Wednesday, October 29, 2008

The D-2 Experience III

While I find time extremely stretched thin at this point, I have had two remarkably relaxed days in a row. I decided to add another chunk of thoughts towards the second year of dental school. This week began as an utter pile of feces. Monday was absolutely the worst day of the semester, by far. Based on my interactions with other classmates, I would venture to guess that I am not alone in this sentiment. It opened with a performance exam in RPD (removable partial dentures). We had to prep rest seats on plastic teeth. These seats essentially help the RPD stay in place and help resist forces. The preps themselves are not too difficult – however, we had to prep four of them with guiding planes in about an hour AND evaluate everything. For those not in the know, a guiding plane is established by shaving the sides of the teeth a bit so that the RPD can fit better and not lock into place in some sort of undercut. So I basically just ran low on time and had to speed through the last prep – which ended up looking pretty damn crappy. I still don’t know how to ‘evaluate’ a guiding plane on plastic teeth without surveying them, but whatever. The director says he is going to go easy on us, but we will see. I smell my first remediation.

So we get all cleaned up around 12:45. We have to be back for restorative at 1:30. Now here is where things begin to suck. I have already vented enough with my peers, so I will avoid becoming immature in my writing, but simply put – Monday afternoon was poor form. I was specifically told the week before, that our most recent project would be turned in NEXT week. I was also told that Monday’s work would be an all-ceramic crown prep and provisional. So what happens? We are told that EVERYTHING is due by 4:00 and that we are doing a VENEER prep and COMPOSITE provisional (something I very vaguely remember doing back in May). So I had zero time to prepare for this change in events, and a lot of my other work was still unfinished because I assumed we had more time because I was TOLD that we did have another week. So ok, they want to simulate the ‘clinic’ and how we are going to be evaluated. I can tell you right now, I won’t be jammed back in a tiny corner about 1 mile away from any materials when I am in the clinic. I won’t need to climb over about 25 units with classmates blocking the isles to get to materials that aren’t even out when I’m in the clinic.

The disorganization was absolutely terrible. And the best part is that if we didn’t finish in time, our grade is automatically a ‘C.’ Incredible. I get that they wanted to try something ‘new.’ But leaving me horribly uninformed about events is not fair considering how much money I pay for this education. It also is a disservice to my own morale as I felt like a horrible excuse for a dental student because everything turned out like crap. This is completely understandable, given the circumstances and simple lack of materials compounded by that horrible excuse for a pre-clinic. The class feels unorganized in general. I hate not knowing what I need to do. I also hate being rushed. Yea I get it, speed is important, but let me freaking get the basics down before you start shoving me to hurry up. If I don’t learn to do it right slowly, how the hell am I ever going to get good at doing it fast?

The grade impact isn’t all that significant, but that’s not the point. My confidence was completely and unnecessarily obliterated by an unorganized and attempt to scare the shit out of us.

Everyone hates pop-quizzes….but pop-performance exams?

So naturally, Monday left me a bit pissed off. Fortunately, the last two days have been complete cake-walks and I have been home by 2:00 each day. I finished up my first full crown wax-up for a #18 FGC. It actually looked pretty good. We sent them off to the lab and they will come back as shiny gold. I am not really doing much school work at home these last few days. I am just trying to relax and mentally prepare for the next big hurdle – endo performance exam #2 on Friday. We are doing full root canal therapy on one maxillary pre-molar that has TWO canals. I am looking forward to working on ONE tooth for a change and putting all three steps (access, cleaning/shaping, obturation) together at once. My only concern is that two-rooted pre-molars seem bit fragile and extracted teeth aren’t the sturdiest of things. So I am a little worried about the crown breaking. Luckily, I have a even the worst-case scenario should be manageable.

I haven’t really practiced, but they have us doing SO much homework and lab-work in that class that I feel like I could get by ok. Still, as with most performance exams, I can feel my nerves slowly creeping up on me.

If I make it through Friday, next week will be a completely breeze.

So enough on current events. I have gotten positive feedback for the class-by-class breakdowns, so I will give a mid-semester update on the fall D-2 curriculum here.

Comprehensive Care IIb
-The grading distribution in this course is a bit confusing, and as always – there are SEVERAL modules.

a) Restorative - 37.5%
-well from my earlier rant, I’m sure you can guess how I may feel about this course. This would be a little off though, because I have enjoyed this module for the most part. It has essentially been mock cases that we work out on our dentechs – applying techniques previously learned and attempting to get them done quickly. Again though, I don’t feel ready to get ‘rushed’ just yet – and sometimes, this is VERY detrimental to my learning. We have done a lot of composite work, as well as some crown preps. Made some models, mounted them, and created custom trays. Nothing really new, just more practice (which is always a GOOD thing in dental school). Aside from last Monday, I have liked the pacing and cases. We had to write an Evidence based-dentistry paper, but aside from that – the grades are based on lab work.

b) Clinics – 12.5%
-this is interesting because we are the first class to get in the clinics with our own patients so early. I would be willing to wager that the current D-1s may get their own patients in the summer rather than just shadow like we did. It is very intimidating to get a list of patients that you are responsible for calling and arranging appointments. Seeing as I am only in the clinics on Thursdays, communication with patients calling in gets cumbersome. For example, one of my patients called and left a message for me. It said “please call back.” So I called back and got the ol’ voicemail. Patient called back AGAIN the next day, left ANOTHER message: “call back in PM.” So I called back…VOICEMAIL! I have called this patient about five times now and she has NEVER picked up her damn phone. I left her my email address last time praying she might attempt another avenue at communication…nope. I will call her once more tonight, but after that, she’s on her own. She is young too, so I’m sure she knows how to use email. Who knows. Thankfully I have gotten ONE appointment for next week. However, from my observations, there is a 50% chance she will cancel. Days we aren’t in the general clinic are spent on rotation. I have had urgent care, radiology, and pediatrics already. Pedo was awesome because we essentially got hopped up on nitrous the whole time. One of us would learn how to set everything up and adjust the gas while the other would enjoy its effects. I am convinced that nitrous SLOWS DOWN TIME.

We also have some random assignments to turn in regarding Medicaid and how we plan on being ‘organized students’ as D-3s.

c) Communications - P/F
-I enjoyed this brief module. The information was quite relevant and while some aspects were a bit drawn out, I did learn a few good techniques towards communicating better. We had to attend all the classes and I still have a paper to write about my first patient interview (even though I have already done this in Urgent Care a few times).

d) Periodontics - 50%
-The grade savior of comp care. Although I fear that this semester’s exams will be tough in comparison to previous semesters. We had to find our own patients to come in back in September for the basic perio exam with prophylaxis (cleaning). Once we wrapped that up, we have been doing lectures on Tuesdays for 2 hours every week. Not much else to add.

Ok..enough comp care already…

Removable Partial Dentures
-This class is pretty good. The mid-term was not as easy as I would have liked, but by no means was it unfair. The practical was not horrible, but I definitely didn’t do that well. You basically started out confused as hell during the first month. Then eventually, everything starts to make sense and come together. I feel pretty good about this class so far, but who knows (especially if you didn’t skip the early portion of this post…ugh).

Oral Pathology
-Pathology has been a part of my life since last January. I am ready to part ways. Thankfully, the information this semester is relevant to dentistry.

Fixed Prosthodontics I
-Frustrating at times, ‘ok’ at others. If it wasn’t for provisionals, I truly wouldn’t mind this class. HOWEVER, I think I may have finally got the timing down with the acrylic so that they are beginning to turn out a LOT better. I still need practice of course. My only concern is how bottom-heavy the grading is. We have only had TWO quizzes all semester. There is no mid-term, and only two performance exams packed in late November and early December. Our row instructors are grading our weekly work, but this amounts to very little of the full course grade. The final exam is going to be insane. We have an average of two lectures every week. Some of them are DRY as hell (dental materials). So we are looking at around 30 some lectures to study for the final exam.

-I like that I am learning..A LOT. But I don’t like how long it takes to set up the unit, how annoying teeth are to allocate, x-ray, mount, x-ray again…THAN work. It is VERY tedious..which is appropriate, given how tedious endo is in general. However, I have enjoyed the work more than most courses (namely because working on real teeth feels far more beneficial). Doomsday is this Friday though..I am really fearing that something out of my control will go wrong. I got through the first one unscathed, but I feel like I am due for a catastrophe. Damn I am negative.

Complete Dentures
-This class is simply not organized. That is really all I can say. I don’t feel comfortable doing pretty much anything and everything related to dentures. Your learning experience seems based on two factors out of your control. The instructor you get, and the patient you get. I feel like I get the big picture, and a lot of the lab stuff makes complete sense to me when I see it. However, do I see myself remembering all of these little things when it is my turn to make them? Probably not. The only saving grace is that we have plenty of outside resources and reading to refer to. So I shouldn’t be completely lost. I bet my first patient that isn’t on recall will need complete dentures. Throw me in the fire!

OK, that is it. I figure the bigger the post, the more off-time I am allowed. Fair? I think so.

I do have a pretty good story of my first urgent care experience last week, but I will save it for another time. I got some relaxing to do.


Saturday, October 11, 2008

Patients Ahoy

Done deal, I have officially scheduled my very first patient. While I am overwhelmed with the heaping pile of work that the D-2 year is, I am glad they throw us into the clinics so early. Granted, I am not expected to do much outside of recall exams, but my group practice manager said if the patient needs work done, we will be doing it. There are plenty of procedures I could attempt competently on a live patient. However, obviously there is plenty I can’t do yet either. Mainly prosthodontic business. I could also do ½ a root canal (haven’t learned obturation yet).

Basically, the school is trying to ‘get our feet wet’ early so that we aren’t as awkward with patients once we hit the D-3 year. So we only have Thursdays this semester to see patients. We also have rotations through radiology, pediatrics, perio, and urgent care. So there really aren’t even that many opportunities to see real patients. There is only so much we can do though because we don’t have the treatment planning course until NEXT semester. This limits us to recall patients.

So come November 6th, at 2pm – I will be examining my very own LIVE PERSON…whoooo. I hope to schedule a few more as well but we will see.

In other news:

Endo has actually turned into a good class. For all of my griping leading up to it – I have learned a pretty good deal and feel pretty damn comfortable with the basic concepts. The worst part was the mounting of teeth (which mainly occurs during the first month). I still spend a LOT of time doing homework teeth and practicing, but things are going smoothly.

Fixed prosthodontics is giving me trouble. The crown preps are coming along just fine, but I cannot for the life of me figure out how to make a provisional successfully. I spend hours and hours and they always end up looking like crap.

Dentures also sucks big (mainly because I feel lost trying to set teeth).

All the other classes are going fine. Now by fine, I am not implying that I am going to be busting out A’s in every class, but I am learning SO much more than I did last year. The things that I am learning are also relevant and PRACTICAL towards what I am doing with my life. And as I’ve mentioned previously, the grade feels less important to me at this point. I am plenty competitive for GPRs which is what I see myself doing in 2.5 years.

The work is hard, I am far busier, but I am enjoying WHAT I am doing so much more. This is a good sign.

This semester is blazing by. I am going to be a D-3 before I even realize it.

Hell, I’m going to be a dentist sooner than I think.

Scary right?