Posted 11 hours ago

6 months in… and a day in the life

I really apologize that this blog is pretty blah lately. Things have been incredibly busy at work. Like, I’m there for 10-12 hours daily and STILL take home some discharge summaries to finish. The hospital has been FULL. Overfull. And our hospitalist team has trouble keeping their staffing up, which means we all stretch ourselves thin to cover all the patients. But I still really enjoy my work. The days fly by. Some weeks are better. Some docs I enjoy working with more than others, but very rarely do I encounter one that I completely do not mesh with on practice styles (such as the one who thinks all maladies can be cured by becoming vegan?). 6 months in, I finally feel like I’m getting a grasp on thinks. I’ve had a few requests for my typical day, so here is today:

7:30am: Arrive at the hospital a little early in order to finish some discharge summaries from the day before. Looking through my patient list, I realize that one of my patients had died overnight. It was expected though, but I was trying to get him home with hospice before he passed. I make a note to write the death summary on him later.

8:30am: I’ve finished my discharge summaries and go through the labs and vitals on my current patients. I have 7 patients that I’ve followed previously and the docs I’m working with have added 4 more new ones. They give me a brief report on the patient, but it usually isn’t much if the patient is also new to them, as most patients are admitted by a special admissions team earlier and then “handed off” to the docs the next morning. I plan my day by triaging these patients. If anyone has abnormal labs or concerning vitals or chief complaints, then the sickest get seen first. The ICU patients are also seen early on in the day, but I don’t usually have patients there.

10:00am: I’m finally on my way to see patients for the day. Due to some abnormal labs I had to call cardiology to consult on some patients so that took up some time. I head to the orthopedics unit first to see a patient with a new hip fracture. We were consulted to optimize her medically pre-operatively. She is quite old with some dementia and new cardiac issues so I spend a lot of time explaining her risks and benefits to the family. We decide to postpone the surgery until her echocardiogram and troponin come back. I write my note on her and head to the next floor.

10:30am: I see a patient who has developed chest pain. I already called cardiology about him earlier. He’s going to need a cardiac cath. He is a known alcoholic. He tells me he uses it for anxiety and pain control. I do some brief counseling and advise him to see a therapist to discuss his anxiety but the main issue of focus at the moment is his heart. I’ve started a nitroglycerin and heparin drip with the help of my supervising MD, since I’ve never ordered those before. I write my progress note.

11:00am: I’ve got a potential discharge on my list, and if you don’t get those teed up early in the day lots of things can get derailed so I head to the medicine floor to plan the complicated discharge on my patient who needs outpatient antibiotic infusions, home oxygen, and multiple referrals placed. I make several calls to infectious disease, the social worker, and the pharmacist.

12:00-12:45: I grab a salad to go from the cafeteria and head to my desk to look up my new patients and get their notes started. I’m a dedicated chart-digger and tend to be very thorough, so new patients take me a while to figure out what other underlying issues I think need to be assessed and followed while in the hospital. I’ve got another ortho post-op with hypotension and a psych patient just transferred from the medicine floor for an overdose. I also get the orders placed for my discharge and the summary started, but there’s no time to finish it right now.

1:00: The echo and troponin are back on my ortho patient. The troponin is elevated and there’s a new abnormality on the echo. I discuss the recommendations with my MD and he agrees that she will be high cardiac risk for surgery but would be disabled without it. I see the family again and they are very indecisive. I spend a lot of time in the room. I also discuss code status, trying to guide them towards DNR, but they decide on full code. There’s a lot of orthopedic questions, which is not my forte, so I call the ortho NP and ask her to come. They decide to pursue surgery and the patient is whisked away with my recommendations to keep her blood pressure up to reduce cardiac risk. I addend my note on the patient with these updates.

2:00-4:00: I round on several other patients, jumping between floors from neuro stepdown to general medicine to cardiology. I notice my chest pain patient got an angio and they were unable to intervene on LAD lesion, medical management recommended. So I stop the drips and let him finally eat something.

4:30: I’m supposed to be done for the day but I had some busy patients earlier in the day so I find myself with a few left to see. I round on one of my “lifer” patients who’s been deemed unable to make safe medical decisions by psychiatry due to his cognitive impairment. He’s kind of been stuck in the hospital for a few weeks awaiting a guardian because he needs to be on Coumadin for a blood clot but refuses so he’s on a heparin drip indefinitely. He’s actually quite lovable and we get along well. He’s got a bad heart too so I really worry about him and his poor decisions. I encourage him to keep working with PT and review his telemetry record.

5:00: I run over to the psych unit to see a patient. She is having a cough and I see that her CXR has some questionable infiltrates. Ugh, the one patient I’d hoped would have no issues! I continue her antibiotics and order some follow-up labs for the next day.

5:30: I finish rounding on a few patients who were out of there room for tests earlier. I do some opioid conversions on a patient complaining of persistent post-op pain and realize she’s not on high enough of a dose, so I put in some new orders.

6:00: I head back to my office to finish notes and double-check that I’ve charged for all my visits and ordered tomorrow’s labs. I finally write my death summary. I sigh when I realize a bunch of prior authorization paperwork for home oxygen I ordered on a patient last week came through on the fax. I fill it out and fax it back. My docs have worked hard all day, too, and trudge into the office. I give them a quick sign-out report on all the patients and they thank me for helping out.

7:00: I finally leave the office. I’m rarely here this late and today was really long. But I feel good about the extra time spent with patients and their families. I feel like I do a good job not rushing anyone and making sure everyone’s concerns are addressed. But I certainly hope that I’ll become faster and more efficient at this in the future!

Posted 11 hours ago
Hello, I'm currently in a masters program and have decided to go the PA route after without taking a year off in between. I plan on working as a PT aide to get patient care hours. I know it's not the best patient care hours but I plan on doing some other things as well. My question is have you encountered many PA students that were PT aides to get hours?
Anonymous asked

There were a few in my class. One worked for many years as a PTA and she was an excellent resource for our orthopedics unit! I feel like that’s pretty reasonable patient care experience, especially if done in an inpatient setting and you get to go to multiple different kinds of units. It’s hands-on patient care, you need to investigate and understand their underlying health issues in order to treat them (so you get exposed to lots of diseases), and you have a lot of interaction with other staff such as RNs and MDs. I do feel like the PTs are not appreciated enough at my institution (and many others) though. Hopefully this will not be your situation but just prepare yourself for that and remember that your job is important!

Posted 11 hours ago
I know this may seem like forever, but do you have any study tips on how to make it through organic chemistry?
Anonymous asked

O-chem is difficult. It’s a lot of abstract thinking. A few tips I can think of:

  • Take it during a semester with a lighter load or over the summer. I worked my ass off to get B’s for two semesters of ochem during the regular academic year, and then chose to take the lab alone over the summer (with no other classes) working part time and kicked butt and got an A.
  • Color code your notes during class. Like for steps for reactions. I went to college in the Age of Notebooks before powerpoints invaded chemistry lectures. I still find the hand-eye-pen coordination jogs my memory better for those things than computer typed notes. Especially if your tests are written (do they DO them on the computer nowadays???)
  • Keep up on your notes and problem set assignments. Don’t let yourself fall behind.
  • Repetition, repetition, repetition. Work through the example problems in the book as well as the problem sets.
  • If you need the 3D animation to understand it, get a pocket molecule set. They’re pretty sweet.

Any other tips out there?

Posted 1 week ago
I was wondering if you had any introverted classmates in PA school. If so, how did they do. I'm an xray tech contemplating PA school, but I would say that I'm more of an introvert. Do you think that would inhibit my performance.
Anonymous asked

I would say there are a fair amount of introverts in medicine. I consider myself to be pretty introverted at times. The amazing thing is, once I’m in the room with a patient I become kind of a different person. I honestly hate talking over the phone for personal phone calls usually. Even when I was a tween in the heyday of the cordless phone. I’m awkward. I don’t have much to say. But calling up patient’s family members for updates? No problem. Smooth talking. I have no idea why. A switch turns in my brain.

I also work with a lot of docs that definitely are a little awkward face-to-face in the work environment but are brilliant and make great docs with their patients.

So YES it is possible! And worse comes to worst, you could always just go work in radiology or surgery :-P

Posted 3 weeks ago
Hello! I was wondering if your study guides are based on the PAEA topic lists or are they what you thought was important for the EOR?
Anonymous asked

Check out this post

Posted 3 weeks ago
I just recently discovered your tumblr and I really enjoy your posts. I find it really helpful. What challenges do you face on a day-to-day basis? Why did you choose this career? What’s your view on the pros and cons?
cynthiatsaywhat asked

Good questions!

Challenges:

-Working with a large team of physicians. I never realized how much practice variation there is. I switch docs every week to every couple of weeks. And wow, some are very minimalist/cost conscious, while some are very academic and like to work everything up (which is how I trained as a student), which makes it very hard to find common ground with your supervising doc for the week.

-Not having that residency to make me very confident and sure of my judgment. I really am envious some days of the fact that the physicians have seen this 1000x whereas this is my first NSTEMI or whatever and I am panicking and UpToDate-ing the shit out of every detail.

-Explaining my role to patients. I guess I’m not in an area of the country where PAs are really common. I think I’m in an area of average common-ness. I still get a fair amount of “so wait, who are you?” and “the doctor has never seen me once, when are they going to be here?” despite me using the key word “team” as much as I do.

Why I chose this career: To be able to practice medicine with more normal work hours and less commitment to years in school than your average MD/DO. To have more control over my patient’s plan of care and to be able to better explain their medical condition and treatment than a CNA, EMT, or nurse.

Pros: Better work hours in general than an MD/DO, usually starting out with a better grip on working in healthcare than a med student, more generalist and well-rounded training than an NP, high demand career, organized professional society (AAPA, etc), constant life learning (maybe I will avoid the dementia??).

Cons: Can be relatively high-stress (IE life-or-death situations that you are responsible for), still has some serious educational investment (usually 6 years post-high school), good pay but can have a significant amount of student debt in comparison to your starting salary (IE I have $120k in debt and accepted a job that I LOVE but unfortunately pays < $80k per year), some patients will never accept you because you are “less than the doctor” and in the same thought some doctors (although very few) will see you as some odd species they either detest or don’t know what to do with.

Posted 4 weeks ago

Real post time

Hey guys, sorry I haven’t posted anything substantial in a while. Been working late many nights. Usually I get home and have a few discharge summaries to write (and I’m trying to train for a race!) so it’s been tough to get regular posts in.

In any event, I feel the need to write a post these days when something really triggers my emotions and I feel the need to document something pivotal in my career. It happened today. Friday. Right now my schedule is M-F so Fridays are dabomb.com. I try and tie up the loose ends and I be dischargin’. And then I get to go home and not think about medicine for 2 whole days. It’s generally glorious.

On the hospitalist service, everyone gets serious pages whether or not it is their patient. This means code blues (cardiac/respiratory arrest) and rapid responses (patient decompensating but essentially not dead yet). A code came through for a particular room. It wasn’t on my patient list for today, so ordinarily I would have ignored it. But I felt compelled to double check the room and the attending physician. And saw it was a young guy who I’d helped care for last week. My heart sunk. This guy had come in with pancreatitis, I had seen him through it, and discharged him. It was most likely alcohol-related. But he did what he was supposed to do, he stayed sober and went back to work. He had a supportive family that cared about him.

Then he got readmitted last week with one of the feared complications of pancreatitis, necrosis, which is essentially the pancreas dying and making itself vulnerable to infection with terrible things. I was really worried about him when he came back. I saw him a couple days, then one morning noticed that he was having increased abdominal pain. I called the gastroenterology team and he was swiftly transferred to the ICU. Since the PAs/NPs on our service generally don’t take care of the ICU patients I did not see him after that.

And then I happened to notice that he coded. He didn’t make it. I talked to the physician I had been working with for this patient. This is someone who went through a grueling residency and has been practicing for many years, she’s seen a lot of crazy things. And she was completely devastated.

"We coded him for 27 minutes," she said, "And it was the worst 27 minutes of my life… I cried when I had to talk to his mother. He had really been turning around, he had been doing so good…"

We both thought of what he we could have done, or didn’t do. Of course it wouldn’t have changed the end result. It was a feared complication of a known disease that took him. But it still haunts me. We tend to be good at making a comedy of things in medicine, to be able to keep our emotional distance and to have skill with sarcasm, to manage to keep our anxiety and hesitations hidden under a thin veil of professional calm demeanor on the outside, because it’s what gets us through the day most of the time. But it’s moments like this that harshly snap me back to reality and make me confront my true emotions. It completely sucks to lose a young life. Even more so to know that you couldn’t have done much to prevent it.

Posted 1 month ago
What do working hours look like for a PA? Are they regular or do you have to be on-call during long/odd hours?
leaveittothewaves asked

This is completely variable based on your job description and how many hours you’re hired to work (FTE).

For me, I work 8-4:30 M-F with some weekends mixed in there. Most days I’m actually at the hospital until 5 or 6 or even later though, and some days I come in early. Most hospital medicine PAs work 7 days on, 7 off, in 12 hour shifts, though, due to the nature of the work.

Any 100% clinic-based positions are usually the most regular hours. This includes most primary care type jobs. Usually these are 8-5 M-F, but one day might be a “work day” for you to get your paperwork done, with limited to no patient appointments scheduled. You may take after-hours call via the clinic cell phone, but again this is variable. You should get paid more for having to take any call.

Any surgical-based position is probably more hours overall if you need to take call for emergency surgeries. This includes trauma surgery, general surgery, cardiothoracic surgery, neurosurgery, etc. Usually you will have certain days scheduled in the OR and certain days in surgery clinic. It may be written in your contract that you will only work x amount of hours, or again if you have to take call you could be working 60-80 hour weeks. You could be in clinic 8-5, then get called for a surgery that goes late into the night, then need to be back in clinic the next morning.’

Emergency medicine jobs would most likely be scheduled as shift work. 7am-7pm or 7pm-7am, or maybe rotating 8 hour shifts. Usually nobody wants to work 100% nights so this ends up getting covered by everyone in a rotating schedule.

Or you could be someone who only works part-time (0.50 FTE, say). You would work two 8 hour shifts and a 4 hour shift. So it’s entirely variable.

Posted 1 month ago
Hi! I'm an undergraduate student and working EMT-B at a school where people tend to graduate and become doctors, not PAs. I, however, have been looking into PA school and I'd really love some advice. My college doesn't have a pre-med track, and my advisers have very little information to give me about how to prepare for the profession/apply to PA schools. Do you do email correspondence by any chance?
jabberwockingly asked

I would say at least 90% of the kids in my degree program were pre-medders and probably 75% of them went on to med school. I was the only pre-PA student I knew. There was a local pre-PA student society I found Googling but it was pretty inactive unfortunately. So you’re in a common situation!

First, to make sure you understand what the profession really entails, you can find some information online through blogs and forums and such, which is where I started. Then you can (hopefully!) find a PA to shadow. This can be tricky. You have to be very persistent. If you already have a personal in somewhere (friend or family) give that a shot. If you don’t know any PAs, drop off letters at local clinics or hospitals introducing yourself and asking if any providers would allow you to shadow them. I’ve found asking providers directly was much more successful and efficient than trying to go through HR or phone calls around.

If you think this is the career you’d like to prepare for, make sure your major allows you to take the necessary prerequisites for the schools you’re interested in. (Meaning, the courses are already in your field of study OR you have enough extra room to take the additional courses, any major can get you into PA school.) They usually post their prereqs online.

After you have your coursework scheduled, you have to think about getting in real-life medical experience. I have a few previous posts on this, but things like EMT, CNA, medical assistant, etc. are good options. If you can get it in while doing your undergrad studies, great! If not (which is most of us) plan on taking a break for a few years before PA school (a better option IMHO). Schools also like to see volunteer experience, which need not be related to medicine.

It’s a lot of preparation but completely worth it in the end! Right now I don’t do email correspondence, but feel free to ask away in my Tumblr inbox.

Posted 1 month ago
I'm a first year PA student currently struggling with Pharmacology. Any advice??
Anonymous asked

My pharmacology course was pretty short, I’d say a week or two. It’s one of those topics in PA school that requires some abstract thinking at times and isn’t best taught with a powerpoint lecture, but unfortunately that’s how it often gets presented! So don’t worry, you’re no dummy, you probably just need a different approach.

Have you tried books like Pharmacology Made Ridiculously Simple?

image

I used Stringer’s Basic Concepts in Pharmacology, Googled whatever else I needed to, and by all means avoided the giant pharm book we also had assigned to us on our “reading list.”

image

Any other ideas out there?

Posted 1 month ago
Hello! I'm on the PA track and will be self studying for the GRE. I was wondering what you or your followers think are the best resources for the GRE. Thanks!
Anonymous asked

At this point I think it was over 4 years ago that I took the GRE? I remember I just used a single book and some vocab flashcards from a friend who had recently taken it, I don’t remember what brand. If I had to do it over again, I’d just go on Amazon and pick the highest rated one!

Any suggestions from anyone else out there?

Posted 1 month ago
Do you have any helpful advice or any resources for those who are curious to see how the didactic material taught in PA school differs from that taught in med school? I thought I finally figured out which profession I wanted to pursue, but a conversation with an ED tech the other week has me thinking again.. Mainly about the comparable scopes of knowledge for PAs vs MDs in the same specialty.. How do you know which will better satisfy your 'thirst' of medical knowledge?
Anonymous asked

I think most programs will post their courses and a short description online, although it may take some link-searching! Every PA program (except for some weird child health associate one I think?) is a generalist program based on the medical model, so you will learn about everything, from pediatrics and orthopedics to psychiatry and surgery and geriatrics.

In my experience, I went to a PA program that also had a medical school. We had the same length of didactic teaching- 1 year (most med schools are 2). We had a few classes together with the med students. And when second year came around we often had rotations together. So it’s pretty easy for me to say that in the end the difference in our didactic knowledge wasn’t much. The med students seemed to have learned more about embryology and genetics, maybe more biochem, and probably had heard more about the less common diseases. They actually didn’t have mandatory lectures or anatomy lab, while the PA students were obligated to attend all lectures and cadaver labs. The PA students also had a lot more background or real life healthcare knowledge to start with since there is usually a healthcare experience requirement to enter the program (2000 hours in my case). Of course most of your learning is done on the job rather than during the didactic year, whether it be as a new PA or as a MS3/4 or resident.

Ultimately, your thirst for knowledge will be entirely quenched in med school or PA school. Overquenched. That fire hydrant overfloweth… And PA school definitely won’t be a dumbed-down version of medical school if you’re worried about that. The material isn’t difficult to comprehend, there’s just a ton of it! And the learning will never stop.

Once in a while I think I should have gone to med school to have a more formal learning experience long-term like a residency (which do exist for PAs BTW), but I’ve come to realize that I’ve already been equipped with the skills to continue learning on my own with evidence-based resources AND get paid to do it on the job!

Posted 1 month ago
I start school in the fall and I want to go for a PA but nursing is still in the air. Is there anything you could tell me to help settle my mind? Thank you. :-)
Anonymous asked

I also weighed nursing vs PA. In my case, I already had a bachelor’s degree so the length of program would have been the same. Both programs would be intense and demanding of your time and energy. You would probably make a larger income as a PA (although not the case for me, unfortunately I am rather underpaid right now and could probably find a job as a hospital RN on night shift making almost the same amount).

Ultimately the most important factor is career satisfaction. I knew from working in nursing that I would never be the one in control of the patient’s assessment and plan as the RN. As a CNA I loathed never knowing what was really going on with my patients, what the REAL plan was, and it was hard to not be able to answer all of my patients’ questions. Because when you are the face that spends the most time with them, it really sucks to be the least in the know. 

There are some days when I think I should have gone into nursing instead. There is some degree of lesser ultimate responsibility for the life and death of your patient, because if there’s a problem it’s the provider or rapid response team that takes over. Of course, it takes a good nurse to recognize what is a real problem and to have the intuition for knowing which patients are going to need closer monitoring. I think it would be easier to be a new nurse rather than a new PA because that white coat seems to automatically imply that you must know everything and not make mistakes, whereas I see that new nurses often get a lot more patience from the health care team in general.

And then I go round on my patients in the post-op unit and see the call lights going off and the phones ringing and the yells “I NEED TO GO TO THE BATHROOM NOWWWW!!!” and think again that maybe it was the right idea to do the whole PA thing!

Just my thoughts. Of course everyone else might have different experiences or opinions.

Posted 1 month ago

Rescued from my failing Mac: my own personal statement

Hey guys, it’s the CASPA application season and I’ve been getting lots of questions about personal statements. Several years ago, I went through the anxiety-ridden process myself and in cleaning out my old Mac laptop that’s on it’s last leg, I found a bunch of files of personal statement drafts and other questions asked by different programs on various applications. I’m planning on doing a few posts in the near future on these topics, so here’s a de-identified version of the personal statement I submitted to CASPA about 4 years ago now (!!!). You can see I tried to follow some of the rules I posted about earlier. Hopefully some of you will find this helpful. Obviously it’s not the awesomest thing ever written and in reading it now some of my obvious attempts at making it more exciting makes me cringe a bit, but overall it did its job and got me into several PA programs.

Personal Statement/Narrative: In 5000 characters or less, please describe your motivation toward becoming a PA.

I graduated from a high school class of less than 70 students and entered into a university class of 7,000 freshman. I was interested in pursuing a degree in science but uncertain about which career path to orient myself towards. Initially I felt overwhelmed in such a large and unfamiliar setting, but quickly adapted and began to explore my interests. I researched many degree options and careers and I began to think about becoming a physician assistant (PA). Our family had been seeing a PA for the past several years, and I was intrigued by her unique role in the medical field. She agreed to let me observe her working for a day in an urgent care clinic, and I enjoyed my first opportunity to meet with patients.

However, I was also interested in research. I began my sophomore year taking the coursework necessary for a degree in medical microbiology, and partnered with a graduate student doing laboratory research involving plant genetics. I gained a great deal of biological knowledge at this point in my life, and was excited to be doing research. Yet, I often found myself lonely and wanting to interact with and directly help people.

That April, I heard about an alternative spring break trip to do hurricane relief work in New Orleans. I scraped together enough money and set out with 20 other college students for what would turn out to be a life-changing trip for many of us. Through the sultry Louisiana springtime we shoveled out wreckage from homes, businesses, and schools, pausing to speak with neighbors and listening to their stories in disbelief. We went to sleep at night hearing gunshots, and then woke up early to go running in the sunshine. There was a constant dichotomy of hope and despair as we worked that week, but our team remained united and optimistic, and I will never forget the wonderful people that I met. I learned that nothing can compare to the experience of putting your heart and soul into restoring a person and giving them hope and recognition in that process, and I knew then that I wanted to experience that feeling of deep satisfaction in my career.

Soon after I returned, I began my work in healthcare. I found a family that needed help caring for their disabled daughter, Olivia, and over the course of two years we grew very close, even sharing certain songs that she would only listen to with me. I also found employment as a caregiver for a woman caught in a very vexing situation trying to find a suitable living option for her aging and ill father, Bob. Within a few months we had devised plans for groceries, medication, laundry, and bathing in a way that Bob could have his independence while his daughter could rest assured knowing that he was safe. I was thanked often for my help, but all I ever needed was a laugh from Olivia or a kiss on the hand from Bob to know that I was appreciated.

After earning my bachelor’s degree I was not yet certain that becoming a PA would be the right fit for me, so I sought clinical experience as a volunteer in the emergency department of a hospital, often amazed at how well the team of physicians, PAs, and nurses was able to handle a variety of situations. I wished to work directly with patients in a hospital, but I had limited patient interaction as a volunteer, so I completed a nursing assistant program and was soon hired at the local teaching hospital.

I have been working on a family practice inpatient unit at the hospital since December 2009, and every day is a new and exciting experience. My patients are of different ages, medical conditions, and backgrounds. Some are prisoners. It is inspiring to see how the nurses and nursing assistants on our floor form such a great team. We have days that are exhausting and our patients are very ill, but we are always willing to help each other and work together. My only complaint is that I cannot do enough for my patients. There are always questions that I do not know the answer to and procedures that I am not qualified to perform.

I recently observed a PA working in her clinic who had a patient come to her in great distress because no one could find what was wrong with him. After an examination, careful review of his record, and conferring with a physician, she assured the patient that he was having an allergy and that they could work together to find the source of it. Seeing the weight lifted off of his shoulders and the relief in his eyes solidified my desire to become a PA and to be able serve my patients so completely.

Five years ago I was uncertain of which career path to take. My experiences in research, community service, home health, and inpatient care have motivated me to go further in my education and become a PA. I greatly desire to be able to evaluate, diagnose, and treat patients, while building long-term relationships in the process. Ultimately I want to be able to experience the deep satisfaction of knowing that I am doing everything that I can for my patients.

Posted 1 month ago
Are your study guides based on the PAEA blueprints/topic lists for EOR exams? Did you take the PAEA EOR exams?
Anonymous asked

They are not based on the PAEA EOR exams. I think they came out with those right after I graduated, so my program wrote their own EOR exams, for better or for worse.

The blueprints are loosely based off of the topics the NCCPA uses to write the PANCE, which my program distributed amongst EOR exams as they saw fit, again for better or for worse!