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.