Nyala Edwards, MPAS

I enjoyed reading Randy Danielsen’s thought-provoking editorial on the controversial issue of PA recertification. I've been an emergency medicine PA for nine years and was a paramedic for 16 years before that, so my background in emergency medicine is well rooted. I am due for recertification in the next year, which will mark the third test I will have taken.

With the changes in health care, we in the ED are becoming both generalized and specialized, so it's somewhat of a catch-22. Our main focus, however, is not to resolve every problem. Our main focus is to be acutely aware, by use of clinical acumen, of whether a patient is safe to go home or not. After that, we ask ourselves "Can we fix it or not?" If we can fix it, we do. If we can't, we summon the appropriate help and come up with a plan.

Some of this talent comes via academia: the things you have to and should know. Some of it comes by years of experience observing, touching, hearing, smelling, and treating sick people, recognizing what's a true emergency and what's not.

My point is that coming up with a real-world way to assess something like this is not easy. You can have brilliant, academic individuals who can recite pathophysiology as if they were reading it from a book, but then can't get it from their head to their hands to save someone's life. Which PA do you want to work on you? The real world wants both. Perhaps our testing models are too academically oriented and not "hands on" enough.

In my specialty, I have to know a lot of bits about a lot of things—but more importantly, I have to demonstrate excellence at the most critical things. If I fail to recognize a sick person, I could kill somebody. That's a scary thought! On the other hand, I might recognize a sick person but not know exactly why they are sick. I then have to know what direction to go in. If I fail at this, the result is a bad outcome.

In that case, is it more important to know the exact disease process, or is it more important to know how to get the patient to someone who does? With the traditional test questions, I'm more likely to get the wrong answer because it won't ask how to get from point A to point B; it will ask what A is. My answer might be "I don't know what A is, I just know they're really sick" … but that's not an option. So, now what?

It's a very frustrating process, and I don't envy those in charge of it. Medicine just isn't that black and white. In my head, I have 25 years of combined experience working beside, and being surrounded by, some of the most extraordinary people I'll ever know. They range from Vietnam combat medics, to search and rescue teams, tactical medics, fellow PAs, physicians and nurses, disaster teams, firefighters, and police officers. It's important that I get what's in my head out to my hands, and out from my hands comes all of the things they've taught me through the years.

All I can do right now, with the current process, is study hard and pray that I pass, because the truth is, I'm a horrible test taker. I must, however, be able to perform at work regardless. Sure, I can put a slew of acronyms beside my name for all of the things I've done. But for me, the real test is in the ED, and that’s where I continue to learn every day. I'm just not really sure how to put that on paper in the form of questions suitable for the world of academia.

Nyala Edwards, MPAS
Walterboro, SC

FOR MORE LETTERS TO THE EDITOR:
A Learning Experience but Not an Impediment
A Vote in Favor of New Model
Recertification: The NPs Have the Right Idea
When Did a Simple Process Become So Complicated?

I enjoyed reading Randy Danielsen’s thought-provoking editorial on the controversial issue of PA recertification. I've been an emergency medicine PA for nine years and was a paramedic for 16 years before that, so my background in emergency medicine is well rooted. I am due for recertification in the next year, which will mark the third test I will have taken.

With the changes in health care, we in the ED are becoming both generalized and specialized, so it's somewhat of a catch-22. Our main focus, however, is not to resolve every problem. Our main focus is to be acutely aware, by use of clinical acumen, of whether a patient is safe to go home or not. After that, we ask ourselves "Can we fix it or not?" If we can fix it, we do. If we can't, we summon the appropriate help and come up with a plan.

Some of this talent comes via academia: the things you have to and should know. Some of it comes by years of experience observing, touching, hearing, smelling, and treating sick people, recognizing what's a true emergency and what's not.

My point is that coming up with a real-world way to assess something like this is not easy. You can have brilliant, academic individuals who can recite pathophysiology as if they were reading it from a book, but then can't get it from their head to their hands to save someone's life. Which PA do you want to work on you? The real world wants both. Perhaps our testing models are too academically oriented and not "hands on" enough.

In my specialty, I have to know a lot of bits about a lot of things—but more importantly, I have to demonstrate excellence at the most critical things. If I fail to recognize a sick person, I could kill somebody. That's a scary thought! On the other hand, I might recognize a sick person but not know exactly why they are sick. I then have to know what direction to go in. If I fail at this, the result is a bad outcome.

In that case, is it more important to know the exact disease process, or is it more important to know how to get the patient to someone who does? With the traditional test questions, I'm more likely to get the wrong answer because it won't ask how to get from point A to point B; it will ask what A is. My answer might be "I don't know what A is, I just know they're really sick" … but that's not an option. So, now what?

It's a very frustrating process, and I don't envy those in charge of it. Medicine just isn't that black and white. In my head, I have 25 years of combined experience working beside, and being surrounded by, some of the most extraordinary people I'll ever know. They range from Vietnam combat medics, to search and rescue teams, tactical medics, fellow PAs, physicians and nurses, disaster teams, firefighters, and police officers. It's important that I get what's in my head out to my hands, and out from my hands comes all of the things they've taught me through the years.

All I can do right now, with the current process, is study hard and pray that I pass, because the truth is, I'm a horrible test taker. I must, however, be able to perform at work regardless. Sure, I can put a slew of acronyms beside my name for all of the things I've done. But for me, the real test is in the ED, and that’s where I continue to learn every day. I'm just not really sure how to put that on paper in the form of questions suitable for the world of academia.

Nyala Edwards, MPAS
Walterboro, SC

FOR MORE LETTERS TO THE EDITOR:
A Learning Experience but Not an Impediment
A Vote in Favor of New Model
Recertification: The NPs Have the Right Idea
When Did a Simple Process Become So Complicated?

I enjoyed reading Randy Danielsen’s thought-provoking editorial on the controversial issue of PA recertification. I've been an emergency medicine PA for nine years and was a paramedic for 16 years before that, so my background in emergency medicine is well rooted. I am due for recertification in the next year, which will mark the third test I will have taken.

With the changes in health care, we in the ED are becoming both generalized and specialized, so it's somewhat of a catch-22. Our main focus, however, is not to resolve every problem. Our main focus is to be acutely aware, by use of clinical acumen, of whether a patient is safe to go home or not. After that, we ask ourselves "Can we fix it or not?" If we can fix it, we do. If we can't, we summon the appropriate help and come up with a plan.

Some of this talent comes via academia: the things you have to and should know. Some of it comes by years of experience observing, touching, hearing, smelling, and treating sick people, recognizing what's a true emergency and what's not.

My point is that coming up with a real-world way to assess something like this is not easy. You can have brilliant, academic individuals who can recite pathophysiology as if they were reading it from a book, but then can't get it from their head to their hands to save someone's life. Which PA do you want to work on you? The real world wants both. Perhaps our testing models are too academically oriented and not "hands on" enough.

In my specialty, I have to know a lot of bits about a lot of things—but more importantly, I have to demonstrate excellence at the most critical things. If I fail to recognize a sick person, I could kill somebody. That's a scary thought! On the other hand, I might recognize a sick person but not know exactly why they are sick. I then have to know what direction to go in. If I fail at this, the result is a bad outcome.

In that case, is it more important to know the exact disease process, or is it more important to know how to get the patient to someone who does? With the traditional test questions, I'm more likely to get the wrong answer because it won't ask how to get from point A to point B; it will ask what A is. My answer might be "I don't know what A is, I just know they're really sick" … but that's not an option. So, now what?

It's a very frustrating process, and I don't envy those in charge of it. Medicine just isn't that black and white. In my head, I have 25 years of combined experience working beside, and being surrounded by, some of the most extraordinary people I'll ever know. They range from Vietnam combat medics, to search and rescue teams, tactical medics, fellow PAs, physicians and nurses, disaster teams, firefighters, and police officers. It's important that I get what's in my head out to my hands, and out from my hands comes all of the things they've taught me through the years.

All I can do right now, with the current process, is study hard and pray that I pass, because the truth is, I'm a horrible test taker. I must, however, be able to perform at work regardless. Sure, I can put a slew of acronyms beside my name for all of the things I've done. But for me, the real test is in the ED, and that’s where I continue to learn every day. I'm just not really sure how to put that on paper in the form of questions suitable for the world of academia.

Nyala Edwards, MPAS
Walterboro, SC

FOR MORE LETTERS TO THE EDITOR:
A Learning Experience but Not an Impediment
A Vote in Favor of New Model
Recertification: The NPs Have the Right Idea
When Did a Simple Process Become So Complicated?