Wednesday, December 23, 2009

The D-3 Experience III

A few days into another nice two week vacation and I unfortunately find my thoughts drifting towards school. While grades have become less important to me, I still have the competitive spirit as well as a personal desire to do well. My last two semesters were frustrating beyond words in terms of final grading. I was borderline in TONS of classes and ended up on the wrong end in pretty much every class. The culmination of those being my restorative clinic grade over the summer (89.7).

This last fall semester was probably my favorite of all dental school thus far. It would have won the honor hands down was it not for a host of TERRIBLE, and I repeat, TERRIBLE lecture classes. I can count on one hand how many valuable lectures we actually received. It was mostly PhD and researchers lecturing us with statistics and numbers. The part that frustrates me is that we would have the same lecture in a different class by a different person and the numbers would be different. I was involved in research in undergrad and my summer prior to school – it is definitely an imperfect system with so many problems that I don’t put much stock in new progress unless there are a TON of papers supporting any given theory/thesis.

But I digress, the other minor gripe I have is that yet again I find myself on the precipice of getting an ‘A’ in all of my classes, yet seem to be getting screwed in a few big ones. Granted, the final grade isn’t up, but my comp care IIIb percentage sits at 91.8 or something like that and of course, this is the one class where you need a 92…sigh. I know there has to be a cutoff at some point, but jeez, help a brother out.

However, in completely opposite fashion, I have cause to actually celebrate. My faculty evaluation this semester went up (albeit a small amount, but up nonetheless) and I consider that the most important grade of all – your own evaluation. I felt as though I had improved dramatically this semester. Not simply in terms of number of procedures – but in comfort level, patient interaction, plain and simple confidence. I have worked with the entire faculty in our clinic at this point (some a lot more than others) but I have gotten positive feedback from each and every one at some point. While my grade didn’t dramatically elevate, it still went up though – indicating that the faculty see improvement as well. Positive reinforcement is always nice.

The point is not about the letter or the percent (unless you find yourself failing or gunning I suppose), but about how you feel about your own dental skills. If you had asked me to extract a tooth last spring, I would have tried sure, but I would have been scared shitless. Now I am jacking them out left and right without a second thought. All the pharmacology crap that I just could never keep straight? It is starting to come around. Yea, I have a long way to go – but I am slowly but surely recognizing medications without having to look them all up. All those first times are gone and now it is experience and practice that I am worried about. How many direct restorations can I finish in one appointment? I started off with one per session regardless of how easy it was. My current record is three, and I realize that with an assistant, I will be blazing through cavities in the future.

At this point in the D-3 year, you need to feel like the clinic is your home at school. The faculty all know who you are, the D-2s are beginning to timidly bring in patients and wear loupes during a routine cleaning. It’s hilarious not because of the utter futility of wearing loupes (with a headlamp even) for a prophylaxis, but because we all have been there. It is part of growing as a dental student and a future dental provider. They will be laughing at the new D-2s next year while I am freaking out about boards.

The D-3 experience is a metamorphosis. You completely evolve into a new type of student. The books and studying still exist, but we don’t really talk about it anymore. Now we discuss whatever tough case we are working on, or help someone out with a denture set-up, or a tip on how to make that surgical guide, and so forth. You find yourself talking about dentistry all the time, for better or for worse. You are slowly changing into a dentist despite still being a student. It is quite remarkable actually. The amount of learning has increased ten-fold while spending less time at school overall. If you blaze through a restoration and finish at 3:30, you don’t have to sit in a lecture hall for another hour, you finish anything that needs to get done lab wise, or you go home.

The D-3 experience still has its frustrations, but it truly is the best year of school. I see why it was rumored to be so. Especially once you get accustomed to your clinic and faculty, it is just plain fun. Now that’s not to say I’m having the time of my life. It is still school, anyway you cut it. I was about ready to gouge my eyes out by the end of finals. The drag of 17 straight weeks with only three official off-days will bear down on anyone. Now I know all you 9-5 jockies are saying: “hey, I do that ALL YEAR, what are you bitching about.” To them I respond: “At least you’re getting paid.” I am paying for this privilege, and paying quite dearly. I don’t remember exactly how much it is, but I think one of my faculty members told me that it costs me 400ish bucks PER AM/PM session to be in this school. That adds up.

But my time is slowly winding down. I was half-way through school back in July, so now I am well on my way, marching downhill, occasionally stumbling, but marching nonetheless. Only four semesters of school stand between me and graduation.

That brings me to a brief topic that I will elaborate on in a future post. What the hell am I going to do when I graduate? Work in a big dental chain? Work as an associate for a dentist planning to retire in few years? Do a GPR? Specialize?

The only one I am 90% confident of skipping at this point is specializing. I honestly prefer general dentistry as a whole over one aspect of dentistry beaten to death.

I am torn though, a GPR seems like a strong move, but do I end up wasting a year of real profit? Is the experience gained worth missing out on getting a large pile of wampum?

You can argue for pretty much any scenario, but I need to have an idea by the summer because that is when you apply for all these things.

Ahh what am I doing? This is my vacation. And dentistry is NOT invited. Have a Merry Christmas/holiday/whatever.

Fin.

Monday, November 23, 2009

Doing It Yourself

Let's be honest. In Dental School, you end up doing a lot of ticky tack tasks that no practicing dentist would ever do. For example, setting up the operatory is a time consuming task, and let's not even get into cleaning up afterwards. I probably spend a good hour out of ever day setting-up and cleaning up, and this is only for TWO patients.

The obvious aside, what about lab work? Most general dentists aren't mounting every case on the articulator or waxing up crowns. I don't know many that even set the denture teeth either - yet we do it as students. I'm glad we do, because you need to know what good is.

Now the point I'm getting at is that it becomes quite easy to get lazy and complacent. Simply assume the lab can do everything. This is ok sometimes, but every now and again we get a situation that requires some improvisation.

So here is my case. I get a patient on public aid that simply can't afford the partial she desperately needs (missing 7-10). She eventually plans on getting the partial but needs more time to save up.




Clearly that is a space that most people would like to have filled up ASAP. So at the college, we require that the patient's balance be UNDER 100$ before we send anything out to the lab. As soon as I prep rest seats, the partial will be charged (and it costs 600$). She needs other work as well that is not covered so we are looking at a couple months before I even start the partial.

So our options:
1) Do nothing, let this lady walk around like this trying to get a job
2) Send to the lab for an interim partial
3) Make the temp myself (flipper)

I had attempted to make a flipper last summer and while I thought it went pretty terribly, the patient never came back (which is actually a complement in this case).

So the flipper is generally made to replace ONE, count em' ONE tooth. If I send to the lab, it will cost her about 300. If I make it, it costs 160. Given financial limitations and my desire to learn - I decided to get a little crazy and attempt to replace the 4 most esthetically important teeth in the entire mouth.






Here it is after about an hour of work and one helluva a time getting it off the cast. She has all of her posterior teeth, so I decided to go without wires.




Now I will be the first to admit that the gingival shade sucks. In my defense, that is really the only color we have to work with in the lab. This is also supposed to be TEMPORARY. I needed to bring the acrylic buccally for a little extra retention. I would not have been comfortable attempting to have those teeth blend into the natural gum line. Again though, considering I couldn't even fix a toilet prior to dental school, I was pretty damn happy with this result. It looks even better far away.




Her voice didn't change at all after a few adjustments but she does use just a touch of denture adhesive. I probably could have used some wires but I used them last time and wanted to try one without.

This post is not to toot my own horn but rather to emphasize how much you can change someone's life by taking the route less traveled. I will never become a prosthodontist, but I would like to think I can help when the easy lab option is not possible. I delivered this thing in september and it is still holding out great. She is interviewing for jobs now and we will hopefully get her partial going early next semester.

With all that said, making your own temps is pretty time consuming. We were never taught this in the pre-clinic so you end up with a little trial and error. With that said, this result completely trumps my first attempt (which I wish I had pictures of) and was quite honestly, a far more difficult case.

Will I be making my own interim partials all the time? Of course not, but it feels good to know I can should the need the arise.

Happy thanksgiving all!

Thursday, November 5, 2009

Experience?

I obviously can’t really compare UIC versus other dental schools because I can only go to one. I have received numerous questions from randoms and friends/family about how much experience I am getting in the clinics.


So I decided - what the hell, why not just run a production report and find out. I could care less about HOW much production I have made in dollar values but I do care about WHAT I have done or how many procedures.


So I am fairly deep into my time as a D-3, why not see just how much experience I have gotten thus far. I will probably do a follow-up towards the end.


Quick note: I am not including EVERYTHING – pretty much just procedural dentistry. I am also leaving out radiographs because I don’t get credit for the ones I do on rotation and I get credit for simply ordering them but not actually doing it. Needless to say, I feel fine with radiographs for the most part.


I am also including things I haven’t finished or will be (hopefully) starting shortly.


RUN DOWN:

7 – Periodic Oral Evaluation (6 month exam)

34 – Urgent Cares (about to become 35 this afternoon)

12 – Comprehensive Oral Evaluations (new patient work-up)

9 – prophylaxis (mostly on kids)

5 – fluoride application (all kiddos)

5 – class II amalgams

1 – MOD amalgam

15 – class V composites

1 – class III composite

2 – three-surface posterior composites

1 – PFM crown (still in process, 4 more in the near future)

1 – FGC (planned, starting sometime next month)

1 – SS crown

1 – 3-unit FPD PFM (not guaranteed yet..but keeping fingers crossed it doesn’t fall through)

1 – Direct pulp-cap

4 – core build-ups

1 – cast-post/core (still need to cement it)

1 – pulpotomy on a screaming child

1 – RCT pre-molar

8 – Quads of SRP

3 – Arches of Full Dentures

1 – RPD (currently at framework try-in phase)

22 – Extractions

1 – Surgical Extraction (which was awesome)

2 – occlusal guard (one done, one planned)

1 – unilateral space maintainer (planned and on the horizon)


So there you have it. This is what I have accomplished so far. While the list isn’t that massive, I am feeling quite content with my current level of experience. While I am definly lacking in Endo and Fixed, I have done a ton of directs and feel pretty good about them. I also have plenty of fixed on the horizon. The only trouble-area is endo. Hopefully I can pick up another one sometime soon.

My experience obviously is going to be quite different from anyone else in my class. I know someone that has done a ridiculous number of endos already and someone else that has been really dealing out the crowns. However, I also know people that haven’t done an amalgam yet, or a denture. It is completely unique and based almost entirely on your patient pool.


Being a D-3 can be frustrating at times. You go through good streaks and bad, but all in all – especially once you start to feel at home in the clinic, it just kicks ass. I see all those silly D-1s running around to with their bone boxes or skulls and just shudder. Thank god I am done with that. 19 months and I’ll be graduating.


Wow.

Friday, October 30, 2009

Performance Exams

I have made mention of these types of exams on several occasions but I felt compelled to give them a post of their own. Anyone that took science classes in high school or college probably had tests known as ‘practicals.’ For example, in high school we had an anatomy practical on the frogs we dissected. Up until dental school, the dreaded lab practical was probably the most stressful type of exam I had ever taken.

In dental school, we still have the standard lecture exams (which are almost exclusively multiple choice). I remember getting really stressed out during the first wave of these back in the D-1 year. However at this point, they are more of a nuisance than anything else. We also got a good dose of practical exams during the first two years. While these were definitely more of a pain on the nerves than the written exams, they still weren’t much different from the crap I did in college.

Now though we get to the granddaddy of all of them – the performance exam. Essentially these are the exams that actually test your physical ability to perform dentistry. In other words, if you can’t do these, you picked the wrong career and now must pay off 200,000 in student loans working in retail. What makes these things the worst type of exam in the history of my educational career is how morale-crushing they can be. There is nothing worse than failing a performance exam. An essence, the instructor is telling you that you fail at being a dentist, which is a tough aspect to shake. Granted, we are still learning, and failure is part of the curve – but it is easy to forget that when you are stuck in remediation.

Now in fairness, they break us in to this new testing format pretty slowly. The performance exams in the D-1 year were all quite easy. We had to cut class I prep on #19 the first semester (and our grade was 100% self-evaluation). In other words if you made the shittiest prep in the world, you still could get a perfect grade if you pointed out why it was shitty. The second semester was a bit rougher, introducing the good old class II prep and amalgam fill (which of course is the same thing we have to do to get licensed). Still, the grading was lenient enough (my amalgam carving was average at best and I still got good grades).

The D-2 year was when things really got crazy. While the summer wasn’t too bad, once we hit the fall – the remediation waves starting hitting the class. I know very few people that didn’t have to redo something during that semester. Whether it was an endo, or a crown prep – pretty much everybody failed something. While I did well on all my endo exams, I remember the absolute terror of those exams. After you do the access, you have to get it graded before you cleanse/shape and fill. So you are standing in this grading line hoping you made it. If you fail the access, you STILL have to finish the exam AND remediate later. I can’t imagine how crappy that would feel knowing you already failed but still have to keep your shit together and continue.

I have plenty of posts on that crap so you can look them up if you want to read about my tortured soul last year. However, what brought about this post is the new breed of performance exam I just experienced yesterday. This semester we have three patient-based performance exams. One is a tx planning exam which is annoying only because it involves a lot of busy work. The other is an SRP exam which I have yet to attempt, and the last is a ‘caries management’ exam which I finished yesterday. The difference obviously is working on real people, but you must also find a good patient to perform the exam on. If you have no patients that have the specified issue, you need to mooch off of your peers.

Ok so what makes this the mother of all stress? The pure fact that you have very little control over another living human being. If they decide they aren’t going to show up on time (or at all), you pretty much got all pumped up for nothing and have to attempt to reschedule. This is particularly nerve wracking towards the end of the semester when you just don’t have enough openings. Another stressor is the fact that some of these exams must be completed in a different clinic. This is the first year they are implementing this and it is an attempt to eliminate bias and favoritism which I can understand. If I was doing an exam with an instructor that likes me because we have worked a ton of cases successfully already, then he most likely will give me the benefit on border line stuff. Still..would have been nice to have the advantage every other class has had up until I got to the clinics…sigh.

So I here I am setting up a chair in another clinic, not knowing any of the faculty, trying to find where they keep all their shit, and praying my patient shows up and the lesion gets approved.

Fortunately for me, the patient showed up spot on time. I got him seated, took BP/P and so forth. Then I had to find TWO instructors and have them sign off that I could do the exam. For this particular exam, we are allowed to pick ANY tooth that has caries on it. Doesn’t need to be a specific class, just has to have decay. I have done nearly 20 class V composite restorations, so I figured go with something I have done a lot of. So I tracked down two faculty I had never met before and had them look at the tooth. Thankfully, they both approved and gave me the green light to start.

Quite honestly, that was the most stressful part of the exam – knowing whether or not I could start and figuring out who would be evaluating me. I had to remove a GIANT restoration and was getting a little freaked out about hitting the pulp, thankfully that did not occur. The prep itself went really well and both instructors gave me the go-ahead to fill. I was feeling confident at this point, filled with composite, and started cleaning up the margins. The only real problem I had during the exam was getting the gingival margins smooth. This usually equates to slashing the crap out of the gingival tissue with the finishing burs. I did notice on the grade sheet however that there is NO category for soft tissue trauma. This was good because this guy’s gums were looking pretty roughed up by the time I finished. Despite having cord placed, there is not much you can do to avoid some tissue damage. I mentioned it to both instructors as they came by to grade, and they both essentially told me: “don’t worry, you can’t avoid it on these restorations and it will heal quickly.” So feeling pretty confident, I gave myself a perfect score on the self-evaluation. Only because both the instructors gave me positive impressions each time they dropped in.

If I had failed, I would have been informed instantly – so things went well. Thankfully it is over.

Another hurdle cleared. Now I need to find a perio patient for that other performance exam. It never ends.

So this rambling went on for a while, but I noticed many of my family/friends asking me about how we are tested, and I find myself constantly explaining the performance exam – so there it is.

Can’t wait till I’m a D-4, where the year is essentially one GIANT performance exam.

Friday, October 9, 2009

Hospital Dentistry

Back after another long sabbatical I know, but typing these things eats up a lot of time as one might imagine. Excuses aside, I did have an experience that inspired me enough to cement it for all time in the annals of the internet. As I have explained in prior posts, as D-3 students, we go on a variety of rotations (most of them in-house). For example, we rotate through radiology, urgent care, screening, and oral surgery to name a few. Now as D-4 students, we still go on rotations; however these are OFF-campus and should be interesting to say the least. I will go into those more as my time draws closer. Yesterday I went on a very unique rotation which sent me off to Masonic – a hospital found a ways north of the school. We had an entire day for this rotation so it felt in essence like an old-school field-trip. This, along with a geriatric rotation are the only outside experiences we get as D-3s.


The day did start at the college as I had to plow through a 15 question radiology final which was thankfully easy. Afterwards, one of my peers also on rotation offered me a ride and we decided to skip the now defunct practice management course – which has been quite useless up to this point. The director of the course took a job at the up-and-coming Midwestern College of dentistry and consequently left us high and dry for this course since it is pretty hard to manage a class when the guy who was in charge of everything jumps ship the same week the class starts. Honestly though, I doubt it would have been useful even if he was still here – the material is geared at stuff I need to know after graduation. Unfortunately, I am so fresh in the clinics and so far from graduating that I honestly cannot process this information at all right now – nor do I really want to. Let me figure out how to do some dentistry before I start learning office politics. Is it important? Of course. Am I learning anything? No.


But I digress; we left around 9:15, ate some disgusting McDonald’s breakfast, and arrived at the dentistry building affiliated with Masonic around 10:30. After taking care of a bunch of hospital paper work and getting I.D. badges, we finally get to see some dentistry. Now I have mentioned being interested in a GPR several times, and I still am. This was my first actual experience SEEING a GPR in action and getting to talk to the residents. Let’s just say I am even more set on doing a post-grad residency at this point. Granted, Masonic is probably one of the better GPRs in Chicago, but it just seemed quite beneficial. They do IV sedation for special needs patients every Thursday, so we got to see some cool cases and really learn what this particular GPR is all about. The bottom line is that you get to experience a TON of different things all the while improving your technique and skill. It isn’t like another year of dental school because you don’t have instructors breathing down your back. HOWEVER, if you need that extra bit of help or advice – you have experienced attendings to fall back on as necessary. To put things bluntly, you also get another year to screw up and not lose your license or get sued. Not to mention you can defer your loans and get paid for a change. So I would make 30-50k which is peanuts compared to an associate position, but you also must consider that getting a job straight out of school isn’t all that easy – especially getting a good one. Having a year of residency on the ol’ resume really beefs things up and puts you ahead of anyone that just graduated.


Now unfortunately we only spent about an hour and a half in the actual dental clinic. After lunch we spent our time in the main hospital. Three of us go to radiology and one goes to the E.R. I ended up in radiology which I was actually interested in. However, once we sat down in this dark room with one of the radiologists, I quickly realized how boring this was going to be. The guy didn’t really talk to us that much, we just sat around him as he dictated a few cases, took some phone calls, and bull-shitted with the other radiologists. We saw ZERO maxillo-facial cases. It was just one brain CT/MRI after another. That was the LONGEST hour and a half of my life.


We returned to the dental clinic and discussed how to analyze blood reports which was pretty useful as I don’t know what I’m looking at when I see these things. At this point it was 4:30 and we were done for the day. I really wish we could have hung out in the dental clinic the whole day instead of wasting time in the main hospital. I know that GPRs send you on hospital rotations as well, but you will never be reading brain scans in a radiology room…EVER.


So my resolve to keep the grades afloat has been refilled. GPRs in general are not super-competitive in comparison to other post-grad residencies, but if you want to have choice and go to a specific location, you can’t be a total schmuck. I figure I’m probably in the top 30-40% or so which is reasonable and my board scores are ‘ok.’ So I just need to keep doing my best and see how things land.


I definitely see myself in a GPR though; it just feels like the right move for me.


In other news, the clinic life is going smoothly. I finally got an endo case and the patient has paid for half of it and showed up for both appointments so far. Single canal on a pre-molar, hope to finish next appointment but I am really struggling with the x-rays. I had the instructor take WL pics for me last time because I missed them on my first try. HE even missed the apex so I felt better despite having to retake them AGAIN.


I am chugging along with most things. I feel like I have gotten a good deal of operative work in – but am definitely lacking in the fixed department. However, I have THREE crown preps coming up in the next two weeks so things are progressing.


Basically I love the D-3 year in comparison to the first two. It still is dental school and it still has its ridiculous moments – but all in all, I can safely state that this is the best year of dental school BY FAR. The fourth year will just be too stressful with all the licensure crap so I can already rule it out.


And with that, I’m off to enjoy the rainy weekend.

Wednesday, September 9, 2009

Getting Adjusted And Pulling Teeth

I am slowly becoming fairly acclimated to the clinic lifestyle here at UIC. I feel pretty confident with basic restorative work (amalgams/composites) and full dentures. I still have had ZERO endo experience which absolutely blows because we have to do a case presentation this semester. As you might imagine, doing a case presentation when you have no case to present sort of makes things impossible. Hopefully I will get something soon..but I have been thinking that for the past 18 weeks now, and I still have seen nothing. I also have done zero fixed work..but I do have several patients on the horizon so that experience is on the way.


So this semester started out with a bang. I am currently on an Oral surgery/medicine rotation that lasts for an entire month. So half my days are spent extracting teeth now which is actually pretty damn fun. The rotation is great because not only do you learn the basics on extraction, but you also get a hefty dose of simple patient management skills, a crash course in pharmacology, and a great place to improve your local anesthetic techniques. I have no desire to be an oral surgeon, but I love this rotation. Outside of third molars, I plan on doing most of my own extractions in practice anyways.

You would be surprised just how much force you actually have to apply to get the tougher teeth out. It is pretty exhausting actually – especially for a tall fellow like myself because the chairs refuse to raise high enough for me not to hunch horribly. The oral medicine rotation is hit or miss. Sometimes I learn something, other times I don’t. The OM faculty do love to talk though – which is good in certain instances, but bad in others. I have seen a potential carcinoma (waiting for biopsy), a salivary stone, and about a million TMD patients (which usually have some form of myopathy rather than TMD). We meet in this clinic on Wednesdays and we meet in OS on the other days.


Now outside of the rotation things are going fine. We have way more classes than I thought we would which sucks, but at least we always finish by 10AM. The actual clinic itself is becoming almost like a second home. The faculty is getting used to us and I honestly feel pretty confident doing basic stuff at this point. I really don’t even feel like I need faculty supervision anymore for certain procedures which is great. Each composite I do looks better than the last, each prep is smoother, and everything is clicking.


Obviously there is MUCH to learn, but I love the feeling of progress – knowing I am inching ever closer the realm of competent dentistry and graduation….ahh graduation.

Sorry for the lack of posts, I just find myself consumed in other activities when I’m not at school.

Feel free to continue emailing questions and I shall reply as promptly as I can.

Transmission End.

Sunday, August 16, 2009

The D-3 Experience II

While I am somewhat disappointed that I haven’t kept up to date on all the happenings this summer, I realize that there are so many ‘firsts’ to talk about that I could never find the time to make separate posts about them all. Regardless, now is as good a time as any to lay down another experience post on the third year of dental school.

The semester wrapped up on the 7th of August, which also coincided with an annual festival right on Taylor Street which happens to be the way I walk home. I like to imagine that they are celebrating another semester taken down by this weary dental student. I also enjoy walking down the middle of a street without fear of getting run over.

So where do I begin? Grade-wise, I’m not sure about most of the classes yet – regardless of the outcome though, I am completely satisfied with my progression and could really care less about the arbitrary letter. I feel like I got along with all of the instructors and I did manage to work with everyone in my clinic at least once. I didn’t make any drastic mistakes and I would say I did a decent job for a first semester in terms of speed and efficiency – clearly there is plenty of room to improve of course. The grades seem so out of your control at this point that I just don’t care. A lot of it comes down to luck – who you worked with, the types of cases you got, type of patient, ect. Plain and simple, some instructors give out A’s for free while others are tough as hell. I really don’t know how our ‘clinic’ grade is determined either, but I do know this one score counts for a TON of the percentage value in more than one class. Again, I got a decent score, but it was about 0.5% shy of what I needed. In other words, much like last semester I got hosed on the wrong side of the A/B border. Frustrating yes, but as each semester passes; I realize more and more that I am leaning towards general practice. I’m just getting antsy to ‘begin’ my life – as in, do things that involve me not being in school. Work hard and actually make money, get a house, start a family, all that good stuff. Obviously I don’t know if my passions will change, but I currently see myself possibly doing a GPR and then hitting the private sector.

Enough on the technical stuff, how does it feel? Knowing that I officially passed the half-way point of dental school back in July? Knowing that yet another batch of incoming D-1’s are on the way next tomorrow? Knowing that I can actually accomplish dentistry on real people without horribly butchering them? Everything is great. Six semesters down, five to go. Seeing new D-1s roaming about made me feel older LAST year, this time around I will likely feel like an ancient relic.

There is a lot changing in the clinics right now, the construction should be finished by October (of course they were supposed to be done by the end of august so this obviously might change again), so we are still all squished together and disjointed. Pre-clinic chairs will still eat up eight of our live patient chairs on Wednesdays, but the big news is that all the clinics are officially merging. There are three pairs of clinics that are adjacent to one another in the school. They are numbered 1- 6. 1 and 2 merged last fall as the pilot group. Apparently, things ran smoothly enough and they are merging 3 with 4 and 5 with 6. I don’t really mind as we have essentially been merged already this summer. My GP manager is taking over group 5 along with my group (6) so I won’t have to adjust to any change in command. I also think my classmates in GP 5 kick ass overall so we will all get along fine. Yea, it doesn’t really matter at this point. Even with change, you still find a way to manage and learn at the same time.

So what do you DO as a D-3? This summer we had several courses to roll through. Allow me to elaborate:

Dental Ethics – Pretty dull overall, most of the scenarios applied to a realm that we have zero experience with – the real world. I was hoping for a few more dental school based scenarios but I suppose dealing with the real world stuff is important. However, it is sort of pointless to expect a bunch of dental students to have anything really valuable to contribute to discussions that are clearly out of our realm of experience. You simply can’t teach ethics, it is something you must inherently possess or had ingrained as a child. I will encounter plenty of tough situations in my professional career, however, reading a book about it won’t help me solve the problem – I will have to sort through them as they arise and hope that my own morals keep things in check. The course ended with a 5-10 page written final due in early July. Afterwards I got to sleep in on Tuesday mornings. Cha-Ching.

Dental Public Health – Nothing to say really. Free ‘A’ if you showed up and turned in the assignments (super easy I might add) on time. Ended in July, slept in on Mondays thereafter.

Pain Control II – You standard OS-style lecture course. Straight-forward overall. The final tripped me up a little, but it was by no means unfair.

Advanced Oral Surgery –Pretty much everything discussed was way over our heads (as in the specific surgical technique to repair a cleft or nerve or something along those lines). We had an entire lecture devoted to facial cosmetic surgery. Like face-lifts and botox and all that crap. I DON’T CARE. The course director also happens to be the head of the residency program here. He is brilliant no doubt and a top flight surgeon. However, he seemed to consistently talk down to us and make us feel like the insignificant worms that we are. He also tended to lecture past 10:00 which is when our patients expect to be seated. Bear in mind that it takes a good 10-15 minutes to set up your chair and get all your equipment ready. Not to mention the exams were insanely difficult. When the high score on an exam is 43/50 (86%) in a class with several geniuses – you might have to revise your educational strategy.

However, I am being a bit whiny, some of the stuff was interesting and I did learn a lot (particularly about the TMJ).

Comprehensive Care IIIa – Not nearly as bad as IIc. We had a few pointless lectures, but we also a few GOOD lectures. Not to mention they CANCELLED the final exam three days prior which was AWESOME. We had to write a random patient portfolio, business report, and complete a clinical photo project. Otherwise this course was laid back. Of course the grade scale is unforgiving as hell and getting an ‘A’ seems based more on luck than aptitude. I feel bad for the classmates I know that want to specialize. They seem overly-stressed out and I don’t blame them. You really can’t control your grades as easily at this point. There is still plenty you can do, but it is not nearly as clear cut as get 90% of the bubbles filled in correctly.

OK, that ends the classes that had lectures. Now here are the clinical courses.

Endo clinic I – This is my only real big gripe. I cannot get an ‘A’ in this class. You know why? Because I simply didn’t get to do ANY endo this summer. I can’t force someone to need a root canal; and when they do need it, I can’t force them to not opt for the extraction because they can’t afford endo. What is even more annoying is that several of my classmates have done MULTIPLE RCTs. I really feel like the school should do a better job spreading the wealth, because it is bullshit and not an even playing field to be graded in this manner. We have to do a case presentation next semester as well. That will be mighty hard to do if I don’t actually get any patients that need endo.

Restorative Clinic I – Pretty much your entire grade is based on the faculty eval. I have no idea how they determine this grade, but I feel like I’ve done a pretty good job so far. We had two performance exams that were fairly basic. One was on the initial exam appointment and the other was on treatment planning. Nothing where you are under the gun.

Perio Clinic I – No idea how they grade, the performance exams were pass/fail. We had two – initial perio evaluation and oral hygiene instructions. That’s right; we had to take a performance exam on telling the patient to brush their teeth. Ok, it was a little more in depth, but not much. My only real complaint about perio is that several faculty members enjoy grilling the crap out of you with very detailed questions. I’m sorry that I don’t remember the exact name of the bacteria involved in chronic periodontitis, that was 2 years ago and I won’t remember it after I graduate (unless I go into perio). When in doubt – remember that calcium channel blockers have the potential to cause gingival hyperplasia!

So there is the class run down. Really though, this summer was a semester of ‘firsts.’ My first MOD, my first DO, my first F/F denture, my first partial (not really close to done yet), my first class III composite, my first pulp exposure and direct cap, my first palatal injection, I could go on and on. Everything is a first, and it is actually surprising how well things can go. It is also not a shock when you have a rough outing. You still learn from both and that is what really counts.

I still have a long way to go. The next semester won’t be as laid back as the summer, we have a couple of presentations and more class to attend – but it still will feel sweet to just continue treating patients. I get to deliver three arches of dentures in the first week! Hope they fit.

I still have another glorious week of vacation on the horizon as well. Two weeks truly is a HUGE difference from the single we got back in May. I would have posted this earlier, but I truly am enjoying the brief respite from dentistry.

I’ll be back at it full time next week…five semesters left till I finally grab that hard-fought DDS.

Wednesday, July 8, 2009

Extension For Prevention

I have found a MAJOR flaw in dental education. Actually, there are plenty - but this one is particularly bad. During the pre-clinical years at this school (and I'm sure everywhere else) we are really hammered on the idea of prevention. Not necessarily cutting the shit out of a tooth with a tiny speck of caries interproximally. Attempting remineralization, PRRs, ect. Back in the day, a gent by the name of G.V. Black came up with an old-school concept called "extension for prevention." The idea is that you extend your preparations well beyond the caries with the idea that you guarantee it won't recur. This thought process was caried out for a LONG time, only recently it seems in education they are teaching the reverse concept "Prevention of extension."

This is what we were taught, conserve structure when you can. Today I finally got my hands dirty with my first DO amalgam (#5). Radiographically, this tooth was a good example of the kind of case I will have to do for my board exam as a D-4. So I start the prep, all is going pretty well. I finally get a real time example of what cutting through tooth and caries feels like. The box was a bit overextended but workable. So how far mesially should I go with the occlusal portion? About half-way is what we are taught unless there is occlusal decay - which there was not. Assuming your walls are convergent, that should be enough retention.

I finish up the prep, and grab my instructor. He proceeds to tell me that I need to, and I quote, "G.V. Black this thing up, extension for prevention." So now I need to cut this healthy tooth all the way to the mesial marginal ridge because I can't exactly argue with the instructor who could easily make my life a living hell for the next two years.

Do you see the problem? What good is the pre-clinical teaching if it is instantly contradicted on live patients? OK, granted there are instructors who are conservative, but nobody seems to realize what we have or have not been taught. It's as if the pre-clinical years are taught at a completely different school.

This sort of confirms my original idea of the clinic - which isn't necessarily all that bad. You will get exposed to many different points of view. It won't take very long to find out whose opinion you actually value and whose you find outdated or downright wrong. This is actually a good thing because it defines you as a professional, you obviously can't agree with everyone on everything.

So the actual fill was quite the bleh, I didn't adapt the matrix band very well and totally stabbed the guy with the wedge which resulted in some unecessary bleeding (good thing he was numb). I put way to much amalgam in initially which took away a lot of carving time. I didn't have my instruments organized very well so I wasted time hunting for various tools and I had to keep grabing the highspeed suction to grab the huge chunks of overfill that were getting dangerously close to aspiration/swallowing territory. I pulled off the matrix and the contact was WAY to tight. I seriously spent about 30 minutes cleaning up the interproximal and reducing the occlusion. My margins were pretty decent, no open margins or excessive excess. Basically I was just too slow and REALLY rusty using all the carvers (I mean it has been about a year since my last amalgam).

The important part is that I didn't have any major errors. I could get the floss through by the end with fairly normal pressure and I got the occlusion down enough so it wasn't bugging him or showing up with the articulating paper. I was actually pretty damn satisfied considering this was my first amalgam on a real person. I need to get faster and remind myself how to use the carvers and burnishers effectively but otherwise, not too shabby.

Now back to dentures tomorrow...sigh.

Monday, July 6, 2009

Warm Fuzzies

Today marked my first truly inpsiring moment in school where I know the crap I do had a true impact on somebody's life. I have a patient in dire need of dental work. She essentially is going to have about 12 teeth extracted (due to extensive perio disease) followed up with partial dentures on both arches. She has no insurance, was laid off last spring, and we are trying our best to spread the extractions out enough so she can pay. We probably will only do the upper arch first. Well this patient has a HUGE gap in the front (#9 missing and #10 has shifted distally). While pretty much all her teeth up top will be yanked minus the canines and premolars, a MAJOR concern for this 40something female is getting that space fixed - especially considering that she is looking for employment and can't stand smiling and looking like Mike Tyson.

So while I know the other anteriors will be extracted eventually, I went ahead and made her what is known around here as a flipper - or interim partial. Basically a removable device that replaces a few teeth - usually used for emergency esthetics.

Now were we ever taught how to make a flipper? You can probably guess the answer to that. So here I am, getting tips from classmates and D-4s, and just really going for it. It took me about 3 hours, but I got the damn thing made. I spent this morning adjusting the wires and removing excess with the patient in the chair.

Was it perfect? No. The thing is not as tight as I would want it in terms of stability and her occlusion is already a bit edge to edge so it is difficult to get that perfect angulation. Her speech is slurred a little with 's' sounds but not too bad (after I trimmed the crap out of it). However, the one part that I knocked out of the ballpark was tooth shade and shape. I added a new #9 and #10 to fill the gap and the color was very close to perfect. The acrylic shade clearly wasn't meant to match african americans, but her smile line is low enough to display zero gum.

The part that makes me happy is knowing that she finally got a job interview for this thursday and I managed to fix the esthetic issue (albeit temporarily). She was happy with the appliance and didn't come back that afternoon which means it didn't break!

So was it the greatest flipper ever made? Hell no. Does it get the job done? Hell yes. Now that my first one is out of the way, I already know what I did wrong and what improvements I can do for the next time. When they say you get out of school what you put into it - this type of experience is exactly what they are talking about.

In other news, I am still chugging along this semester. These next two weeks will be rough. Endo exam (despite having no lecture class), public health final (took today), and OS midterm on friday. Ethics take home final (5-10 pages) and Caries patient portfolio both due next week. Not to mention all the extra lab work I have on the horizon. It kinda sucks having essentially removable cases exclusively. But I can make a custom tray in like 5 mintues now.

First DO amalgam on wednesday coming up. Hope I remember how to use all those carvers!

New D-3 experience post probably up by the end of this semester.

I miss summer vacations.

Thursday, June 18, 2009

FAIL

So far, I have been pretty lucky with patient’s actually showing up on time for appointments. Most of them have been making all payments as well, so yea – good fortune. I have had a few patients’ cancel their appointments but they have always done so at least a day in advance. True it isn’t always enough time for me to fill the spot, but at least I have a chance.

So today, of all days I had my first patient failure. This equates to the patient not showing up, not calling, and you simply can’t get a hold of them to find out why. I was going to do one of my performance exams on this patient so I am justifiably pissed. Not only did I waste my afternoon (which costs about 150 in tuition), but I have to find a new patient to do the PE on. School policy is that I can dismiss this patient because she failed the initial exam (normally we have a 2-strike policy after they have been coming for awhile).

I am at a crossroads. This patient cancelled the previous initial exam last week but called the day before. She also made her own FMX appointment and got the x-rays taken without me having to do anything. So I don’t quite understand how to take the situation.
If she doesn’t call back by tomorrow, I will most likely dismiss her as a patient. Just sucks that I was all ready to get some requirements out of the way and now am back at square one. On the plus side, I have scheduled a transfer patient for an appointment who is a veritable gold mine of directs and crowns. So I will finally get some consistent operative experience.

Funny side note:

We are required to call our pedo patients the day prior to our rotations. I have pedo on Friday..hence calling on Thursday. We don’t have to actually schedule them, we just verify that the scheduled patient still plans on coming. Well, it seems that 2 out of every three kids I get does not speak English. I don’t speak Spanish. So when I call and mom answers with: bueno, I naturally get a bit off guard. I totally half-assed my way through, and she seemed to understand. Needless to say, my classmates around the phone area were laughing their asses off. Get your jollies now people, it will happen to you to.

Tuesday, June 16, 2009

Cutting REAL teeth

Today was my first foray into the operative component of dentistry. It was definitely a nice change of pace from the constant stream of perio problems, dentures, and RPDs. It was the perfect starter for any newbie like myself – a very conservative prep on the distal of the left second premolar. I didn’t even need to provide anesthetic. I rarely used round burs on the plastic teeth, but that was all I used this afternoon to make a nice little slot in the side of the tooth. Got my instructor to check, and he said “looks good.” Sweet. The hard part was placing the composite. You really don’t understand what working in a wet mouth is like when you practice this stuff on plastic teeth. Composite resin requires a DRY field to work in. Placing a rubber dam is not always practical (especially when the patient lacks any posterior teeth to clamp). So I just loaded her up with gauze and the suction tip.

The placement went ‘ok.’ I had a bit of excess that I didn’t notice until after I cured everything, but my instructor showed me a few good tips on how to really take advantage of the finishing burs. I finally had her bite down on some articulating paper to check if the restoration was too high. I hear this horrible crunching sound. SHIT! Thankfully she only fractured a tiny bit of the marginal ridge off, which was the high part anyways. I just smoothed it off, checked occlusion again and sent her on her merry way.

GO ME!

Sunday, June 14, 2009

Uninformed

Ok, here is my first post in a bit. I really haven’t had any reason not to post, outside of rediscovering what having a life is all about. I actually have time to do stuff…it is a crazy feeling.

That’s not to say that things can’t get stressful. In fact, I would say that school itself IS more stressful in the clinics, but you get used to it, and then you go home and drink a beer or scotch. I mean let’s consider: on the one hand, you are sitting in a lecture hall fighting to stay awake while you learn about kidney stones or something. Yea, not stressful. On the other other hand, you are running around the clinics like a chicken with its head chopped off trying to find the vitrebond, or locate a professor to help you use the facebow or do something else you vaguely remember being taught in a half-assed fashion eons ago. Yea, stressful.

In fairness though, things would be much smoother if all the damn construction wasn’t conveniently scheduled for my entrance into the clinics – again, something that would have been nice to know during interviews..cough cough. Would I have gone somewhere else? Probably not, but it still sucks.

So clinic craziness aside, things are still great. You learn a billion things a day and you feel the experience growing with each and every patient encounter. I no longer am timid when rooting around someone’s mouth. I am slowly improving my operator positioning as I learn how much easier it is when you can have the patient move their head to one side or the other (the mannequin head lacked this quality).

My major complaint as of now is that I STILL have not cut a tooth yet…seriously. I have classmates that have done tons of direct restorations, crowns, ect. I have been doing initial exams and dentures all day every day so far. All my initial patients seem to have zero caries and tons of perio issues which will require either more dentures or RPDs. However, good things are on the rise. A recent transfer patient needs about twelve, count em’, TWELVE directs. Not the crappy class V’s either. I’m talking class I’s, II’s, and III’s. The stuff we get tested on for boards. Hopefully he returns my friendly phone call for an appointment. Keeping my fingers crossed on that one.

OK, time for the gist of this post. How hard would it be to sit us down during one of our ‘comp care’ lectures and outline exactly WHAT we are expected to accomplish/turn in this semester? This course is run by so many different people that clearly don’t communicate with one another and it is impossible to get a straight answer. We have FOUR performance exams that MUST be completed before this quick 12 week semester ends. Yes they aren't part of the comp care course, but we also have no lectures for these courses..so when else are we supposed to find out? Two of these are for perio and two for restorative. Yes you can find all this information if you dig around on blackboard or ask an upperclassmen. But why can’t there be one big sheet of paper they hand out during one of numerous lectures that says: “THIS IS WHAT YOU HAVE TO DO BEFORE FALL.”
There is some random endo exam we must take in July also. What should we study? Who knows.

Ahhh but complaining feels stupid when I am still in such a good place. Yea I spent 6 hours at school this weekend doing assorted lab work and filling up my scheduler. But I even impressed myself at how easy making record bases and wax rims was this time around (first time in 6 months..must be like riding a bike). I can only pray that this technical carry-over applies to operative procedures as well.

I was going to whine more, but I see no point. This is how dental school goes, just suck it up and learn as much as you can. There are plenty of great teachers and opportunities to really develop. These last two years are what count the most towards getting off on the right foot in the real world. Real-time job training.

Friday, May 22, 2009

The D-3 Experience I

Amazing. Exhausting. Terrifying. Fun. These four words spring to mind after completing one week as a D-3 student. I have gotten home exhausted pretty much every day, I am amazed at how much experience I have gained in five days, I am terrified by how little I actually know, and I am having fun amongst it all. I love it. I may be a bit blinded by how much hatred I had for the last semester of D-2 year, which finally got our grades up this week and I did pretty awful compared to previous semesters. What sucks is that I was border line in every class - but where I would usually end up on the better side of that border, I seemed to get hosed in nearly every course this time. Key difference though, I don’t give shit. A ‘B’ is not a bad grade, and it isn’t a damning grade either towards any future aspirations (at least for someone who isn’t planning on specializing IMMEDIATELY after graduating if at all).

I am totally digressing though, this is not a post to whine about last year, it is to discuss initial impressions of my new found status as an upperclassmen. I know I will have bad days, I will be humbled, humiliated, ect., but I hope to learn a LOT. I see no other alternatives when you are practicing dentistry on real people every day. So far, I have really enjoyed it.

I was nervous Monday morning, had that same uneasy feeling you get when you are about to step into a new world – very similar to orientation. Once I got going, things just blazed by and before I knew it I was sitting at home with a beer watching TV.

So what is my schedule you ask? Here goes:

Monday:
8-10: Dental Public Health (meets 6 times, done in July)
10 – 4:30 - Clinic (lunch is designated 12:30-1:30)

Tuesday:
8-10 - Dental Ethics (meets 8 times, done in July)
10 – 4:30 - Clinic

Wednesday:
10-4:30 Clinic

Thursday:
8-9 - Pain control II
9 – 10 - Comp care IIIa lectures
10-4:30 Clinic

Friday:
8-10 - Basic Oral Surgery (but less basic than last semester)
10-4:30 Clinic

OKOK, now some of these numbers vary. Clinic time can be spent in many ways. We generally have a morning block and afternoon block of time, so we usually can’t see more than two patients a day. HOWEVER, we also have several required rotations scheduled at various times that take precedence over general clinic. Now we won’t all go through the same rotations this summer, but by the time graduation rolls around, everyone will have spent an equal amount of time in each rotation.
Generally when we have a rotation, one session occupies half of any given day and lasts a week. So when on rotation, half your time slots will not be available to schedule patients for that week.

Here is a breakdown of what I go through this summer:
Urgent Care (12 sessions) – Basically we treat the walk-in emergencies of the day. Usually end up referring to post-grad endo or OS. If we get lucky, we can do something interesting like a pulpotomy. The best part of urgent care is that you can pick up new patients with interesting cases. Most of your endodontic experience will be gained through urgent care patients. I had my first rotation this week, and picked up a new comprehensive care patient (which is great as most of my current patients refuse to call me back).

Oral Medicine (2 sessions) – We will be in here checking out oral pathologies and working on our clinical exam skills. I need to remind myself to reschedule one of these rotations as it conveniently overlaps one of my OS finals.

Radiology (5 sessions) – become cheap labor in the radiology department and take FMX and pans all morning/afternoon. I have this in 2 weeks and am glad because I need more practice.

Invisalign Training (1 day) – Get certified in invisalign in 8 hours, sounds good.

Pediatric Rotation – EVERY FRIDAY AFTERNOON FOR THE ENTIRE D-3 YEAR. Holy crap..that is a lot of pedo experience. I really hope I can learn to manage little kids by the time this is all said and done.

My only gripe is that I am missing out on the oral surgery rotation that most of my classmates seem to have. It lasts three weeks and must be completed before you can start extracting teeth without heavy supervision. Seeing as MANY urgent care patients require simple extractions, it sucks that I won’t really be able to start until I get my OS rotation (hopefully early in the fall).

All other clinic hours are meant for our patients. If a patient cancels, or you just couldn’t book anyone, you are expected to help out in urgent care, assist classmates, call patients, do lab work. You can’t just take off (although it seems like nobody would notice in the chaos that is this summer due to all the clinic shuffling). I really don’t mind doing UC when I have nothing else going on; it provides extra experience and offers the slim possibility of picking up a new patient.

Quick breakdown of courses:

Comprehensive Care IIIa – I loathe comp care. Simple as that. This class seems like it will be very similar to last semester, with a constant stream of ticky tack assignments just to bug the hell out of you. I’m not sure of the grade breakdown yet.

Dental Public Health – Haven’t had the class yet, but I doubt it will be a problem..most likely to be annoying though. 8 am still sucks for any lecture.

Dental Ethics – While this class sounds terrible, I can actually find value in it. There are plenty of really tough situations that I wouldn’t mind talking through with my classmates and faculty.

Endo Clinic I – This class is carried over a bit from last semester (I’m not exactly sure what else we do to get graded). I know if I get at least one RCT done this summer, my ‘experience’ grade will be an ‘A.’ Other than that…not sure.

Basic OMFS – very similar to last semester, some of the intstructors write absolutely dreadful multiple choice questions which pretty much makes easy tests much harder.

Pain Control II – The bad lecturer from the other OS classes is not in this one, so thank god. Hopefully the tests will actually be manageable. We get to load up each other on nitrous again at the end of the semester.

Perio Clinic I – I honestly didn’t even know this was a class until I looked up my schedule while writing this post. I assume we will be evaluated by the perio faculty for this grade.

Restorative Clinic I – Not sure how we are evaluated (performance exams most likely), but I will update when I figure it out. Hope I actually get to do some direct restorations this semester…it sure feels like all of my patients only need RPDs, Dentures, or Perio.


So that wraps up the official schedule, here are some drawbacks that will become more apparent as I get further into the year:
1.) Not enough chairs – with all the construction going on this summer (not to mention over-matriculation of international students), we are really tight on space. I am lucky if I can book a patient within a week at this point which sucks.

2.) Lack of endo – several of my peers have completed root canals already (some have done more than one). This sucks because it is pure luck if you find one through urgent care which seems to be the main avenue for RCT cases. This is also the one specialty I am interested in, so I would like to get some experience to determine if my interest stays legitimate.

3.) Lack of patients – yes I still lack a good patient pool, I know I will be getting more and more as the summer progresses, but I still have a TON of blank spaces on my calendar.

4.) D-4’s still around – I was under the impression that MOST of the D-4 students would be on rotations this summer, but it seems like they are all still around. Of course having them around is also helpful, because they can quickly offer advice/help when you most need it.

5.) Performance exams – Finding enough patients to practice, and then finding a good one to get graded on for any procedure simply sucks. I still am unaware of our actual requirements this summer, but I know it will be stressful.

6.) Not knowing what the hell you are doing – yes, believe it or not, the two years of pre-clinical training really can’t prepare you for live patients. It is frightening to be responsible for someone’s well-being when you feel so na├»ve and overwhelmed. All of the upperclassmen claim that it takes some time, but we will eventually feel pretty confident doing many different procedures. I hope so!

7.) Unclear expectations/goals – I really don’t know how we are evaluated, or what we are expected to complete.
Enough bitching! Most of that is pre-emptive bitching anyways because I haven’t had enough experience yet. Bottom line is that I am quite happy with where I’m at right now. I look forward to getting the ball rolling with my patients and actually improving their quality of life. I haven’t even thought about that yet.

Now I’m off to enjoy a three-day weekend. The nice weather has finally arrived!

Tuesday, May 19, 2009

Period Of Adjustment

Two days into life as a third year dental student and the differences can easily be identified. First off, we don't have that much class, simple as that. I had monday morning off and I have tomorrow morning off (this means I don't have to be at school until 9:30 or 10:00 depending on if I have a patient or am on rotation). That extra 1.5 hours of sleep already kicks sooo much ass. Two of my courses this semester also end in early July, meaning I will only have early class on Thursdays and Fridays. I will break down the schedule in a week or so.

So what am I doing then? Working my ass off in the clinic trying to adjust and get used to everything. While our early clinic exposure did help during the D-2 year, it is a completely different animal when you are in there all the time, expected to be doing something, and doing that something well. One major flaw I already see in myself is lack of speed. I am far to slow and cannot adjust to changes in appointment plan fast enough. For example, I planned on getting 1/2 my initial exam done on my patient this afternoon. Instead, he spent 1.5 hours getting full mouth radiographs taken, then I essentially spent the rest of the time trying to deal with all his health problems that were clearly not under control. Blood pressure of 180/110 is NOT good. Blood glucose of 241 mg/dL is also NOT good for a 'controlled' diabetic. Had to write up a medical consult, and then before I knew it, I was already 45 minutes past the time we are supposed to be DONE!! So all my chart entries are unapproved because our instructor pretty much jetted after he signed the med consult. So now I have to hunt him down tomorrow to get all my unapproved entries swiped through.

I got home around 6pm, tired and drained. But instead of studying pharm..or reading endo...or writing a bussiness report...I opened a beer, grilled a few hot dogs and watched tv.

Now THERE is the big difference.

I know things will change. For one, I won't be able to drink a beer and do nothing every night I get home. There will be projects and lab work to do, and the few courses I have will require a bit of out-o-class time, but I know it will pale in comparison to the first two years. On the plus side too, I doubt I will be stuck in the school an hour late doing simple procedures after a few months grinding it out in the clinics. I am bound to get better by sheer repitition. I am aware of my shortcomings, which is a great step in learning to resolve them.

Everyone says D-3 year is the best. I can see this being true - especially after I adjust and get better at things that I know are simple, improve my communication with patients, and improve my general knowledge of common clinical problems such as what to prescribe for so and so or how drug X may interfere with treatment option Y...and so forth.

My only gripe is in regards to the lack of chairs. This would not normally be a problem at this school, but they decided to refurbish the pediatric and ortho clinics this summer. So those two clinics have been crammed in with the undergrad clinics and we are all shuffled around right now. That in itself isn't horrible, but what really steams me is the fact that the admissions committee cannot do simple math. They over-accepted on international students in the last cycle and they don't have enough room in the pre-clinic for the newcomers. This means that 8 of our clinic chairs are getting sucked up for pre-clinical courses. Guess what clinic they are in? Mine of course. So there are only 10 restorative chairs on tue and wed for my clinic now. Hmmm..there are 11 D-3s, 3 IDDP-2s, and 11 D-4s. This is going to work out great right? Ok ok..several of the D-4s will be out on rotation and we never ALL need restorative chairs (often need perio and sometimes endo)...but still. This is how I feel.

Well I will save further ramblings for my formal D-3 experience post. Just wanted to let all know that things have started and I am learning to adjust. I hope to be fully assimilated by the end of this summer.

Back to total relaxing and sleeping in until 9am. SWEET.

Thursday, May 7, 2009

The D-2 Experience VI

It has happened, I never thought this day would get here but it finally has – I am a D-3. FINALLY. Time usually flies in dental school, but the tail end of this semester has just dragged on and on. This year was without question, more difficult than the D-1 year. Anyone that argues otherwise is probably above average with their hands and hates studying basic science. Yea every school is different, but the basic route is still about the same – first year is essentially all books, second year is essentially all pre-clinic, and 3-4 is all patient care. Granted, the curriculum at UIC is getting a face-lift – but I really feel that this will mainly affect the D-1 portion of the curriculum. You still have to learn all those pre-clinic skills and PBL or whatever the hell they are calling it will never replace the bulk of the pre-clinical requirements.

The year in general was a rollercoaster. Every semester had a different feel to it. There was the Summer Semester of Waste, the Fall Semester of Saturdays, and the Spring Semester of Bull. I will elaborate on these personalized names right about now:

Summer Semester of Waste:

Waste, truly the best descriptor I could concoct to describe how I felt about the Summer. It was a shorter semester (about 12 weeks as opposed to the fall/spring 17 week marathon), but it still felt pretty long. Overall, the course load was manageable. We had comp care IIa, Intro to pediatrics, Path II, Pain control, and Dentures (this class started in July). We spent a lot of time with the comp care course learning how to use composite as well as preparing class III/IV teeth. We also did inlays and onlays towards the end. I remember the restorative portion of this course being really frustrating because they never really teach you how to polish anything here; you just have to sort of figure it out. Yea, it isn’t that hard to do – but there are a few tricks that would have been beneficial to know AHEAD of time. Perio was mostly lecture based, with a few clinical sessions. EBD was blah as usual. I suppose the true interesting aspect of this course was that we began assisting in the clinics. This was beneficial a few times but was also boring and useless on other occasions. Basically if you got stuck perio charting, you didn’t learn much (except that the perio instructors are VERY anal about EVERYTHING.)

Pain control was a standard 1 credit course, but of course STAB LAB stole the show. It was not nearly as scary as people made it out to be. The only drawback is that I haven’t done an IAN since last August…watch out next patient that needs mandibular work. Path II was the same as path I, lectures simply way to long.

Pedo was an interesting course. The tests were made impossible because each lecture covered around 200-300 slides of material and we had 2 lectures a week. Try keeping up with 600 slides PER week. However, the director gave out extra credit like candy and if you did all the lab work – you most likely got an ‘A.’ However; I do remember some of those lab days dragging on forever. Learning how to bend wires into a lingual holding arch was bad, but it could have been worse. Soldering and polishing was actually pretty interesting although I probably won’t be doing it very often.

OKOK, so the course load during the Summer of Waste really wasn’t all too bad. The kicker is that I took the National Board Dental Examination Part I in August right after the Summer of Waste ended. You know what that meant of course, I spend pretty much all of my evenings and weekends deep in study.

I call this the Summer of Waste because it truly was a wasted summer. The weather never got insanely hot, perfect breeze, and there wasn’t an inordinate amount of rain. The biggest treat I had all summer long was getting to sit on my deck and study for the boards. OK, maybe I’m embellishing a little, but not by much. I am sad to think back on how little ‘fun’ I got to have, but it’s all part of the game. Plus, I have this next summer to look forward to (the schedule looks AWESOME..more on that later).

The Fall of Saturdays:

The name is self-explanatory. I am NOT exaggerating either; I was in the school at least 14 out of the 16 weekends. Most of my classmates did their extra work during our Tuesday afternoon board study time, but I found that day to be too crowded because the D-1s were always doing something in the pre-clinic or wet lab. So I started the unfortunate tradition of coming in on Saturdays…every Saturday. Time was variable, but I would say the average was 3-4 hours.

Course load:
Compcare IIb: restorative, perio, communications, and clinic components (actually got a few of our own recall patients).
Fixed Prosthodontics I: Hardest class of the semester
Removable partial dentures
Complete Dentures
Pre-clinical Endodontics
Oral Pathology

The list may not be that long, but each and every one of those classes was a monster in terms of time/work involved – particularly Complete Dentures, Endo, and Fixed.

I spent so many hours groping my way through disgusting jars of extracted teeth, finding maybe 1 in every 20 to have any potential use, x-raying them, finding only 1 in 3 of these to be useful, mounting them in stone, and x-raying them again. This was all just to prepare for the course. That doesn’t include actually performing endodontic therapy on these teeth – which takes a LOT of time in itself. This class was my Saturday class for the first half of the semester. Afterwards the shift was towards Fixed and Dentures. What made endo stressful was that I had no extra teeth for practice. It wasn’t like fixed where I could go to the window and buy 10 plastic teeth to prepare crowns on – I could only use what I had, or what I could get via the mooch/trade with classmates. Not only did I not have to remediate, but I averaged an ‘A’ on the performance exams which was a true lift to my dentistry morale considering how poorly I did in fixed.

As just mentioned, fixed was terrible during the Fall of Saturdays. I averaged a 71% on the two performance exams(had to remediate one of them) and generally felt like I sucked at everything. I just couldn’t find a good technique for making a provisional and many of the labs had us doing very important things that I already can’t remember how to do (cast/post and core with biscor build-up for example). If not for my absolute domination on the final exam, I would have gotten a ‘C,’ which is the bottom-line goal I had coming in grade-wise – no C’s, D’s, or F’s.

Complete Dentures was not too bad until we got to setting the denture teeth. We had to use mounting jigs to get these things set on our articulators (a facebow transfer would work in a real patient). The jigs were pieces of crap and essentially created an extra 5-6 hours of work for me. My original mounting was off; I simply had no inter-occlusal space to set the teeth. So instead of suggesting a remount, every instructor had me grinding the base plate and the teeth for HOURS trying to make room. I FINALLY decide to try remounting after measuring the space on a few classmates (we all use the same jig)…so I pry the thing off, remount and voila, I have another 5-6mms of space. Turns out, I used one of the ‘crappy’ jigs. Bullshit I say. There was so much theory involved and not enough hands on in the mouth experience. Some things were simply not taught like how to pour up your final impression using the plaster/pumice box technique – I still have no idea what a clinical re-mount is and in all honesty, have no clue how to properly do a facebow transfer. So I guess this will be trial by fire in the most literal sense of the phrase.

So while the Fall Semester of Saturdays was the toughest, labor-intensive semester of dental school at this point, I still probably enjoyed it the most out of all three during the D-2 year. You simply learn a TON of dentistry, and that is what I am in school for.

Now for some crap, the Spring Semester of Bull. This past semester was probably the worst out of them all (with the possible exception of D-1 Spring). Hmmm, maybe the spring semesters just suck? It wasn’t ‘difficult’ per-say…it was mostly just complete bull. I had to do so many random projects and other filler-material that made me realize UoP graduating dentists in 3 years probably IS more feasible than I once thought assuming you trim the fat – like having to sit through 18 EBD presentations (9 of them during finals week).

Comp care was more spastic and all-over the place than usual. We had a clinical component, a portfolio to write up, and the implant course. The aforementioned sections were how we got graded. However, there were a billion pass/fail sections. Radiology, Pediatrics, Perio, Endo, Urgent Care rotations all had to be completed (many of them requiring little write-ups to prove attendance). I don’t know how many root canals I could watch while coming up with an interesting “what did you learn today” response. Ummm, watching root canals is perhaps the most boring thing I have ever done in my life? I would love to actually DO the root canal…ahhh maybe next semester. We also had to tape-record ourselves during a patient interview and play the recordings during a communications rotation which was blah..then of course we had to write the obligatory reflection paper. There was a bunch of other random crap to do as well, but I’m not in the mood to sort it all out. The bottom line is that I felt completely stretched thin in this class, every time I thought I would get a little break in the action, some new and annoying project or paper would randomly appear. It was one thing after another.

The implant portion of Comp care was valuable in the sense that I actually did learn a TON. However, the quizzing and final exam were complete jokes. Case in point – we had three lectures given by three different specialists (prosth, OS, and perio). EACH one gave a different number for surivival rates of maxillary implants. So go figure, this exact question appeared on the exam. Guess what? ALL three numbers appeared as answer choices. Give me a break. The lectures were NOT organized and the teaching was often haphazard at best. However, the labs were beneficial and again, I learned a TON despite my previous bitching. I also give this course a little lee-way because I believe we are only the second class to have it..hopefully things improve for the future.

Pharmacology was the biggest waste of time/effort this semester. I will sum it up: “Here is a massive list of drugs. Memorize everything on this list even though you will maybe prescribe 1% of them and can easily look the others up as necessary because there is no way in hell you remember any of this.” I will not even dignify its presence with further comment.

Ortho also turned into a class I dreaded going to. The lectures were insanely long and ended up repeating themselves over and over towards the end and the tests covered things we weren’t exactly taught. I learned a lot, but have officially been turned off to ortho as a future career route. Far too much theory and guessing for me. Not a huge fan of working on kids either.

OS and Endo were standard lecture classes, not much else to say. Treatment planning was somewhat useful but as mentioned in previous posts, I probably could have used this class earlier in the curriculum.

Fixed II was easier than last semester, but that doesn’t make it EASY. I magically developed skills with acrylic during our winter break so that is something to be happy about.

The best part of this semester was that I finally started getting my own patients and have seen a few of them already. I look forward to seeing lots of patients in the VERY near future.

The Spring Semester of Bull, aptly named because there was so much random crap to do, felt as though we took a significant step back in our dental education when compared to the intensity of the fall semester. It was a lighter semester in terms of work, but motivation was definitely a struggle.

Conclusions:

I found the D-2 year to be one hell of a challenge – both mentally and physically. I truly did enjoy it more than the first year though because everything was FAR more relevant. My small taste of the clinic life has made me realize just how little I actually know about dentistry and just how different real people with not-so-ideal problems compare with plastic teeth.

I am nervous about treating live people, but I am definitely ready to get started. No amount of pre-clinical practice/study can compare to real experience – and that is something I hope to get a lot of in my final two years of dental school.

Wow, I am officially half-way through. I can only imagine how insane things will be two years from now when I am two days away from graduating…

Now it’s time to enjoy my week off!