Sunday, June 29, 2008

Stab Lab

You know something is going to be fun when it is affectionately referred to as stab lab. As a D-1, you hear about this experience quite early on, you know it is coming, and eventually it is upon you. Delivering anesthetic for the first time was an absolute positive experience. Don't let upper classmen horror stories convince you otherwise. No you don’t want to hurt your classmates, and yea, getting prodded and needled left and right doesn’t feel ‘good.’ But this is the first ‘doctorly’ thing you ever really do. You grab a giant syringe, load up your lidocaine, pry open your partners mouth, and slide that sucker on in, hoping to hit your mark.

We met up in groups of four in one of the school’s clinics. A brief demo is provided by the instructor, and then you pretty much just go stab happy. As easy as loading a syringe, capping and following all the safety precautions is, everyone is kinda clumsy and bumbling about.. it is the first time after all. I got to go first; I set everything up, administered the topical and took a stab at it…quite literally. We were going for inferior alveolar nerve blocks first. For those of you not in the know, a mandibular block injection or IAN (inferior alveolar nerve) block is a very common procedure performed in dental clinics across the world. Essentially, we deposit anesthetic around the IA nerve which will effectively cut off all sensation (aside from pressure) to half of the mandible. The anesthetic infiltrates the nerve fibers and blocks sodium channels from opening which consequently keeps the nerves from sparking action potentials (sending/receiving info).

The inferior alveolar nerve is a ways back, so we used a 27 gauge long needle. You palpate the coronoid notch of the mandible and pull the buccal mucosa taut so you can clearly see the pterygomandibular raphe. You inject just lateral to the raphe because the m. pteryoid muscle is just behind it. The major interior land mark is the lingula, a small hill of bone that crops up just anterior to the opening of the mandibular canal (which is where the IA nerve travels). The goal is to contact the lingula, re-angle slightly to cross over it, aspirate, and inject. Aspirating is a safety precaution to make sure the needle is not inserted in a blood vessel. The lingual nerve is also in close proximity so half of the tongue is commonly numbed up as well. It really isn’t that complicated, but even simple things feel difficult with zero experience. Sorry for all the technical babble, but this is helping me prepare for tests and the boards.

I needed to reinsert the needle a few times on my partner because I was failing to contact the lingula (or any bone for that matter). I was not aimed laterally enough, although I eventually found my target and provided a successful block. We next performed a much easier maxillary infiltration over the first pre-molar. An infiltration could be performed by a monkey. You just pull back the lip, and slightly stick the needle in just enough to get near the root apex. Easy.

Afterwards, we switched and I got jabbed by my partner. Note: never go out drinking the night prior to stab lab. Even if you aren’t hung over, your body will not enjoy being invaded and hopped up on lidocaine early the next morning. I felt a bit crappy for most of the day, but I attribute that to the drinking, because my partner did a good job. Shaving with a numbed face is pretty cool though. Aside from this, the entire experience went quite well.

In other news, I am studying for boards a lot still…trying to keep up with my classes…and practicing for a performance exam on Tuesday. Class IV composite restoration and Class III prep on #9. Pedo midterm on Thursday... fourth of july on the way.

I will be taking the boards before I know it


Saturday, June 21, 2008

Wasted Time

The most important tip I could give to anybody concerned with getting through dental school would be ‘time management.’ Nothing is hard to understand, there is just so much information coming from every direction. If you know how to manage time, you will be successful in your school; this includes developing hand-skills.

It is a pity that dental school education in itself is a horrible failure at time management. I have wasted so many hours with poor curriculum coordination and fluff classes that I could have applied to practical things, like NOT being at school for once. This summer has been much worse in the organization department compared with the bulk of our D-1 year.

First off, the schedule we were given is unreliable. I have showed up at 8am only to be told that this is ‘study time’ or ‘there is no class.’ We also are spending too much time just putzing around the clinics. I was excited at first, but after my 4th trip of ‘assisting,’ I would much rather be studying for boards. Basically I always get assigned to a corner in the clinic that has no room to squeeze a chair in on the other side of the operatory. So I end up standing. By the way, I’m taller than average, so I can see jack shit while observing. At least I get to provide suction while not being able to see, and having to bend over awkwardly whilst every muscle in my back screams in agony. Let’s not forget how fun it is to fetch instruments and equipment for the upperclassmen. Seriously though, I can’t blame them – I’d be doing the same thing. The faculty never told them we were coming, and what the hell are they supposed to do? I know I wouldn’t want some newbie slowing down the appointment (which already proceeds at tortoise speeds). But to put a positive spin on it, every student I have worked with has been really nice, and the faculty in my group practice are fantastic (at least so far). This greatly eases many of the concerns I had about entering the clinics full time.

I am completely digressing though. Yes, sitting in a hot clinic wearing full PPE for several hours essentially watching nothing and suctioning teeth you can’t see isn’t very enlightening. HOWEVER, I at least am seeing what the clinics are like..and getting a basic idea of how smooth (or un-smooth) things go. This is the positive I take.

I draw the line however at this week. Thursday afternoon, a few classmates and I had planned to attend a luncheon with all the incoming D-1 research students. I am not really doing research anymore, but realize how beneficial it would have been to have any D-2 actually talk to me when I was getting ready to start (for tell me NOT to waste my money buying 90% of the text books). But wait, this commitment had to be cancelled because I was told that all D-2s were required to attend a perio lecture DURING OUR LUNCH HOUR. This wasn’t an ‘actual’ lecture. Essentially, we were given several handouts and told that we need to find our own patient for a prophy exam we will be doing this fall. The handouts explained everything, and a monkey could have figured out what we needed to do if you had just sent him an email. Making us all file into a lecture hall to explain something so mundane is a terrible waste of everyone’s time. Sure people may have questions, but it isn’t that difficult to seek out the department head. Lunch was provided although I didn’t get any because certain individuals take it upon themselves to grab about 5 portions worth of food before everyone has gotten through the line. I was taught growing up that this is a rude behavior, but maybe that’s just me.

So Friday morning we had to go to ‘cultural competency.’ I showed up at 9, was told that I had to take an online course in July that will eat up several hours of my limited free time….and that was it. We were done in 15 minutes. Did I really need to be present for this? Attendance was mandatory…so yes. Again, email would have been a bit more time efficient. It’s bad enough that I am required to take this course during a semester that is already busier than it should be, but do I really need to be at the school to be told these things?

I realize I am bitching excessively, but I am just tired of wasting so much time with unnecessary frills in the curriculum. There is a board exam coming up that we get no time off to study for…pre-clinic work leaves me tired enough as it is – c’mon school, sharpen up please.

Aside from these rants, things are going really well though. I actually am enjoying this semester more than the first two (simply because I like NOT sitting in lectures all day). I am doing ‘ok’ with my board review up to this point…but I have less than 2 months left and a LONG way to go. Take out the studying for boards, and this semester would actually be, dare I say it, fun.

I think the overall mood of this post is reflective of the depression I feel being in school all summer. This last week was the nicest weather we have had all year, and I spent it sweating away in the pre-clinic, followed by studying dental decks at home. I see all these other young people walking around, enjoying the breeze, having fun, living normal lives and I wonder…what was I thinking?

But as mentioned several times before, there is an ending. That is the glimmer of hope that keeps me running through the toughest times in school, it is only four years. Actually, only three more for me now. The time also goes by at such high speeds, you don’t even really realize HOW much you have learned until you start rattling off random dental lingo without a second thought.

I should also reemphasize that I don’t regret coming to UIC at all, dental school itself is just a real pain in the ass – and I’m sure that it is no different anywhere else in the country.

Back to studying on a Saturday in June

Monday, June 9, 2008

Any Way You Want It

So I’ve been meaning to post on this since the summer started but haven’t had time and wanted to remain as tactful as possible. The subject of this post is simply put – on international students. Our class was overrun with them beginning day one of the D-2 year. I know UIC has a large IDDP program, but a little notice or reminder that about 30 new faces would be sitting in lecture with us would have been nice.

Much like in any elementary school..err dental school, the new kids are usually not welcomed with open arms. It is actually pretty funny. The lecture hall has three main sections with two stair/isles separating the sections. ALL of the IDDPs are in the middle (first 5 or so rows). ALL of the D-2’s are sitting in the hall perimeter..making a U like shape around the room. It is like that junior high dance scene where all the boys are on one side, and girls on the other.

Now it has gotten a little better since day one, but there are some obvious problems.

Number one being that these foreign trained DENTISTS are ridiculously overqualified to be stuck in a D-2 curriculum that has them cutting preps on plastic teeth. Yes this is unfair to them, but it is also quite unfair to us, because they simply KNOW so much more than us and have actual experience. This isn’t that big a deal right? Well when we get put into small groups, for Evidence based dentistry – things couldn’t be any more blatant. These students know what to look for on radiographs, know how to diagnose a lot more than we do, and pretty much are better at dentistry in general. So do you think there will be equal contributions to these discussions? My group has been pretty good actually, but I have heard pretty annoying stories from others about certain individuals taking over the discussion. The question: is this fair when the EBD grade is based entirely on participation and group input? The answer: hell no.

I’m not sure if our tests are graded in the same pool however..but if that is the case – than the curve is going to shoot up quite a bit.

Still, what I find most unbearable is when we are doing some intro to perio (again) lecture where the professor asks a bunch of questions. Call me insensitive, but there is nothing harder to comprehend than 10-12 IDDPs attempting to answer a question at the same time. Don’t get all PC on me either, you know as well as I that 12 people speaking perfectly fluent English would be pretty hard to understand if they were all just blurting out…well add some accents and you get an almost daily experience of ‘what?’

What makes this worse is that the professor is often standing right by the IDDPs (who sit near the front) can make out the answer, and doesn’t REPEAT it…he will just be like.. “correct.” And EVERYONE sitting around me is simply looking at one another and mouthing…what the fuck?

The point is that this is unfair to both the D-2s and the IDDPs. They simply shouldn’t be in ½ of these classes…but I guess the school needs to make money somehow…as if raising my tuition wasn’t enough. I do like the few of them that I have actually interacted with though, so at least most of them are pretty nice.

Oh, and if you understand the clever title of this post, you are invited to Summer Fest II this august after I take the boards. Last year’s is going to look like a Sunday social compared to this…(hopefully).


Sunday, June 1, 2008

The D-2 Experience I

As the semester gets underway, I thought it fitting to collect my own initial impressions on the current curriculum and whether or not I think we are getting enough time to study for boards.

I most certainly do not. We have graciously been given a whole 6 Friday afternoons off for ‘board review time.’ This will be ample off time to prepare for a test that covers everything we have learned (and several things we haven’t) up to this point. More on that later.
Granted, the course load is less in terms of credit hours - fifteen as opposed to the twenty-four of last semester. However, it seems like I will actually be spending more time IN the school than I did last semester with all the lab work we are beginning to do.

The only saving grace is that pathology II is really the only course requiring studying on a consistent and regular basis which does leave me lots of evening hours for boards, the catch being that I feel less driven to study after spending an entire day doing lab work.
Here’s the skinny:

Pain Control I:
-Meets once a week and goes over everything you would want to know about pain and anesthetic. We will eventually be stabbing each other in late June I believe. I like the lectures so far as they are straight-forward and mix a lot anatomy and physiology that I already know.

Intro Pediatric Dentistry:
-Still attempting to figure out if this class will be a pain or not. We don’t actually treat live patients (thank god) but there is still a lot to learn and we have a full lab component to pile on the work. Seeing as it is worth 4 credits, I’m assuming we will be doing a good deal of work. The course title really is self-explanatory.

Pathology II:
-I was quite sick of this class last semester. Now they have doubled the agony. We meet TWICE a week for 2.5 hours. I cannot learn this way. Period. Fifty minute lectures became the gold-standard for a reason, it is the ideal time to learn and actually stay attentive. 150 minute lectures is obscene and literally painful to sit through… and we have to do it TWICE a week. The only real blessing of this class is that the tests are very manageable if you put forth reasonable effort. Studying for the mid-term and final can pretty much be accomplished by simply reviewing all the old quizzes that you took prior to said test. This class also feels like the D-1 year, still clinging to life and trying to drag me back into utter boredom and futility.

Complete Dentures:
-We start this after July 4, so I can’t give any real commentary yet. I have heard that it is a royal pain in the ass though.

Comprehensive Care IIa:
-What semester would be complete without good old comp care? Again, restorative dentistry rules the day, owning up to 50% of our grade. Periodontics squeaks in with 30%, and (get ready for it) Evidence Based Dentistry has broken the bonds of P/F and taken up 20% of our final grade. Gross. I’m hoping it is an easy hundo, much like perio has been so far. Restorative looks to be quite a beast this time around, but we definitely will have a lot more in-class practice time. Our final performance exam will be identical to last semester, except on the maxillary arch (crap). Tuesday afternoons and all day Wednesday is devoted completely to restorative.

There are several new components to this course that I will attempt to elaborate since the other business is old news. These components are all P/F but will probably be quite a bit more relevant than EBD.

An introduction to endo has been jammed into comp care this semester. The actual course begins in the fall. We have had 2 lectures so far and start some clinical exercises next. We were once again reminded that we need about 25 teeth of varying type and in good condition just to pass the course. This blows hard. I have zero connections in the dental world, so I have no assistance in finding these damn teeth. This means I have to call random offices and awkwardly ask if they can spare me some. This is frustrating as many of my classmates have siblings/parents/other family doing all of this work for them. Yea I don’t hold it against them of course; I would be doing the same thing. Unfortunately 90% of the teeth I collect are worthless broken down third molars…thank god I picked up a bunch in Decatur while I was still in undergrad..those are by far the best I have (several anteriors in decent shape). I have one more jar filling back in the burbs, but I am sick of trying to find them. I haven’t sorted yet, so I’m not sure how many good teeth I even have…better get on that because the fall will be here soon.

We will have a radiology clinic session at some point which I believe will introduce us to actually TAKING radiographs. This will be useful for me as I have no experience.

Now there is a clinical component to both comp care as a whole and the perio subsection. In perio, we get partnered up (7ish times in all I believe) with a D-3 or D-4 for the morning or afternoon. We are instructed to watch/help if they ask and simply ‘reflect’ on the experience and answer some random questions in written format for each session. I have had one of these already and it went fine..aside from the fact that the patient was late and spent ½ the morning in radiology.

Now the other clinical aspect is P/F and involves several afternoon/mornings where we actually just get to hang out in our respective group practice clinic and assist whenever we want. We are expected to make impressions, dish out anesthetic, take BP, and other assorted basics. Nothing is kept track of however and there is no arbitrary number to ‘pass.’ We are simply supposed to get our feet wet in the clinics as it were. I like this no pressure/grade approach, because many dental schools won’t get you in the clinics until the very end of your D-2 year or even wait until the D-3 year altogether.

Interacting with live patients is a very different experience and getting into the clinics can be VERY intimidating. Getting rid of that intimidation WELL before entering full time with real patients is a great idea and I applaud our school for making such changes (we are the first class to enter the clinics this early).

That’s about all I can say for now. I do however believe this year is going to be tougher than the D-1 year simply because you are taken completely out of your comfort zone (lecture halls) and thrown into massive loads of pre-patient and real clinical care. I have already skipped lunch twice in the two short weeks we have completed just to finish the day’s assignment. Lab work is also often completed and graded same day, which adds a whole new pressure as well as frustration (because there sure as hell isn’t enough equipment for all of us).

I have other experiences and topics to discuss, but am finding less and less time to work on this. My original intentions were to be much more organized, but I just can’t keep up.

Obligatory apologies for slowness in email response.