 one person's opinion could have ended my whole career. So these supplemental question banks were very instrumental in me passing my end of rotation exams and ultimately the pants. Learn every little tiny bit of information and practical experience that you possibly can because those are the rotations, the rare rotations where 100% of your confidence as a new provider comes from. Basically your test-taking strategy is going to be read the last couple of sentences first, then read the question choices, and then if you still need to go back and skim the rest of the question. Hey guys, my name is Boris, I'm a physician assistant and the topic of today's video is going to be how to survive in clinical year of PA school and this advice just might save your ass. So the inspiration for this video came from this question in the physician assistant, physician associate, student and new grad group on Facebook, pre-PA students, current PA students ask questions and then current PA students are practicing PA, such as myself. When we see a question that we think that we have some good advice on, we answer the question and hopefully that responds, helps some people and helps them get through school, right? So definitely something I utilized while I was a PA student. And so I'm just gonna answer this question right here. It just says, hello, I just finished the didactic phase of PA school and I will be transitioning to clinical soon. If you do not know, most people here probably do but if you do not know, PA school has two phases. There's the didactic portion where you learn all your book learning. Basically it's a year to 18 months or so depending on the program and you do all of your classes. So you do clinical medicine, you do pharmacology, you do anatomy physiology, you might have some humanities courses thrown in there depending on the program but that's the basis of what you do. You just get all of your didactic which means from the books, all your theory, kind of all that kind of stuff in place. And then once you do that, then if you pass all of that, you take your final exams, you pass didactic portion, then you're on to the clinical portion which is usually about a year. Some programs, it might be a little bit longer. For most programs, it's one year, 12 months, usually eight to 10 rotations depending on how long they are in all the basic areas of medicine plus maybe some elective depending on what your interests might be. But all of them, you can find them online but it's primary care, internal medicine, women's health, psychiatry, so mental health, emergency medicine. I'm gonna drop a link on a bunch of the other ones but there's some core rotations which are I think eight of them and then depending on the program you'll get some electives. So this person in particular just passed their didactic portion so congratulations, that's awesome. That is definitely very difficult to do and then they're on to their clinical portion. Of course they say they're nervous and they just want some advice how to prepare what they can do to survive the clinical year portion of PA school. Some people say clinical year is easier, some people say it's harder just depending on you and also your situation. So when I saw this question pop up I was actually at work and we had a snowstorm so a few people didn't show up I had a little bit of downtime and so I actually took some time to think about it and write out a well thought out response which you see here on the screen in front of you and I'm just gonna read that to you and just kind of riff on it. This is in no way, in no way is this comprehensive. There's definitely other advice I would have on clinical year. There's a lot of other good things that people said below about clinical year and what they would recommend but this is just kind of what came to mind based on my experiences during clinical year some of which are extremely positive and I learned a ton, some of which were kind of negative and I also learned a ton about medicine but also just about human nature and about what some people will and will not do and how easy it is to possibly put your entire career at jeopardy based on one or two people's opinion. Yeah, so if that doesn't send shivers down your spine and make you terrified, it should and you should definitely watch the rest of this video because this advice and my situation and what happened to me might just save your butt, okay? So without further ado, here was my response to this person who basically just wanted some general advice on surviving clinical year of physician assistant school. I also think this would be applicable to nursing school, you know, medical school, any sort of medical training where you have a clerkship sort of a deal where you're in person with a preceptor or multiple preceptors. So I'm just gonna read my response word for word and also just riff on it and see if there's anything else that comes to mind, okay? Let's do it. So I said, my first patient no showed because of the snowstorm, so I have some time to drop some nuggets of wisdom, LOL and basically I just said how to survive clinical year. Number one, except that your preceptors are human. They are not perfect, they're stressed, they may or may not have time to teach you anything or even pay attention to you. Some just might not like you, it happens, all right? So me, like probably anybody else going into clinical year, I thought that it was gonna be this like very hands-on learning environment where your preceptor just rolls out the red carpet and they can't wait to teach you and you get all this wonderful hands-on experience, all this stuff that you've been learning. In theory, you finally get to be hands-on with patients, actually do the exams, actually do your history taking practice, learn all these different disciplines from these extremely experienced preceptors who are fantastic providers and they just can't wait to put an effort in teaching you and making you as good of a future provider as possible. That's what you expect. When you get there, sometimes you get that and sometimes you get preceptors that even exceed those amazing expectations and sometimes you don't, okay? Sometimes your preceptor might be busy, sometimes they might have things going on in their personal life, outside of work that are distracting them, sometimes it's just a fricking personality conflict and they just straight up don't like you and that makes it so that they can't really teach you as well as maybe they could or should. Either way, just this first piece of advice is just to kind of curb your expectations a little bit and just understand that your preceptors are human even if for some students they might be fantastic preceptors for you, they might not be and vice versa. You might really gel, really jive with certain preceptors and you learn a ton from that and some people go like, I really did not have a great experience with that person so it's just not everything is perfect, not everything is black and white, not every situation or preceptor is the same to every student and just understand that they're human, they might be trying their best, they might not be trying their best. Situations may or may not come up where the experience, the learning experience might be great for you, it might not. So basically just understand that your preceptor is human and give them that grace and just do what you can to get as much out of the rotation as possible whether or not they're a great preceptor or they're a great preceptor at the time. So just understand they're human, they may or may not be perfect and it's up to you to just make it the best and it possibly can be for you because it's your career, it's not theirs. So that's number one. Number two, when you do get a rotation that is really, really good in a good learning environment and in my experience and that of people I've talked to you might get two or three of these if you're lucky, you might only get one, you might not get any rotations where you really learn anything. Like I said, don't be idealistic, it's not perfect but if you do get a rotation where you and your preceptor get along, they actually do have time and effort and they actually do take your education seriously and they do really wanna train you more often than not, take full advantage because you may or may not get another preceptor or rotation like this again and these are the rotations where all of your confidence as a new provider comes from. Again, ideally all eight to 10 of your rotations, you're gonna be hands-on, you're gonna be taking care of patients, you're gonna be getting frequent feedback from your preceptors, they're gonna be open to teaching you, they're gonna be energetic and motivated and wanting to teach you ideally but in reality from my experience and from those of dozens of other PA students that I've talked to, it's just not the case most of the time. So you get one, two, maybe three of these amazing rotations regardless of the specialty, even if you don't wanna work in that specialty, just where all the stars line up, you get along with the preceptor, they have the time and the energy and the desire and motivation to teach you and all those things line up and it is an actual good learning environment for you practically hands-on, learn every little tiny bit of information and practical experience that you possibly can because those are the rotations, the rare rotations where 100% of your confidence as a new provider comes from. So go in early, stay late, ask every possible question without annoying your preceptor too much. Don't leave a bad taste in their mouth, don't exhaust them but do as much as you can and take full advantage of the learning opportunity because you may not get another one. And again, for the third time, this is where 100% of your confidence as a new provider will come from is from these awesome learning experiences, these awesome rotations with these awesome preceptors. So please, please, please take full advantage and learn as much as you can when you do finally get a good one. And this might be your first one, right out of the gate, you might realize, wow, everything is going as it should. Yeah, like put in as much possible effort as you can, learn as much as you can from that one because it may or may not happen again. Okay, yeah. Advice number three, buy the Roche Review supplemental question bank for every rotation that it's available for. This is a life hack that's well worth the money. I think they're like 100 bucks for like an extra 100, 120 questions. And I personally, I mean, I'm not sponsored by freaking Roche Review, take this at your own risk, whether or not you get anything out of Roche Review or not. But me personally, my first, I think two or three end of rotation exams, they were kind of, I passed everything on the first try. I didn't have to remediate anything, but those first two or three, I think they were kind of like average, like 50th percentile or lower. And I think one, I even really struggled to pass. I was like barely, barely passing. I passed by just a few points. And then when I started getting these supplemental Roche Reviews question banks, which are available for all the core rotations, not all of your elective rotations, but definitely all your core rotations. When I started buying them, I just noticed that my scores were at least 50th percentile, if not better and usually better and actually better and better as everything went along. And then of course, I passed the exam at the end of the year. I forget what it's called. I passed the pants. So these supplemental question banks were very instrumental in me passing my end of rotation exams and ultimately the pants, you know, and of course, ultimately getting certified by the NCCPA as a physician assistant, right? PAC, not just PA, but PAC, which is what you need to practice. So my third piece of advice for clinical here is to get these Roche Reviews supplemental question banks because for me personally, they helped tremendously and they were really, really worth the money, okay? Piece of advice number four, find ways, now be careful with this one. Piece of advice number four is find ways to study these question banks every spare minute you get. So you're at home, you're in the bathroom on the toilet, just get it on your phone and do some questions. You're waiting for your meal at the restaurant, do some questions. You're, I don't know, sitting in traffic or somebody else is driving, I hope. Do some questions, you're just sitting around at home, do some questions. Anytime you have a spare moment, take out your phone and do even one question. And you know, look at the explanation if you got it wrong. Just find ways to incorporate this into your life. But with a giant caveat, do not let your preceptor see you studying unless you're 100% sure that they're cool with it. Ask me if I know. How do I know? Because I think this has burned me a couple of times. Now nobody told me, hey, you shouldn't be studying on this rotation. You should be doing X, Y, and Z. No, sometimes it'll just get like a sideways glance and you can tell that they're not, they don't like it and then you stop. Maybe even ask them if there's downtime and I'm not seeing a patient and you're busy, is it okay with you that I study? And ask them like honestly, make sure that there's no ounce of your preceptor being offended by you studying during your rotation time. Because that can really burn you and later in this video you'll see exactly how and why. But if your preceptor is cool with it, they promise you that they're cool with it, they're not offended by you studying during the rotation, you know, if you have a spare minute, do a couple of questions. There's nothing wrong with that. What you wanna do is to do these questions over and over and over and over and over again. One, solidifying the information in your mind and two, even more importantly, practicing your test taking strategy, which I've talked about numerous times on this channel, but basically your test taking strategy is going to be read the last couple of sentences first, then read the question choices, and then if you still need to go back and skim the rest of the question, but usually just those last two sentences and the question choices will give you everything you need to answer the question and move on because speed is of the essence. You only have 60 seconds on average on the pants and on your end of rotation exams per question. And sometimes they're very long questions, you know? So this advice definitely saved me and got me way better at test taking. So anyway, a little bonus tip, how to test take in PA school, especially during clinical year when you only have that one minute per question. But I made a whole video about this, I'll link it above, you know, check that out. Anyway, so piece of advice number four is study these question banks and just the general rush review question banks and whatever pants prep question banks you have. Just study those every spare minute of your life during clinical year because you will need that repetition. All right, piece of advice number five for surviving clinical year is, ask for feedback frequently and very humbly, okay? This is a weird one I said because I found that some preceptors kind of get offended when you seem confident about anything, you know? Like basically there's this whole like medicine or a confidence is earned in medicine mentality that some people have, which I agree with. I mean, the last thing you want is to be a provider that's reckless. You don't know what you don't know. You don't know when to ask for help. And of course that is could be deadly, you know, in medicine, so humility is definitely extremely important. I just personally think that it goes in two different directions. You could be very confident even as a new provider that you know what you know, but you also know where the line is. You know what you don't know and you are more than happy to ask for help and you should if you don't know something. But some preceptors just do get kind of scared and kind of skizzed out by a student or even like a new provider who's confident about anything and speaks confidently about anything. So yeah, this definitely with some people definitely got me, I wouldn't say necessarily in trouble, but definitely some preceptors I could tell did not appreciate it and they even told me so. Basically, because I mean, I had been trained to at least appear confident from years and years ago in the military, for instance, like I was in the ceremonial guard where literally your whole job is to sit there and look pretty and look confident and make the United States government and the US Navy look good. So like I just have that training, you know, my shoulders are back, my voice is usually pretty confident, my eye contact is just like, my whole air is just like being trained since my time in the military to make people think, all right, I got this, I know what I'm doing, you can count on me, right? So I just have that air, it's not something that I'm going to train myself to get out of and if it offends people, you know, sorry, that's their effing problem that you don't like the fact that I'm confident. I understand why a preceptor might not be comfortable with a student that seems so confident when they don't really know anything, you know, the practical knowledge as a provider, I totally understand that, but that doesn't mean just because I come off as confident, that does not mean that I'm not going to stop when I don't know something and ask for help. Like obviously I have in my entire clinical practice so far of over a year at this point, yeah, that's what I've done. Anytime I run into anything that's remotely, like I don't know 100%, I'm doing the right thing, I asked my supervising physician and he's happy to help, you know? So this is kind of a weird piece of advice, but ask for feedback, be very humble about it. And if you are one of those people that seems just has like an air of confidence about them, kind of maybe think about hedging that a little bit and just trying to be a little bit more humble in every way that you interact, especially with your preceptors. And then I also said, yeah, I guess some preceptors, this might be an assumption, but might seem more comfortable if you as a student have this air of like being nervous and terrified 24 seven and never seem confident because, you know, they think that you shouldn't be as a student. I don't know, it's just take this for what it is, take this with a grain of salt, but that was my experience that my confidence actually got me in trouble with some people, some people didn't like it. So I don't know, take that for what you will. Maybe that will help somebody. Finally, number six, do I have a number seven? No, I don't, just number six. This is where the rubber meets the road. This is the most important one in the video, okay? And I even said, number six, piece of advice for surviving clinical year of PA school is, and this one will save your butt if anything is wrong on the rotation, even a little tiny bit, anything at all. And even if this is your first rotation, I don't care. Anything at all seems off. You're not getting opportunities to learn for whatever reason. Preceptors are not paying attention to you or as much attention as you think they should be. It seems like the preceptor doesn't like you. Do not just brush it off as in, oh, it's okay, it'll all be okay. There's any tension or drama or negativity whatsoever. You get any sort of a bad vibe in your stomach, even if you're wrong, even if you think you might be wrong, even if you're almost sure that you're wrong. If you get any, any bad vibe whatsoever for any reason, you just get that pit in your stomach like something is wrong here or might be wrong here. Please, please, please bring it up to your clinical coordinator and any leadership in your PA program, whoever that may be. The dean of the program, the whatever, your clinical coordinator, whoever you're supposed to bring things up to that might be wrong on rotations, please bring it up. Don't get dramatic and say, oh, this person didn't pay attention to me as much as I think they should be. So I'm just, I need another rotation. You need to take me out of this. Like, no, absolutely not. Don't tell them what they need to do. Don't be dramatic about it. Don't be, whatever. But definitely if you feel like anything is off at all, bring it up. Say, hey, look, I don't know. I mean, I'm just a student. This is one of my first rotations. I don't know what is right and wrong, but this is how I feel. Is this justified? Just letting you know what is your advice when you're talking to the clinical coordinator. If anything feels off, bring it up to them. Tell them how you feel. Here's why. Here's exactly why. Because so for me, I try to not be dramatic at the workplace. If something feels off, I just have an attitude of, okay, whatever, it's temporary. Let's just deal with it for whatever reason. This person is not paying attention to me. Maybe they're not being very nice. Maybe they're not being very friendly. You know, like whatever, this preceptor. My attitude is I don't want to rock the boat. Like, this is a rotation that the school needs. This is a rotation that I need. The preceptor is obviously getting something out of this whole deal. Let's just not rock the boat. Let's just do my best to not be dramatic. I'll get what I can out of the rotation even if it's not much. You know, let's just do it and just get through it. Like whatever, who cares? That was my attitude. And on two separate occasions, it actually almost screwed me. On one separate occasion, it kind of screwed me. On one other separate occasion, it really almost screwed me as in almost totally destroying my career before it even began. So listen up. This is one that you absolutely need to pay attention to because it might save your butt. If something feels off, even a little tiny bit, you get any sort of a bad vibe from the rotation or from the preceptor, bring it up immediately. Bring it up immediately. And here's one. On one of my last rotations, and this is a true story and I'm reading word for word from what I told this person. So on one of my last rotations, it was kind of like this. The rotation was in a small town and there was actually already another PA student there for a few weeks when I had started. So I was brand new. It was my first day. The student had been there for like three, four, five weeks. The student was local. She was from this small town. She already knew everybody. I think she was actually a patient at the practice at one point. So like everybody there knew her, loved her, grew up with her for years. She's also brilliant, super nice, super friendly, super smart, super organized, just a fantastic PA student. So nothing against her. Like she was fantastic, right? But long story short, it was kind of hard for me to figure out my place on that rotation and the preceptors honestly weren't really friendly or approachable or open to teaching me. Like sometimes they would say, oh, I've already precepted for this other student once this week or twice this week. Like I'm not, I don't wanna do it again with you. Basically, some just barely even said one word and they were just like, yeah, whatever. Or like, hey, can I follow you today, doctor, whatever, PA, whatever. And like they would kind of turn away, like super standoffish. Like just not, like I could just tell they didn't want me there. Maybe they were already exhausted from having another PA student and like here comes another one. I don't wanna teach them whatever. I don't know, but like the vibe was just off, right? So this person, this other student had already like felt really at home. She like had her go-to procedures, whatever people were expecting her. Like on Tuesday she was with this person, on Wednesday she was with this person. Like the rotation was set up very well for her. When I came in, it just seemed like they were just, they did not want me there. You know, in not so many words. The practice manager was super friendly, super nice. The primary preceptor, at least at first, seemed super friendly and super nice. And all the other ones were just kind of neutral to not so much. Like I said, just after being on a few rotations, this being one of my last ones, I felt that I was not really wanted. There was not like a clear path, you know, forged for me, like it was basically make it whatever you can, get your hours and whatever. But like, I just, I could tell that it just wasn't very well organized. The communication wasn't there. They, most of them didn't seem to want me there. It just was what it was, right? And so like I just told you a second ago, I was just gonna, you know, just put my head down, get through it, do what I can, learn what I can and just get out of there. But as you'll see in just a moment, that was a massive mistake. I should have said something. I should have said something on the first day, or the first week at least. But anyway, so what I just said was, I had difficulty figuring out my place on the rotation. Their communication really wasn't good there. Most of the preceptors weren't very friendly or open to teaching me exactly like I just told you. I asked the primary preceptor when this person was at work, they rotated and shift. So they weren't always there when I was there. But I asked them for feedback every single time that we worked together daily, every time I was there with them on the same shift. My mid rotation evaluation was good. So you get a evaluation to warn you about anything that you might not be doing well, things that could be improved, and just in general to see where you are. Basically, so you're not surprised at the end. My mid rotation evaluation was good. Everything was satisfactory or better, except for one thing that was just below satisfactory that we had already talked about. And I worked to improve that. And so my mid one was totally fine. I was getting decent feedback from everyone that I worked with. There didn't seem to be any problem, at least officially, right? Like I still didn't feel like I was really welcome. I kind of felt out of place, but whatever, like on paper, everything seemed fine. So I was just like, all right, a few more weeks, let's just get through this. Obviously, these people don't want me here, but whatever, let's just not rock the boat, not mess up the rotation for me, for them or for my school and just get through it. And again, like I told you a second ago, that was a huge mistake. So like I just said, my mid evaluation evaluation was good. Then one week after the rotation is over, one week after the rotation is over, I'm waiting for my final evaluation to say, you know, you passed the rotation, here's your feedback, blah, blah, blah, like every single other one I had passed. I never had an issue passing your rotation. So a week after this rotation is over, I find out that the primary preceptor actually failed me and gave me one out of five in like every category just about and said in their comments that I have an overall lack of understanding of medicine, which is like the worst feedback you could possibly give a clinical year, PA students towards the end of their clinical year, like yeah, this person overall just doesn't know anything. I don't think they should be a provider. And you know, when my mid rotation evaluation, everything was satisfactory or better except for one thing. Now everything is like way below satisfactory, one out of five, you know, going from three out of fives or four out of fives or five out of fives to one out of five for like everything. And with this kind of like crippling feedback. And this was actually one of my last rotations and by the way, I aced the end of rotation exam. That was my best one yet. It was like way above average, way above 50th percentile. So obviously I knew the material. I knew what I was doing at least to some degree or I wouldn't have passed the fricking end of rotation exam and this person still gave me, you know, all this feedback basically made me fail the rotation, right? One out of five on almost everything, which is terrible. And what ended up happening was I had to do an extra rotation to make up for this one on which basically my future depended on. So if this extra rotation would have been bad and there would have been another preceptor that like for whatever reason had a negative opinion of me, that would have been it. I would have been out with no makeup. Like that would have been it. 10 plus years trying to get into PA school all that time money effort and my life dedicated to becoming a PA and getting into this career finally getting into the school and being on my last couple of months of the training, it could have all been taken away just like that because of one person's opinion. One person's opinion, right? Not even objective fact, like the end of rotation that's objective. You pass it or you don't and I pass it with flying colors. One person's opinion could have ended my whole career. Okay? Now if that doesn't send shivers down your fricking spine, nothing should. And you know, that'll go into the later part of this message that I'm writing here but just to put that into perspective all that time, all that effort, all that money getting into school, getting through school, training blah, blah, blah. One person's opinion could have ended all of that. One person who by the way just weeks before that gave me official feedback that was basically all good. Like you're on track to pass the rotation, you're fine and then just changing your mind at the last minute. Yeah, that happened. Okay? So I almost would not have been sitting here. I almost would not have that stuff on the wall. I almost would not have been a PA because of this one person's opinion. An opinion that they by the way did not even communicate to me or the program or anyone until the rotation was over. So this goes back to if anything feels off even a little tiny bit, even a little tiny bit bring it up to your program leadership freaking immediately. So they can maybe get you on a different rotation they can intermediate, they can whatever they're gonna do but let them know that something feels off because if you ignore it and if your preceptor happens to be vindictive if they just have a negative opinion of you if they're for whatever reason they would do something like this to you at the very least it's on your leadership's radar that something's been off since the beginning you try to address it and nothing came of it but take your career into your own hands because like I said one person's opinion can end it if you are not careful, okay? So just finishing up my message here. Yeah, so basically what I had to do was this one extra rotation upon which my entire future basically depended on and thank God the preceptor at this makeup rotation was a great guy, he was honest, he communicated well he actually gave a crap, he taught me he took time out of his day even though he was extremely busy to teach me things, to show me things to quiz me, to test me, to have me see patients on my own and with him together like this was an actually good preceptor also this preceptor was very impressed and a bunch of times I actually tried to get me to work there at the current clinic that I was rotating with and in general in the hospital system down in that one town that I went to like he kept saying hey by the way if you need a job I can get you basically any job in this hospital system just say the word and I was just like thank you very much but I already had something lined up at that time I wasn't gonna work there but that just goes to show that I did know what the crap I was doing I did have a decent understanding of medicine this person was very impressed kept trying to offer me jobs obviously if you have no understanding of medicine you're not gonna be offered jobs and I got not to mention this job offer plus the one I already had accepted and wanted after I was done with school plus two other ones, okay so four out of my rotations straight up offered me jobs on the spot so anyway I said sorry for the very long story the point is if you feel a bad vibe even a little bit tell your program leadership immediately ASAP do not wait do not think it'll just be okay it probably will be but it may not be and if you want an example of how it may not be listen to the story that I just told you and I said I guess one bonus lesson here is that if your preceptor has come oh and I said I guess one bonus lesson here one bonus piece of advice is that your preceptor has complete power over you and your future and in parentheses I said which is completely insane given what happened in my situation so keep that in mind and act accordingly all right I don't know how long this video is because I probably rambled and backtracked here and there but I just wanna communicate very very clearly that in clinical year the number one tip I have for surviving clinical year is that your preceptor has 100% total power over you and of your future okay so act accordingly and if you feel a bad vibe at all even a little tiny bit immediately bring it up to your program leadership because that may save your career all right guys hopefully you got something out of this video those are my tips for surviving clinical year like I said of course there's many others there's lots of other stuff I could have told you but this was the biggest thing and especially wanted to share the story of what happened to me it hopes that it could prevent something like this from happening to you all right guys I'll see you in the next video let me know if you have questions and have a great day