I am on break for the Holidays! And it is sort of surreal.

I have this little alarm in the back of my head, and it is stressing out right now because it feels like we should be studying. So I thought I’d calm it down by writing another blog post.

My class has now finished two of the three semesters of our didactic year. And amazingly I have not been kicked out. The workload is still insane, but I have learned to cope with it. And learning what material to focus on for the tests has led to much improved grades. I imagine when we graduate, our degrees will just say on them in big bold letters: I survived!

It is exciting to think that we have only one more term of hell before we are on rotations. According to every second year student, rotations are fun. They are significantly less stressful than first year, and you get to see all of your hard work go to use.

While this is encouraging, it is also intimidating. We have been cramming so much in our heads, so fast, that I can’t help but think: one more semester? Is that all we get? Am I going to be ready by then?

One of the common fears of all PA students is that, as we cram all of this information into our heads, most of it comes tumbling out the other side.

PA school is so much about survival that I often feel like I am learning the material just well enough to (hopefully) recognize the correct answer on a multiple choice test. As soon as we finish a test, we move onto new material. Within a few days, I suspect that if I were to retake the test, I would fail.

When I brought this up to my academic adviser first term, I was almost in tears. He told me not to worry. That all PA students have this exact same fear. He said to trust the process because I am retaining more information than I realize.

“Trust the process.” I have heard that phrase more times than I care to count.

I believed him more once I heard this echoed by second year students. They assured me that they had felt the same way. On their first rotation, they were all shocked by how much they knew. When an attending would “pimp” them with questions (a strange term that describes a doctor grilling a student), they were surprised to find their own hands reaching up into the air with answers.

“You are learning more than you realize,” seems to be the general consensus among second year students. And I have actually heard from multiple sources that the PA students outperform the med students on rotations.

But if you ask me right now for a list of drugs that can cause cholestasis, I don’t think I can name very many. We learned it last term, but now that information is gone. So it begs the question: if you learn all of this information during your didactic year and most of it dissolves away moments after the test, what information stays and what information goes? Essentially, what do you REALLY learn during didactic year?

I can say, for starters, that while I may not remember the entire list of drugs that can cause cholestasis, I do at least remember what cholestasis is and that it can be caused by drugs. In other words, even when you forget information, at the very least you retain a knowledge that that information exists so that you can consider it when making a diagnosis and look it up again when the circumstance calls for it. As you begin your career, you will relearn what you use in practice and many of these “lists” will become second nature.

I constantly surprise myself when a friend or a relative asks about a disease process and I, uncontrollably, start rattling off information at them like a machine gun. By the time I am done, this friend or relative is bored or annoyed (and probably concerned for my mental health). And I feel a little embarrassed because it is clear to both of us that I am showing off.

I do have to wonder, though, to whom am I showing off more? Them or myself? Because it is in these moments that I get a sense of how much we have learned over the past two semesters. At school we are constantly drilled on the particulars (of a drug/disease/process). Our assessments are so challenging that it is hard to realize that we are, at the same time, mastering the more basic concepts. So when a friend or family member asks a question from the perspective of a layman (as most patients will), I find myself overwhelmed with information to tell them. If anything, the challenge is learning to narrow the information down and to present it in a way that they can understand.

In other words, while it may feel like we are forgetting much of what we learn, the most important stuff (the concepts) is strongly implanted in our brains. The details we will pick back up as we go, but that foundation is there, whether we notice it yet or not.

This is the general emotion that perpetuates this fear of forgetfulness (amnesiphobia?) in students:

During didactic year we are constantly submerged. We are so in-over-our-heads in information/tests/lectures that we are gasping for air. There is no solid footing, much less an island, for us to stand tall and gain a vantage point over this “process” in which we are all involved. At best there are a few opportunities to get a vague sense of how far we have come on this journey (too far to turn back now). All I feel I can do is to trust those who have gone before me and believe them when they say that when the time comes I will be ready, as they were.

I guess “trust the process” is about the best advice that we can get.