question that might come my way. In the morning I put on my best suit and with my portfolio in hand headed to the lab. There I met with their COO who was very friendly and enthusiastic. I learned some of the history behind the lab as well as its future direction. He drove me to another hospital from which the lab receives its specimens to meet with some of the other pathologists. I briefly met with each pathologist and introduced myself to each of them one-by-one. Everyone was very kind and the process was not nearly as stringent as I had partially feared. We headed back to the laboratory and met with a few of the other pathologists where I had the opportunity to talk with them one on one. Lunch was provided and I then moved on to the gross room.

I was happy that the supervisor of the gross room had remembered me when I first came to shadow at their lab nearly two years prior. I was given a tour of the place and introduced to the talented and hardworking PAs there. It’s quite a busy lab and they receive over 50,000 surgical specimens every year. The laboratory receives specimens from a number of hospitals and labs, so the range of specimens that they receive is pretty much everything from A to Z. For me personally, I couldn’t have asked for a better place to increase my abilities. I was also impressed in that the lab was specifically built with grossing in mind during the construction. Specimen processing is very stream lined and PAs are used efficiently to spend the vast majority of their time doing what they do best, that is grossing. Specimens are received on a one at a time basis and cassettes are created on the fly, nearly instantaneously. They use the Voicebrook speech recognition software that I’m familiar with, but I will still have to get used to their information system which is Power Path. It was amazing to see the PAs gross through complex specimens on the computer just as fast as a person speaking into a dictaphone could. The benches are high tech to maximizes efficiency and eliminate lost time. 

It’s also fortunate that the supervisor and everyone else at the lab are very focused on helping its employees achieve their highest potential and professional growth. I got the feeling that I was very welcome there and it really made me want to put out my absolute best. 

One of the other interesting parts about the interview was a special test that I was given. It was a test designed to measure my descriptive abilities as well as how much time it took me. I was given three everyday objects and asked to describe them on paper. I had heard of a similar test in a book I read a while ago for prospective surgeons having to carve a bar of soap. The test was a good mental exercise for me and I found what I had wrote to be surprisingly detailed, although it did take a little longer to put my thoughts onto paper than I had hoped. 

On Tuesday morning I returned to the lab and was elated to discover that they had offered me a position there. I couldn’t imagine a place that I’d rather be and so I was eager to accept. I’m still moved at how understanding everyone was that I wouldn’t be able to start work until mid-January (visiting Hanako and her family in Japan). Everyone was very professional and had not just their heart into the business but also their own workers lives. I still can’t believe how lucky I am. I’ve made it my mission to become the best PA that I can be and to repay them by adding to their team. Man, I can’t wait to graduate!

Week Three at UPMC Presbyterian Hospital

Finally, after having labored for three weeks and two weekends, my power point presentation on lung neoplasms is complete. It's quite a task to make a presentation designed to last only 30 minutes when there are so many things to be talked about. The only thing left for this is to remember what to say when the presentation day actually comes.

The biggest thing that I'm looking forward to right now is my interview on Monday. I'm reading up on some of the many questions that they may ask me, but it always seems that no matter how much you prepare there is always one curve ball of a question which comes your way. Even though our monthly test and my presentation is just four days after this interview I can't think about anything else at the moment.

So far being in the gross room at UPMC Presbyterian has been another big learning experience. It seems almost like a polar opposite of grossing at Charleston. Since we are once again using CoPath to make our dictations, the pace of grossing specimens has dramatically decreased. But, that is because of all of the attention to detail and procedures that must be followed. The grossing system at UPMC Presbyterian introduces a whole new set of minute issues to deal with as opposed to just speaking into a microphone. Some of the things which come to my mind are...
- writing our name in the 'grossed by' field
- using dictation templates for a whole variety of specimens
- being super careful to make sure your dictation is absolutely correct
- taking photographs of a wide variety of specimens from small to big (and excellent quality photos at that)
- ordering cassettes and waiting for them to print (at Charleston they are hand-written)
- writing the patient's name on the side of the cassette as well as any special notes for histology (decal, on-edge, etc...)
- being super careful to make sure your dictation is absolutely correct
- recording the amount of time that the specimen has spent in formalin
- providing the clinical history of the patient (at other places the transcriptionists may handle this for you)
- correcting spelling and punctuation mistakes made by Voiceover or yourself
- for gross-only specimens, being able to use the correct templates to insert the correct final diagnosis
- being super careful to make sure your dictation is absolutely correct
- for specimens in which frozen section has been performed, to know the right format and structure to report the findings
- for specimens that need to be sent to other labs for further studies, know which special forms to fill out or log book to record it in
- have a PA proofread your dictation to make sure everything is correct
and of course, it's important to not forget...
- being super careful to make sure your dictation is absolutely correct
I'm fairly good at making an easy to read and easy to understand dictation which includes all of the information that you will need to know. But, when all of the above little things are thrown into the mix my pace goes way down again. There are a lot of good things about this system however. It has really given me the time to reflect on how I word my dictations so that I understand the specimen in-depth. At some of the other places, you may be doing specimens so quickly that little thought goes into the disease process or techniques involved in cutting the specimen. Also, because a lot of the specimens involve taking photographs, it has given me an excellent source of example specimen templates and their associated pictures for my own personal use. It's very satisfying to open up a word document of a previous case that you've done and read your dictation and correlate that with the picture. It brings back a kind of nostalgia and you can think to yourself "What a job well done."

There are always going to be a lot of new things to get used to when moving to a new lab. I will worry more about my interview first, then focus on getting into the flow of the lab.

-

Moving Back to Pittsburgh and a Pleasant Surprise

Our time at Thomas Memorial Hospital has come to an end and a new chapter will be opening at UPMC Presbyterian in Pittsburgh. Thomas was a really great place, not just because of the wonderful people, but because it's a really great place to improve on one's speed. It was just the rotation that I needed.

At Thomas, us two PA students are in full charge of grossing the specimens. Of course, we always have the pathologists on hand to help us when we have questions, but it is up to us to complete all of the specimens before they have to go on the processor at 3 PM. The pressure is on for us to go as efficiently as possible and we find different ways to maximize our capabilities. The specimens are laid on on a counter for us to choose from and we can do them in any order so long as we finish them. In this way, we'd choose to save our messy specimens (gallbladders, placentas, etc...) for last and do our less messy specimens earlier. If we worked quickly and finished our specimens early then there were times where we could study or relax in the side office until the next batch of specimens came in. It really felt as if we were really working as PAs and not as students. Also, because the grossing stations were left up to us, our responsibilities were greater. No helpful fairy godmother was there to remind us to put a certain specimen in decal or to process a specimen a certain special way. We had to be on top of our game just as any other working PA. If given the opportunity, I would have chosen to work at Thomas until graduating at the end of December.

Besides having done relatively well on our monthly test, there has been another thing which has made me extremely happy. I have kept in contact with a laboratory in CA where I am from and I have recently received a call from them to have an interview in the near future. They are the same place where I first shadowed a pathologist's assistant. I was very impressed with their laboratory and if I am accepted for their position it would be like a dream come true. I'll be sure to write more as events develop.

In the meantime, there is a presentation that needs to be made and another not so distant test that needs to be studied for. Have a great week!

Commonly Asked Questions

I am in the fortunate position to have received many emails, over this past year and a half, with questions regarding the field of pathology and pathologist's assistant schools. It is always my pleasure to be of help to anyone who asks. The following are some of the more common questions that I have received.

I have a background in... what can I do to be competitive in getting into PA school?
I can't speak for each and every PA program, however, I believe that your competitiveness in getting into PA school can basically be broken down into three main categories.
-Your background/experience.
-GPA/GRE score.
-Letters of recommendation/essay score/interview score.
Now, there are always exceptions and it is even quite possible that the exceptions predominate. As far as West Virginia University's PA Program is concerned, of course having a background in the health sciences is going to be to your advantage, but people who have majored with other degrees (for example, art or business) have been accepted into the program and done just fine. As long as you have the prerequisite courses taken (WVU's can be found here: http://medicine.hsc.wvu.edu/pa/Admission-Process)  then it should not be a hindrance, though you should still have a good reason why you changed directions in life.
Experience in the pathology laboratory or in any healthcare laboratory will be seen as a plus. But, you shouldn't give up just because you've never worked in a laboratory. You should try your best to get some experience working in a lab or at least shadow someone. I'll talk more about shadowing below.
Your GPA is also a big factor that makes you competitive. If you have a 3.5 GPA from undergrad, then you are competitive enough grade-wise, but WVU and other programs will accept as low as 3.0. However, I must say that people who achieved close to a 3.0 in undergraduate school are going to really have to amp up their studying. The PA program is basically a shortened version (2 years) of medical school and we take courses alongside other medical school and dental school students. Any average GPA of below 3.0 while in the program gets you kicked out. You may be asked during interviews (not just at WVU) how you think that you will be able to handle the academically rigorous schedule with a low GPA from undergrad.
I believe that each PA school places a different emphasis on how much they value letters of recommendation, essay scores and interview scores. Try to get your letters of recommendation from health professionals who have observed your work, preferably a pathologist or pathologist's assistant. Your personal statement may be one of the few things that interviewers will remember you by. During the application process, the interviewers see so many applicants that it becomes difficult to remember who was who. You should spend a lot of time on your personal statement and how you can make yourself stand out from the dozens and dozens of other applicants. As far as the interview is concerned, it feels more like a formal procedure. It is a way for the faculty to know whether you have the right personality and focus for being successful in the program. The usual rules for interviews apply. Before your interview, the interviewers already know your background and may have at least partially decided whether they want to accept you or not. During the interview, don't give them a reason to disqualify you.

Should I take the GRE?
As you may already know, many PA programs require applicants to take the GRE. West Virginia University is one of the programs which does not require the GRE. Nonetheless, I would still recommend taking the GRE even if you are applying to WVU. In my opinion, because the competition is so high, even if you are perfectly qualified to enter the program there may not be enough seats open for you. If you really want to get into PA school, be prepared to move. You should apply to PA school as if you were applying to medical school and do a shotgun approach. Apply to as many programs as you can. Before I was accepted into the WVU PA Program, I too was studying for the GRE. There's always a very real chance that you may not be accepted due to space limitations and taking the GRE is like having insurance to apply for other programs.

How can I get shadowing experience?
Depending on where you live, it may be difficult to get access to a laboratory or to see an autopsy. Don't be put off if you are rejected. My best advice is to write a very polite letter to the head of the laboratory or the medical examiner/coroner explaining your situation. State your background and write your request professionally. It may be hospital policy or laboratory policy that non-personnel are prohibited from entering and they have no choice but to turn you down. You may have to broaden your horizons and travel a bit from your hometown to get the shadowing experience.
One of the great parts of WVU (in West Virginia, Morgantown) is that the pathology laboratory is always open to shadowers. Of course, you should contact our program director if you are interested. If you have been unable to get shadowing experience anywhere else then after your interview at WVU you may go see the hospital surgical pathology laboratory. I would highly recommend it even if you already have shadowing experience.

What undergraduate classes should I take?
Once you have met the requirements for the programs that you are applying for, it is up to you what other courses you would like to take. If you have the opportunity to take any of the following classes, I would highly recommend it. The list below is what I think the most useful courses will be for you while an undergrad in descending order.

-Anatomy and Physiology  <---- very highly recommended (including any courses on autopsy dissection)
-Pathology (usually offered as a graduate course so may not be applicable to your case)
-Histology
-Clinical laboratory science related courses
-Medical Microbiology
-Immunology
-Cell Biology
-Genetics

As always, keep your grades up and you will be competitive.

What should I write for my personal statement essay?
Some programs give you a specific question that you must answer as your essay to enter the program, but at WVU the essay that you must write is much more broad. This can be a good or a bad thing depending on how well or analytical of a writer that you are. Your personal statement essay should cover basically, "Why should they accept you over all of the other applicants?" You are going to need to make yourself stand out because at the end of the whole process when the interviewers have to go over all of the dozens and dozens of applicants, faces can get blurry, who said what, and which face went with which interview (Which is why you are requested to send your photo in. So they can remember your interview!) can become a real mind-boggling task.
You'll want to emphasize the experience that you have or have had and relate that to how that will make you a successful student and future PA. You can try to give a specific example of something that you did that makes you qualified or gives you an edge over other applicants. You can even use your experience outside the field of pathology. For example you can mention your leadership activities within your church or your mentoring experiences or how people depended on you during your job or how you successfully organized and carried out a project. The possibilities are near limitless. The hardest part is thinking of something to write about in the first place. Once you have an idea, write out your essay and have someone read it over.
One thing that I should mention is that this is a hard-professional program so stick to Times New Roman or Arial and don't put anything that might detract from your essay such as printing on colored paper.

How will having a family affect my school experience?
It is true that the majority of students who are in the program have yet to form their own families, but that doesn't mean that family will prevent you from being successful in the PA program.
As I have yet to form my own family, I am only speaking from conjecture, but if you are accepted into a PA program, then you must be willing to put school as your highest priority for two years. Tests do not wait for children's soccer games, sick family members, cooking for dinner or laundry. It is very highly recommended that you attend every lecture that you have and that may conflict with your other obligations. You may even have to be willing to separate from your family for months or longer at a time. Now that we are in the digital age, living far from home is not so alienating. I have used SKYPE and email to stay in contact with my family members and some of my classmates do the same with their families.
If you are lucky and your spouse can afford to stay at home, then having a family close by could actually be a great boon for you. There have been many times when I have wished for a good home-cooked meal but not had the time to make it day in and out, so I settled for quick microwave items. (Usually this only occurs during heavy test weeks.)
It goes without saying that being responsible for a family will put a considerable amount of financial strain on you. Working is highly discouraged while in the program so you should have enough funds saved up to afford your cost of living for the next two years as much as possible.

How did you get interested in the field of pathology?
I had always been interested in the laboratory sciences ever since elementary school when my mother took me to her workplace during my summer vacations. She worked as a laboratory assistant in a county public health laboratory and I got to see a lot of neat bugs and blood specimens under the microscope. In high school, my favorite class was anatomy and physiology and I knew from then on I wanted to go into a field using that knowledge. I had considered going into medical school to study pathology, but before that I absolutely had to experience life in another country. There's really only one chance that you get, (for me it was after graduation from undergrad but before entering into graduate school) and I couldn't pass it up. Upon returning to the U.S., I couldn't bring myself to study another 10 or so years in medical school, so I decided that the field of pathologist's assistant was my best and most preferred option. I don't regret my decisions at all and I'm quite happy so far with how everything has turned out.

How do you feel about Morgantown?
Morgantown is a college town set in a rural area of rolling green hills. There are many conveniences such as fast food, supermarkets, restaurants and large chain stores such as Walmart. I personally prefer the country life to city life and I really enjoyed my time in Morgantown. I purposefully lived close to campus so that I could walk to school and in fact, this entire time I have never owned nor driven a car. (For transportation, I take the bus, taxi or pay gas money to my classmates.) Morgantown has a small town feel to it but can get really lively during football season. I would have stayed in Morgantown longer if given the choice.

How do you feel about your program?
I have never taken any other PA program, so I have no set point to base any of my opinions off of, but I can say that this program will ensure that you enter into the field as a prepared pathologist's assistant. There is a lot of information to absorb throughout all of your courses and at times it can feel overwhelming. Because the grading structure is strict (no less than a 3.0 GPA) it will keep you on your toes studying. The large amount of studying is for your benefit so that you pass the ASCP certification exam (all graduates of WVU's PA Program have passed the ASCP certification exam on the first try.) The range of rotation sites during the second year is fantastic. You will get experience through UPMC's "Centers of Excellence" where each site focuses on something different such as gynecological pathology, GI pathology, genitourinary pathology and pediatric pathology. You will get experience performing autopsies, working at general hospitals and even a tissue bank.

What do you do for housing?
It's best to live as close to campus as possible, as that is where you will be commuting for the majority of your days. If you can get in contact with another student who has been accepted into the program and share rent, that would be even better. Craigslist is hit or miss. You will be moving around quite a bit during the second year, so try to find someone who is flexible with their leases. Don't lock yourself into a 12 month lease if you're only going to be in Morgantown for 3 months.
Housing in Charleston, West Virginia is provided by the kind pathologists who work at Thomas Memorial Hospital.
For Pittsburgh, Pennsylvania, you will again need to find your own housing. Try to double up with a fellow classmate to share the cost.

What is the job market like?
There is one disturbing trend in the pathologist's assistant field and that is that the average age is decreasing. (I believe that it is somewhere in the 40's, but please correct me if I'm wrong.) That means that there are a lot of new graduates coming in to fill up job vacancies. There are still a number of job openings available, but the market will get tighter as time goes on and the PA programs graduate more students.
It seems that there are jobs open all across the country, but significantly more so on the West and South West. States like California and Texas are hot spots for PA job opportunities. The reason for this is that all of the PA schools are located on the eastern side of the US and graduates typically stay close to family.
I have written another post regarding factors that affect the future of the PA profession here:
http://pathotoko.blogspot.com/2012/07/how-supreme-courts-ruling-on-individual.html

What books can you recommend to learn more about pathology or start studying from early?
The two most helpful books that you can get, in my opinion, are: 
-Robbins & Cotran Pathologic Basis of Disease 8th edition
-BRS Pathology
These two books complement each other and will probably form the meat of your studies. 
Besides books, there are some great anatomy websites that you should study from. They can be found either through google or on the right hand side of this page.

Are there any other ways to become a pathologist's assistant?
It used to be that pathologist's assistants were on-the-job trained and many of the older PAs got into the profession through their workplace. Recently, there has been new regulation stating that for high complexity testing, either a certified PA (one who has graduated from an ASCP certified PA program and has passed the PA certification test) has to do it or a pathologist must be on site while the specimen is being processed. I do not know of many laboratories which are training people on-the-job, however. Many laboratories now want a PA who is ready to go from the first day. Your best bet is to still graduate from one of the PA schools.

As time goes on I am sure that there will be other questions that come my way and I will be happy to expand this list as I see them. Feel free to add to this list by sending me an email or asking me in the comments!