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!