The D-4 Experience II

Let’s face it; I’m due for another one of these. It is difficult to come up with a proper description of the fourth year at this point. It actually feels similar to the fourth year of high school, or the fourth year of college. Similar in that you just are ready to get the hell out. Your third year is full of so many learning experiences and adjustments and failures that you barely have time to take it all in. Now I feel like I have pretty much come as far as I can in the dental school setting.

Sure, there is still a lifetime of learning ahead of me, but it seems best suited that I do that learning in the real world at this point. Seeing two patients a day truly limits what you can do. Not ever having an assistant truly limits what you can do. Having to do your own lab work, wrap your own chair, become a collection agency, or get cases sent to PG because they are “too tough” truly limits what you can do.

Don’t get me wrong, I still do learn at school – but I feel like I’m trying to squeeze juice from a turnip rather than an orange at this point. For example, I started my first bridge maybe a month or so ago. The preps were great, the temp was ok, and the impression turned out awesome. So I tried to send the impression, bite reg, and opposing cast out to get a framework made. Wait, no that is not allowed. For some reason I am required to trim my own dies and mount the case myself first…to get the framework. I am no longer naïve enough to think that general dentists mount every single bridge case themselves. In fact, I KNOW they do not. ESPECIALLY in cases where you can get MI without bite reg. So why am I forced to waste another week sending out the impression to get poured up so I can trim the die and mount it myself while attempting to work around all my rotations…sigh. That is one example of why school just annoys me nowadays.

The framework try-in is tomorrow. Assuming it goes smoothly, this poor bastard may have his bridge by the second week of January. So this will take at least 3 months. Ouch.

But bitching aside, what do I like? Pretty much feeling like the big fish again. All the people that used to be scary or intimidating are truly pleasant to me at this point. I feel like the faculty is giving me more and more lee-way with cases. Discussing cases with classmates has become a regular occurrence with genuinely good debates and questions regarding what the appropriate treatment should be. You just are feeling close to becoming a dentist which I guess is how it should be given how close graduation is.

School feels like a home away from home now. I enjoy just sitting around the conference room, BSing with faculty, classmates or the one dental assistant in our clinic. I also like having NO class. I only have to be at school by 8am one day a week for urgent care/screening sessions.

Now the other huge difference between the third and fourth year is rotations. Third year you are on a bunch of in-house rotations. The only truly beneficial block was oral surgery (8-weeks of extractions is pretty sweet for any third year). The fourth year has REAL rotations though. And while my experience is a bit different from the majority (mainly in that I am gone 19 weeks as opposed to 10), it is still unique to the fourth year. In fact, accepting my invitation to the 2x2 rotation program was a great decision. Sure the overall complexities of the cases I get outside are not all that great, but the sheer volume of work is what makes up for it. I still do get the occasional crown or endo, but it is mostly directs, exams, and extractions. However, you generally see 6-10 patients per day (as opposed to 0-2) and you also get a glorious assistant. Yea there is a lot of pedo, but that has been GREAT for me. It has made me comfortable with a very large portion of dentistry.

My first stainless steel crown at the college took me 2.5 hours to complete and it still was opening the kid’s bite. The last SS crown I completed was last Thursday and it took me 15 minutes from start to finish (note the pulpotomy was already done at a prior visit). This would not have ever happened without the massive pediatric exposure that these rotations provide. I am planning a future post comparing rotations to the school so I will save my comments.

The final difference I am going to touch upon today is the licensure exams. Third year is stressful because you have a bunch of performance exams to get finished each semester. Fourth year is stressful because everything you have done so far won’t matter if you don’t get licensed. I can graduate, but if I don’t have my license, it sure will be hard to practice dentistry. That thought alone is terrifying. Now granted, I feel that once you hack up the 2k that this licensure exam costs, that pretty much gets you the license. Sure you may have to retake something, but I honestly have NEVER heard of anyone failing the retakes. I hope I’m not the first!

The exams are simply stressful, but each one you knock off just brings you that much closer to the light.

One more HUGE hurdle and about three smaller ones is all that stands in my way.

Closer and closer every day.

GPR Bound

Officially got offered a contract today. Next year I will be busting out dentistry over at Illinois Masonic. Nothing officially signed yet, so I will get into more details about the program in future posts. Needless to say, I am in very high spirits tonight.

Much like passing manikin boards or part II of the written exam, there is just this rush of pure euphoria. The soaking-in period should last a good week or so. I am on rotation so I am busting my ass off seeing 10ish patients per day but this was a nice bit of news.

While the stress wasn't as intense as the week leading up to finding out that I passed the manikin exam, it got pretty bad the last few days. As mentioned, I only applied to two programs, and while I got interviews at both, you really can't account for the luck factor involved in any application process. I feel like I interviewd well at both, so luckily my top choice panned out. Everytime my phone would start vibrating, my heart would crank up the pace for a few minutes. And so many times it was a friend or patient or even wrong number. BUT NOT TODAY!

All I know for sure is that I gotta buy a christmas present for one of my letter or rec writers because several of the interviewers mentioned how impressed they were with it. I wish I didn't sign away my right to read it because I'm damn curious now.

Pass NBDE part II - check
Pass Manikin CRDTS - check
Get into GPR - check
Pass patient CRDTS - taking in march
Don't die before graduation - pending

So there you have it, really not much left. I still have an endo performance exam to complete on a posterior tooth and a few implant cases to finish (surgeries already done); but otherwise I'm pretty much graduated. Holy crap.

Posts on the way:
D-4 Experience
Rotation v School

2/3

Done. I have one more major test to take before I can legally practice dentistry (assuming I also graduate).

Let me see if I can portray just exactly how stressful this crap is. So as explained, the mannikin exam is just as it sounds, we perform several dental procedures on a fake patient with plastic teeth. There are two sections: prosth and endo. Prosth involves prepping #9 all-ceramic, #5 PFM and #3 FGC. 3 and 5 are to be made as a bridge prep meaning the must draw together. Endo equates to a #14 access and #8 full RCT. If you fail ANY tooth from any section you must remediate the entire section. So if I have 100% on my bridge prep but leave an undercut on #9, I have to redo all the prosth section. This also costs 950 dollars...ghee.

OKOK, so now realize we have been practicing for this thing since the summer pretty much. I failed the summer mock mock exam. I also failed the mock exam we had this fall. The trend was not looking good. So imagine my utter jubilation when I finally found out my score this morning. PASS. And REALLLY passed too. No score was below 90 which washed away any and all dental self-confidence issues I had been experiencing over this exam.

But let me emphasize that this was a terrible process indeed. First off, the exam itself was extremely stressful. But that's not even the bad part. The bad part is waiting 26 days for them to actually grade it. TWENTY SIX DAYS. It wasn't so bad for the first two weeks because you know it will take awhile. But oh boy, this last week I was border line going insane with anticipation. To the point where I was having trouble sleeping, concentrating on school, doing ANYTHING. I'm sure I've lost a month off of my life simply do the accelerated aging all this stress has placed on my organs.

I though the joy of passing the written exam was going to be tough to beat. I was wrong, this definitely takes the cake. And I'm sure the only thing that will surpass this feeling shall be finishing that last portion come spring time. Knowing that it is finally over. Good lord I can't wait.

Now I can move on with my life and get out of the mire of simply not knowing. I have two GPR interviews coming up. Seeing as I only applied to two programs, I couldn't have asked for anything better. They both are in the next week so my focus must now shift off the academics and towards the future.

Just thought I'd throw this celebratory post up before I head off for the evening to continue taking in all the good vibes. The blue label is coming out tonight.

Off I go!

Out There

This is my first lap top post. I am writing this as I lay on a tiny bed in Rockford IL in a dumpy little duplex out behind the Rockford Memorial Hospital. I hate typing on these things. It feels so unnatural and the keys don't have the same feel.

I wonder what most people think of when they hear the word dental student. Hard work? Stressed? Insane? An amalgamation of the aforementioned descriptors (get it?). Or do they picture some dude sitting in his boxers on a bed after pounding down some taco bell typing about dentistry and dental related experiences. Sexy.

These rotations have been great though. The sheer volume of learning is expanded beyond what the traditional school setting is capable of. I mean just this last week at school, I spent about 5 hours of in-school time busting my ass catching up on paperwork and doing lab work that practicing dentists never perform. Why can't I send my impression out with an opposing cast/bite reg and get the bridge framework back? Why do I have to trim my own die and mount the case. Do they realize that this adds approximately 10 business days to the patient's already long-ass wait. I was so excited that I hammered this bridge prep out (my first one actually) in two appointments. But I probably won't deliver it until mid-January because of all the red tape.

I've said it many times, there is a window of maybe 60 minutes each day at school where I am truly learning and perfecting my craft. The other 5+ hours is completely worthless. This is coming from a fourth year student mind you, I would be pretty brash to say the same one year ago.

Did I mention the tuition is insane. My girlfriend and I will be combined over 500K at graduation. That's HALF A MILLION...geeeeh. Granted our combined income will be nice, but not .5 million nice...

Speaking of future. I got my second GPR interview last week. That makes me 2 for 2, not too shabby. I am really looking forward to the interviews which are both in the same week of november. Both programs have their pros and cons, I shall elaborate in future posts.

Back to the rotation. Today I got a great refresher course on emergency dentistry. A patient I was working on started out normal, but just sort of drifted off mid-procedure. At first I attributed this to sleep. The pulse-ox was good and I could get her carotid pulse fine. Still something clearly seemed off. Once the doc came in to check on me, he had me sit her up and verbally snapped her out of it. Now this clinic caters exclusively to mentally disabled patients, so you get some really tough cases. As such, sedation is used as necessary. However, some parents decide to self-medicate and not tell the dentist. As per today, this patient was loaded up on valium without us knowing. Needless to say, the doc was pissed and the mom lied about it. Ugh. Thankfully nothing bad happened, but it got me thinking.

WHAT THE HELL DO I DO IN THESE SITUATIONS!? This is PERFECT example of why I want to do a GPR. I have no confidence in handling emergent situations. Why is it tough? Becuase they are so freaking rare in dentistry that being experienced is near impossible. Thankfully my preceptor is extremely good at walking me through the more medical aspects of dentistry and he really boiled it down to the essentials. Airway, breathing, circulation, drugs, BAM. It is all stuff I've learned, but in a real emergency, the dentist needs to keep it together and know what the hell to do. None of it is complicated, it is a matter of staying calm and acting correctly.

Today was a "slow" day at this clinic, yet I saw 9 patients (4 which required ops/exts). Again, rotations = mondo experience (by dental student standards). It also serves as a blunt reminder that you are indeed "not the shit." I mean, this clinic has handed me my head on a platter more than once. Trying to place 2 back to back MO/DOs on a screaming punching 250-pound autistic adult in 15 minutes is extremely difficult and quite frankly, scary as hell. It truly is great though, because you walk out of there with a new confidence everyday. Even if your work wasn't anything to brag about, the amount of experience and simle comfort level with tough patients earned is unbelievably useful.

Speaking of which, it is time for me to hit the head followed by the hay. Getting up at 6am and working until 6pm is hard.

Keeping my fingers crossed that I passed CRDTS. I know I overtapered the distal of my molar to get the bridge to draw...but was it enough to fail? Gulp? My endo felt meh overall, who knows. I'm mentally preparing myself to retake the whole exam because that way I won't be crushed if it actually happens. And on the flip side, if I passed 1/2 of it or the entire thing, I will be pretty damn sassified.

Here's to good luck!

One Small Step...

Just finished up the official mannikin portion of the CRDTS test today. I am too exhausted for a full debriefing. Let's just say I didn't have any glaring mistakes, but my endo was definitely not my best work. You don't realize how exhausting this exam is.

I practiced a good six times including our mock exam. Each practice takes about 7 hours. Then you finally get to the real thing. By the time I was on my last procedure (full RCT #8) I was just out of gas. I think it's OK, but who knows. The good news is that I felt pretty similar walking out of this thing as I did walking out of the written exam that I took in August. Not super confident, but not down either. So hopefully the result will be the same. We won't know for about three weeks. I will brood over it for a day or so, then it will slowly leave the forefront of my mind until the grades show up...gulp.

I really hope I passed simply because I'd hate to spend another 900 bucks to retake it. Not to mention the arduous process of preparing and actually taking the exam.

We go from 7:30am until 4:00pm with really no true lunch break. That just tires you out. Especially when you are trying to make everything perfect.

Needless to say, I went out with some classmates for a few beers afterwards. So here I sit now, ready to just pop a movie in and relax with the lady.

I think I outlined this exam already so I won't even try to do it right now. I figured I'd post while in that hazy after-aura of just completing part of the most important exam in my life.

Whew. Now I have to recover tomorrow and get back in the trenches starting monday. I have to give a case presentation on thursday. Why the hell did I sign up for the first time slot? CURSE YOU PAST SELF!

Sorry for the lack of posts, just been all over the place with board prep and rotations and life experiences.

In other news, I got my first GPR interview coming up in november. 1 for 2 in interview offers so far. Haven't heard anything from the other yet. We will see.

I'll shoot for another D-4 experience post by the end of the month. No guarantees, just a goal!!

Sorry for slowness in response to emails, same excuse as above. I will get to them ASAP though.

And I'm done.

Celebration Amongst Impending Doom

While I am begining to feel the full weight of the CRDTS licensure exam as I mailed out my 1,900 doller chasier's check, there was a nice ray of sunshine to brighten up the begining of this semester - I passed the written boards part 2.

I didn't knock it out of the park, but I didn't sneak by either, a satisfying "in-yo-face' moment to open the letter and see that magical word PASS.

What makes it more gratifying is that aparently my class is being subjugated to a mandatory 'mock' NBDE part II exam in three weeks. If we do not attain an acceptable percentage - we will not be certified to take the exam. This is bad form in general because three weeks notice is not enough time to prepare for anything, not to mention we have mock boards in 2 weeks as well as more rotations to deal with.

But I can't complain because I already passed and am excused from the test. What actually appears most interesting is that I think I am the only person that has taken it in my class. This roughly makes me a hollywood action star in the school as droves of my classmates congratulate me and ask for advice. Fun times.

It is the same as with part I. The summer semester is the best time to prepare for any big exam - get it done.

Studying for this test amongst licensure preparation would simply be too much for me.

For those wondering - I used the MOSBY text, the dental decks only for prosth, pharm, path, and radiology, and finally, all of the old released ADA exams. Studied lightly from May until August. Some days of heavy cramming but not much, usually averaged 1-2 hours a day.

Passing the test requires a much higher raw score compared with part I, so study accordingly.

Enough of the test though, on to more pressing matters.

Let me explain how the Central Region Testing Services (CRDTS) is handled during this final stretch of dental school.

The test is broken into 5 parts.

Part 1 = NBDE exams (both 1 and 2) - DONE
Part 2 = endodontic exam
Part 3 = prosthodontic exam
Part 4 = periodontal exam
Part 5 = operative exam

So Part 1 gets done on your own time. Everyone should be done with the first NBDE exam by now, it is simply a matter of knocking out part II.

Part 2 and Part 3 will be taken in october, with a mock exam in two weeks. This is known as the manikin portion of the test because we work with plastic teeth. This makes the endodontic portion seem a bit absurd to me..but hey whatever.

For the endo section we must access, cleanse/shape, and obturate #8. We must also access #14. We need to follow all sterile protocols and place a rubber dam. We actually get to measure #8 by hand prior to placing it in the dentech to determine working length (see why this is sorta dumb?)

Afterwards we have the prosthodontic exam which we already practiced once over the summer. This entails preparing #3 FGC and #5 PFM for a bridge and #9 ACC. We must make PVS occlusal indexes prior to preparing the teeth as these will be used to evaluate reduction.

Still with me?

The big daddy is Part 4 and Part 5 which we will be taking in March. There is also a mock test for these portions as well in February. The periodontal portion involves probing, detecting calculus as well as removing said calculus. The operative portion involves completing one class III and one class II prep/restoration. This will be the most stressful portion simply because the patients are real and not always predictable - both in terms of what the tooth will look like when you start working and if they actually show up on time.

I will go into this more later because the thought of it is stressing me out right now.

We got a big packet of info regarding the test that I have just begun to read through. Needless to say, this will be the most stressful/important exam of my entire existance. Fitting as it will be the last major exam I ever take.

Two semesters left.

I am also apparently one of the "top 30 dental blogs of 2010.'

Back pats for all!

Profiling the Pediatric Patient

After spending four weeks (with one more to go) at a clinic devoted solely to pediatric dentistry, I have begun to notice that every patient falls into a specific pre-determined (by me of course) category. Allow me to elaborate:

KEY:

Tell-Show-Do = this is when you show the kid everything you are using (aside from the needle) and explain what it does. For example, I will let them see the mouth mirror before I use it. I will show them my “tooth fixing wand” (the highspeed) and show them the noise it makes and even spray their arm with the water a little so they see what it feels like. This goes on as necessary.

N2O = Nitrous Oxide, a commonly used anxiolytic in the medical setting. Easy to use, easy to remove the effects, and pretty much no chance of killing someone.

Manhandling = when all else fails, you just go medieval on the kid to get the job done. This includes papoose boards, head holding, mouth props, and half-assed dentistry. Really, there is no way to do a great job on a patient with zero compliance. You just need it to last long enough for the permanent teeth to get in. Manhandling is more commonly used for the 6 and under crowd but there are always exceptions.

Difficulty = a generic scale of how tough the kid is to work on. Scaled out of five. One being easier than an adult, and five being extremely tough (general anesthesia candidate).

And now for the profiling!

The Vomiter

This patient, like most kids, wants nothing to do with the dentist. Once you papoose their ass and headlock them with two assistants, they still find ways to defend themselves. Frankly, they try to puke all over you. And it isn’t friendly gurgling puke, it is projectile – get in your eyes puke. What’s worse is that they inadvertently could kill themselves by choking on said puke. So you need to brave it out to suction all that shit up (god bless the assistants). The only way to tackle this patient is to wait out the vomiting because they will eventually run out of ammo.

Tell-Show-Do - ineffective

N20 - ineffective

Manhandling - marginally effective

Difficulty = 4/5

The Old Man

This patient is actually pretty relaxed. Nitrous can work wonders sometimes. They may still get crotchety during the injection, but afterwards they will just sleep – THE ENTIRE APPOINTMENT. A real treat to work with. Only annoying when mom comes back and thinks I OD’d her kid on nitrous…bah.

TSD - unnecessary

N20 - extremely effective

Manhandling -unnecessary

Difficulty - 2/5

The Stoner

A close relative of “The Old Man,” this patient wants nitrous and wants it bad. It may be hard to associate a 9 year old with a 25 year old pot-head. But when one sees these kids craving the “magic nose,” one can’t help but make the comparison. These patients generally are pleasant to work on because they are riding the good waves of N2O. I’ve even had kids laughing while getting a block…crazy.

TSD - Pointless, they aren’t listening

N20 - EXTREMELY effective

Manhandling - unnecessary

Difficulty - 2/5

The Question Asker

This patient simply doesn’t shut-up. They constantly need to know what you are up to. N2O is only marginally effective because they never stop talking. TSD is only helpful to a certain extent because I still haven’t found a pleasant way to show them the 25gauge needle. I am good at hiding it like a magician though. These patients can be really easy or really tough – they are unpredictable.

TSD – Marginally effective

N2O – Marginally effective

Manhandling – Effective when necessary

Difficulty – ranges from 2-4

The Victim of Circumstance

Perhaps the most depressing patient to work on. This is the kid who shows up with cheetoes all over his teeth and a bag of skittles in his pocket. This is the patient with parent’s that are ignorant, negligent, or just suck at parenting. “I can’t get him to shut up at night without giving him a bag of Doritos and a pepsi” is the most ridiculous thing I have ever heard. Suck-it up and lay down the law. These kids are generally too young to know any better, so it is really the parent’s responsibility to take care of them. Unfortunately, I see a lot of neglect going on.

TSD – variable

N2O – variable

Manhandling – variable

Difficulty – variable

The Momma's Boy

This patient generally arrives clinging to mom and is too old to be exhibiting such behavior. They generally freak out once detached and go one of two ways: total meltdown or total calm. Again, a bipolar patient type. If they freak out, being extremely stern often solves the problem immediately. Parents are not allowed in the operatory if the kid is 5 or older so this type is always a wildcard. After the procedure they always run straight back to their leech like hold on mom’s leg.

TSD – Effective to Useless

N2O – Effective to Useless

Manhandling – always effective

Difficulty – 2 to 4

The Screamer

Name says it all. This patient screams the entire appointment with variable pitches. Surprisingly easy to deal with if you aren’t fazed by the noise. The papoose is usually all that is necessary, they rarely thrash their heads around.

TSD – ineffective

N20 – ineffective

Manhandling – very effective

Difficulty – 3/5

The Negotiator

This patient will do anything to get out of the chair. They will bargain with you. For example, "please don't put that in my mouth (bite block), I promise I'll keep my mouth open." You may fall for the negotiator at first, that is until they bite down on the running bur and change that small occlusal composite into a pulp/crown. I usually just re-negotiate. "Be good and you get a shiny toy." If this doesn't work - proceed to manhandling.

TSD - slightly effective
N20 - slightly effective
Manhandling - effective if necessary
Difficulty - 2-3/5


The Mongolian Warlord

Containing attributes of both “The Vomiter” and “The Screamer,” this breed is the absolute worst. They are combative, spit at you, vomit on you, scream at you, and essentially struggle the entire time. Unlike other difficult patients, they don’t get tired. These patients unfortunately seem to have the most neglect as well in terms of oral hygiene. If they require multiple pulps/crowns – they are best referred to a hospital for general anesthesia, there is no way you can get it done acceptably otherwise.

TSD – ineffective

N2O – ineffective

Manhandling – ineffective

Difficulty – 5/5

The Angel

This is the type of patient that makes you happy to be a dentist. They are cooperative, exhibit very little apprehension, and are just cute as the dickens. TSD and N2O are always effective but are often not necessary as the patient will be compliant regardless.

TSD – often unnecessary

N2O – often unnecessary

Manhandling – unnecessary

Difficulty – 1/5

I may add or edit this post as the year goes on. I haven’t covered all the types – just the most common run-ins for me so far.

PS. sorry for the lack of spacing after periods. I swear I didn't type it up like that... but the mystery makes it even more exciting right?

The D-4 Experience I

A little over half-way through my first semester as a D-4, shall I elaborate? I summed up the major feeling of fourth yearness in my “lords of the idiots” post – so just go back three posts and poof.

The curriculum at this point is one giant garbled mess. We have the most useless course in the world still chomping at my toes (comprehensive care IVa). I seriously need to explain the evolution of the comprehensive care class. I have had it EVERY semester. So this is my 9^th go around. The class has progressively gotten more and more useless each and every semester. At the beginning it was great – it focused heavily on all of our pre-clinical perio and restorative, the kind of stuff we need to know. Now it has simply turned into a stereotypical college level class that revolves around regurgitating paper after paper that do not stimulate any sort of joy – but rather decreases your brain matter as your bullshit your way through one double-spaced, font twelve, times new roman page to the next.

Case in point – I am required to right a progress plan for June that discusses all of the things we have been doing reports on since last year. Things like production, unpaid treatment, unapproved notes, ect. OK. Fine. I can do that, not a big deal. But we have to do ANOTHER one that is due 4 weeks after the first. I am on rotation (and MANY others are as well). This means I will be in the clinic seeing patients a total of eight days (prosth exam and holidays account for weird number) before the next one is due. How much do you think will change in these 8 days? Will I somehow increase my production by 5k? Will I end up having tons of unapproved entries? Will the same dead patients that didn’t pay before, magically come in and pay now? I’ll probably see about 10 patients and six will fail/cancel. Not much to write about there.

We have some “delivering bad news” presentation later this week as well as some other portfolio assignment that I haven’t looked at yet.

Now in our restorative class – we have to write some silly paper that involves, you guessed it, EBD. Thankfully it is short and we simply fill out a template provided.

None of these assignments are bad on their own – they just snowball when you add it to the massive pile of crap I already have flooding into my summer free time. Gets really tough to keep everything straight.

Examples:

Getting my GPR application put together through PASS (letters of rec, personal statement, transcripts, etc)

Going on rotation for 2 weeks a month

Studying for NBDE II (failure rate about 30% last year due to random increase in difficulty)

Attempting to schedule all my requirements around my rotations (implant cases, limited ortho cases)

Doing TONS of lab work

Practicing for prostho exam

Scheduling performance exam patients and praying they don’t fail

The list goes on

Apparently, based off of what one of the head honchos told us today at our ‘town hall meeting,’ the comp care class will be obliterated in the new curriculum. So I guess this point will be irrelevant to the entering classes.

We also have a mock mock prosth exam next week. Why two mocks? Because the real mock exam is September. We have to prep #9 all ceramic, and a 3-5 bridge (3 as FGC and 5 as PFM). The catch? There aren’t enough manikin heads and equipment to go around so we can’t all practice at the same time. The problem? A lot dental students are assholes and will hang on to the equipment for way longer than necessary – screwing others over in the process. I am taking this test next week and I hope to practice this weekend…assuming I can actually check out the right stuff. I haven’t cut a plastic tooth in a LONG time, so I feel like at least one practice attempt is mandatory.

OK, enough bitching. What do I like about D-4 year? I like knowing the end is near. I like that the faculty in general treat you with a lot more respect. I like going on rotation and being treated like a full-fledged dentist. I like feeling extremely confident with tons of dentistry.

There isn’t much more to it. I’ve entered my 7^th week of studying for boards and I have increased my correct percentage from 50% to around 70% which should pass (yay me). I’m taking the test in early august so I still have plenty of time.

I just am tired overall. Obviously deciding to take boards has destroyed any semblance of “summer” very much like part I did oh so long ago. I don’t regret it though. Assuming I pass – my life in the last two semesters will be just a wee less stressful.

What else can I address? I have become a little more jaded on our society in general the last two years. I see so many people that want something for nothing. People that are single, have no job, have five kids from three different fathers, and get pissed at you when their free insurance doesn’t cover the cleaning and they have to pay a whopping thirty dollars. Then they get on their blackberry in their SUV and speed off blabbing to all their friends about how shitty this clinic is. Their free insurance that MY taxes pay for essentially rewards the socially and financially irresponsible sect of this country whilst punishing the responsible. Now granted this is an extremely generalized statement and abuse of the system goes both ways no doubt. I’m just getting wearied by it all, especially as I see my debt piling up. I won’t even pretend like I know anything about our current healthcare system or politics in general – but I have noticed my interest and knowledge base slowly increasing – which can’t be a bad thing when I am so close to graduation.

I do like to counter-balance negativity with positive stuff. There have been plenty of ‘feel-good’ moments. That one smiling kid, grateful parent, or patient that brings you a sponge cake are all great things. Experiences like these make me thankful for the opportunity to be a part of the profession. I only keep my fingers crossed that there will be more of these to come in the future and less of the ‘other.’

Life is just helter-skelter right now. I am bouncing from one thing to the next with little time to breathe. This post obviously reflects my current scatterbrained thought process (and it wouldn’t be the first time). That is why I sometimes like posting when I am completely exhausted or frustrated or exasperated. I capture that pure emotion in this little time capsule and can read back on it years from now and think…daaaamn was I strung out! Or wow, look how ignorant I was about THAT. I would also like to emphasize that my life is great and I really am a whiny bastard for complaining at all. I have been lucky with my life – great family, great relationship, great friends, great profession, great everything. Anything I manage to gripe about can’t really stack up to that at the end of the day. How’s that for inspirational? Did I mention I have to write tons of bullshit papers where you just make stuff up that sounds good? Lots of good practice.

Kidding, kidding, kidding!

And holy crap, the scary part about summer in Chicago is that I cannot tell the difference between fireworks and gunfire – but there is definitely something going on by my house!

Time to hit the MOSBY review again with my 12 year old glen Fiddich. Still got to have some luxuries right?

Right.

19 Weeks and Counting

I started my 2x2 rotation on Monday. I have just finished my third day and am a just a wee bit less exhausted than the first two..maybe I'm adapting.

I am paired with a classmate, so for the most part, we will both be at the same site (rockford being the exception). However, my partner got trapped on the east coast due to flight cancellations over the weekend and I had to go solo on monday. He didn't know about the cancellation until Sunday..so monday was booked as if he would be there. Nothing like getting thrown into the deep end right? Everything went great though and I'm having a good time so far.

Did I mention this clinic is inhabited solely by women? The dentists are all women, and ALL other staff are as well. I probably need to get used to that though since most practices have a similar ratio. Not that I have anything against women - far from it. However, anyone knows how the dynamic of a lunch room changes when it is all ladies as opposed to guys - and if you are the sole member of the opposite sex surrounded by these swarms, it can be an interesting social experience to say the least.

So I have probably accomplished in three days on rotation what I did in maybe 4-5 months of pedo at the college. Remember that I only spent 1/2-1 day a week in the pedo clinic during my D-3 year. The work load is absolutely overwhelming at first. You bounce around doing the POE check-ups and then run back to the nitrous room to do 3 fillings on a screaming 3 year-old in a papoose.

I have plenty of learning and adapting to go - but wow, the experience curve is amazing. Perhaps even more importantly, is learning to work with assistants. Some of them are amazing, others not so much. I still am getting used to ordering them around because I honestly have never been in a position of such authority in my entire life - as in pretty much the boss. Granted, I am still a student, but the assistants are supposed to treat me like any of the other dentists in the clinic - and they do...and it takes some getting used to.

I have no interest in pediatrics as a specialty, but I feel like this sort of rotation really really ramps up my comfort level. I mean, if you are OK with nitrous and a papoose board, you can deal with a HUGE percentage of the child population.

Complaints? The unit set-up. You can't sit at 12:00..ever - which makes the maxillary teeth a living hell on my back because I'm trying to learn new mirror angles. Why can't you sit at 12? Because the nitrous stuff and all the handpiece motors are right there...bleh. I also don't like the bur selection. Pretty much a huge block of 330s and round burs is all you get. I need a longer guy for those damn boxes...and I really really am sad they don't have enamel hatchets. But it's ok - you adapt...and fast because there really is no choice. My final, and perhaps biggest gripe is the gloves..they are slippery as hell. I have dropped my handpiece TWICE (thankfully never while running) and I honestly don't feel like I ever have a good grip on it because of it's awkward position in the operatory.

It's been a long couple of days...I haven't been this exhausted in a LONG time. But it still feels great. I feel like I'm working a real job. Yea we still get prep and restoration checks (but not always) but POEs are free game. If I think we need to do an amalgam on #I, then it gets tx planned and the kid comes back.

So I have 19 weeks of rotation this year...I really feel like this will be great for my technical speed. My only big concern is going to be lack of fixed work which is already a HUGE weakness in my experience belt. We will see though...there is an 18 year old coming in tomorrow for a PFM on #19...mayhaps I get to do it!?

Well I plan to post about my various rotation experiences as the year goes on. I still have 22 more days at the Children's clinic - so we will see how things play out in the coming weeks.

Expect a D-4 Experience post in the coming weeks.

Out.

The Lords Of The Idiots

The title sums up how I feel to be a newly minted D-4 here in good ol' dental school. You are a king amongst morons, and that is putting it politely. Dental students in general are neurotic, obssessive, over-achieving people. You don't realize how insane they are until you see the classes beneath you. Then you realize how you were pretty much exactly the same way.

I see the D-3s going through the exact same pitfalls that I was stumbling through right at the begining of full-time clinic. Getting upset about failures, freaking out about openings, freaking out about pretty much everything.

Ah, but now I get to sit back and take it all in. It was actually quite remarkable. The day we changed to fourth year students, it seemed like the faculty in general treat you a LOT differently - and in good ways.

Faculty members I was terrifed of 12 months ago are yucking it up with me about this, that, and the other. You truly feel like the big dog....of the idiots of course. We still are students, we still have bullshit assignments, we still get talked to like little kids (by the academic departments), and we still are paying out the nose for three more semesters.

The greatest thing is the no class aspect of D-4 year. We have a total of around seven times this entire semester where we have to be at the school at 8am for good old compcare + rotation paperwork business. Other then that, my alarm is set for 8:15 and I'm enjoying the shift for every ounce of greatness that it is.

Rotations have started for the "A" group. Being in the "B" group means I go out two weeks from now. Expect some sort of post on my rotation experience after I complete the first set. Children's Clinic ahoy!

So what are my requirements this semester?
Direct peformance exam (class II, III, or IV)
Perio Maintenance/Re-eval/SRP (three exams total that need to be finished by the end of Fall)
CaseCAT - Annoying research paper that they are piloting on my class. God I love it.
Assorted CompCare Crap (ACCC) - The usual stuff I presume..although they still haven't really told us
Scary Mock Prosth Exam - Prep 3-5 bridge (3 - FGC, 5 - PFM) and #8 All Ceramic.

The big change to note is that EVERYTHING is now pass/fail. This is good in that stress of performance exams is GREATLY reduced. However, it is sort of silly because your entire grade is going to be determined by the most biased and uneven portion of the gradebook - the faculty evaluation. I'm to far along to care at this point though. Case in point - I nearly got a 4.0 last semester and my GPA didn't move - so I guess I'm stuck with what I've got. Way to many credit hours in the books to move.

Still no C's in dental school though...hope to continue the streak.

So the schedule doesn't seem terrible right? Well, remember that I am on rotation for 5 out of the 12 weeks this summer - leaving me a grand total of 7 to get anything and everything accomplished. This doesn't include all the assorted graduation reqs I'm trying to coordinate (limited ortho case, Implant case, other). Did I mention that performance exam patients love to cancel/fail appointments?

I also seem to have a TON of lab work that has just really started piling up. Despite spending ample time in the lab due to a rash of patient failures/cancellations - I still seem to be falling behind. Damn dentures.

I'm also applying to GPR programs..and getting together my recommendations and applications is just another chore.

Let's also be reminded that like an idiot, or lord of the idiots if you prefer, I decided to register for the NBDE Part II and am taking it on August 10-11....oops?

So I'm pretty busy.

Right now my only strategy is to read the MOSBY review book and do all the released exams. Updates shall be forthcoming.

So while the glories of being a senior student are nice. I still feel this mounting pressure in the back of my head that probably won't be letting up until May next year.

The pressure is also going to keep getting worse

and worse



and worse









and worse

The D-3 Experience V

HUGE post been working on for a few weeks…get something to eat.

I’ve done it. Three years in the books. One more to go and you can legally be treated by me without supervision. Scary right? So to get back in touch with my blog roots of over-analyzing and nitpicking every little thing about the curriculum, I’m going to do a D-3 breakdown by semester with clever little names: The Summer of Firsts, The Fall of Rollercoasters, and the Spring of Bliss. Creative right?

The Summer of Firsts:

Ok, so you just wrapped up an insane final semester as a D-2. You have studied until your eyes bled; you have crammed and stayed up late for weeks on end knowing that at some point, it all has to end. Well ladies and gentlemen, welcome to the Promised Land. School is still school, but the third year of dental school blows the first two away in terms of pure awesome. The stress is there, but it is more in waves this time around and of a completely different nature. For example, as a D-2, I was horribly stressed about finding extracted teeth to get through my endo class. Entering the clinics full-time, the stress is now about finding a LIVE person to actually come in, pay for, and sit through the entire root canal procedure which takes FOREVER at the school. That is merely one example however. Yea it’s stressful, but oh so sweet when everything falls into place and that first final case turns out perfectly.

So my clever little title explains it all. The Summer of Firsts is pretty much all your firsts. Your first class II, your first denture, your first partial, your first crown, etc. This semester was probably the most stressful of the entire D-3 year. Not due to curriculum requirements, but just getting acclimated to the clinic lifestyle. Learning how to deal with patients and learning how to deal with instructors and so forth. Sure we had been in the clinics a little bit at this point, but nothing prepares you for five days a week until you get thrown in.

But you want to know what the best part of this summer is? You actually get to enjoy your summer for once. You aren’t studying for a bunch of bullshit courses with pointless minutia to cram for – which you will promptly forget of course. Sure you get home exhausted because you suck in general at doing anything efficiently yet, but there is nothing to stop you from sitting on the porch/deck/alcove/whatever you have, and having a drink of your choice. Grabbing dinner with friends, watching the white sox lose, or just listening to tunes. Your evenings are actually evenings for once, not just peripheral extensions of lecture classes. And believe me, it is a sweeeeet feeling.

So don’t let me get too carried away, there still is class. And unfortunately, the lecture classes during the D-3 year in general were not so good. They just sort of existed. Some of them had uses, and I’d be lying if I said I didn’t learn anything. But the time was managed so poorly and the coursework in general was just inefficiently taught. On top of that, thank god I have no desire to specialize – because these classes are actually harder to get A’s in for the most part. Not because the material was difficult, but because you would get ONE exam for your entire grade. How about having a 20 question final worth 100% of your grade right? Get three wrong, good bye oral surgery/ortho/whatever. That has GOT to be stressful.

But again, that isn’t my goal – so this post really doesn’t apply to the gunners out there…sorry guys. I still haven’t gotten any C’s (don’t know about spring grades yet), but I really don’t mind seeing a few more B’s here and there – ESPECIALLY in these classes.

So what kind of class did I have in the Summer of Firsts?

Comprehensive Care IIIa – Good old comp care. The requirements are simply all busy-work oriented. BS paper writing and making stuff up so that it is 4 pages long font size 12 with single spaces feels way to college-like for a professional school. I know schools have to do so much for accreditation…but really? This is the class that also spurs all the paranoid comparisons and child-like competitions regarding production in the clinics. Good god people, you do realize that means jack shit overall? Unless you are like 5k behind average (hence not showing up to school enough), then your production is based either on luck, or being underhanded - neither of which is really brag-worthy.

Dental Ethics – easy class, some interesting discussions, overall unnecessary. You can’t teach ethics, because I see plenty of people who got A’s in the class do some preeeety questionable things.

Dental Public Health – easy class, some bullshit papers, more crying about underserved areas. Again, this is stuff I would be more receptive to if I wasn’t being bled dry for this education. Sorry guys, I won’t be going to Alaska to work for free when I have 300k debt to pay off. I feel bad for the state of healthcare in general, but my hands are literally bound by financial commitments that are absurd. Quite frankly, I kind of want to live life for ME a little bit too once I graduate. Selfish? Maybe. Necessary? Yes. I have my whole life to give back (and I intend to once I am capable).

Basic OMFS – Don’t even remember this class anymore. I do believe that things were a bit more than ‘basic’ though. Like plastic surgery and botox for example. Not really interested in that guys.

Pain Control II – Should have been combined with OMFS and filled the lectures spaces about stuff most oral surgeons don’t even dabble in (plastics). These classes stressed things I simply cannot remember without repetition and real experience. Some of it was a bit too hospital oriented which is way too overwhelming and confusing at this point. I think the main problem was that we are all just so focused on the clinics now. Lecture classes simply are obstacles in the way of REAL experience. Having 9am classes also is a TERRIBLE idea as the lecturers get all pissy when people start leaving at 9:30 to set-up for 10am patients. Sorry guys, but if I didn’t have to set everything up myself for that 10am root canal, I could maybe sit through another 30 minutes of IV-drip brand names and compositions. I know I’m coming off as a little bastard, but I’m just pointing out how MANY students feel in this situation. We are still so fresh in the clinic that it is near IMPOSSIBLE to focus on anything as obscure as botox injections or MRSA infections. In my defense, I never did leave lecture early (well maybe once or twice), but even if I stayed – I just couldn’t focus. I would be too concerned with what I may possible screw up in the next hour and how this class is now forcing me to rush. Ok, rambling over.

Restorative Clinic I – Two performance exams (treatment planning, initial exam) and faculty assessment make up your grade.

Perio Clinic I – Two performance exams (oral hygiene instructions, initial exam) and faculty assessment make up your grade.

Endo Clinic – This class goes all the way until our D-4 Fall semester. You get experience points per canal of endo and need a certain number to pass/get a good grade. We also have to take one performance exam which is an anterior RCT.

Summary:

Scary overall, but you start to get used to everything by the end. You aren’t a total dental wiz yet, but clinic life is starting to become normal. You are experiencing more real life pleasures as free-time is suddenly far more abundant, but the stress still exists. Now instead of cramming for tests, you are freaking out about getting performance exams done.

Quick note on exams – DO THEM ASAP. We had Four to get done in the summer. One treatment planing case, and one initial exam for restorative, as well as one initial perio and one oral hygiene instructions (seriously) for perio reqs. Twelve weeks goes by REALLY fast. I will leave it at that.

The Fall of Rollercoasters:

Aptly named, this is when things get interesting. As mentioned over and over in old posts, dental school is bipolar. You have moments of intense euphoria and triumph only to be completely shattered the next day by a horrible mishap or four patient failures in a row. The fall semester really put an exclamation point on this sentiment. At this point we have been in the clinics long enough to feel less uncomfortable, but still too little to be supremely confident. It is that awkward phase, like when you are growing out your hair and there is about a two month span between awesome long hair and awkward shortish/long mullet. That is poor analogy since most guys have the same short cut (where everyone looks the same) in dental school anyways. To the few that understand, you know who you are.

Back to the point, you will find yourself learning at an accelerated pace. You will have a nice routine down in terms of setting up your chair and getting your instruments in just the right spot. However, this is also when a lot of phase three stuff starts showing up (like partials, crowns, posts, etc) and you may find yourself doing a few more firsts while you’re at it. Delivering final products kicks ass. The very first week of the fall semester I delivered three arches of dentures. I had been fuddling my way through the entire process all summer long and it was awesome to get some great results. Unfortunately some not-so-great moments are likely to occur as well. My particular example was simply a partial denture that refused to get finished. Every time the framework came in, it wouldn’t fit right and I would have to start over. Redoing lab stuff is a real bitch at the school too because you have to get three different forms signed by the faculty working with you. This is so frustrating the first time because nobody tells you about it, so you get one form, fill it out, come back – and what do ya know, you forgot the other two. Oh my, the gopher running involved.

Again, the biggest problem with D-3 year is the classes. Some were useful, but most were drawn out far too long.

Comprehensive care IIIb – refer to my last talk about comp care several paragraphs up – same stance.

Restorative Clinic II – same as above except they threw in a glorious EBD presentation to the mix. We also had to do an RPD treatment plan exam as well as caries management performance exam.

Perio Clinic II – same as last semester except with new exams: one SRP performance exam and one radiographic interpretation written exam.

Internal Medicine for Dentists – Far too much information crammed into 50 minute lectures. The course was very heavy on the science and biology behind the diseases rather than how to handle the patients. I felt like a first year medical student. Useful information, but again, the timing is awkward and the presentation was too dense and not focused enough on what I, as a dentist, should and should not be doing.

Practice Management – Total joke. The guy in charge of this class jumped ship for the new dental school opening in Downers Grove in 2011. So he left us high and dry with a class that nobody had time to teach and consequently was unorganized and haphazard. It was a free ‘A’ though, so I can’t complain. Unfortunately this is the one aspect of dentistry in general that I am clueless about which is not good.

TMJ Disorders – No reason this should have been an entire stand-alone course. Every lecture invariable had the same message. We don’t fully understand the TMJ, and we don’t really have any good methods of treatment. Warm compress, analgesics, and in rare cases – surgery. Could have been done in 1 or 2 lectures of another course.

Special Patient Care – Honestly don’t remember much from this course. It had some relevant information on cleft lips/palates but we had already had that in OS. Pediatric based.

Radiographic interpretation – Big review of radiology from D-1 year compressed into seven or so lectures. This class was actually kind of nice to have as an overall refresher.

Dental Therapeutics – Way better than pharmacology. Some lectures were a little weak, but a lot the material was taught well. I just have so much trouble learning drugs. Can’t blame the course, I blame the topic in general.

So again, the classes aren’t bad per say, there is just a ton of overlap. I also think the biggest problem is simply that we are all too focused on the clinical aspects of dentistry. I wish these courses had more clinical discussion involved and not so much biology/disease process. Yea that is important, but it is even harder to retain at this point and I may just be a grumpy student who is tired of hearing about renal failure.

Note: I am NOT turning my nose up at these topics. I know how important they are. I am just being honest from the perspective of a third year dental student. It is simply difficult to concentrate on most of these lectures at this point in my dental education.

Summary:

The Fall of Rollercoasters is just as advertised. You have tons of victories, and plenty of failures, some big, some small. As I’ve said previously, the amount of clinical knowledge you attain during this year is insane – especially during this semester. You are learning to manage several patients in various stages of treatment, whereas in the summer, everyone was pretty much needing initial exams and treatment plans. You are also beginning to feel comfortable with the entire faculty because by now, you have worked with most (if not all) of them. You know who to go to for advice on partials, who to avoid when you want to do a conservative posterior composite (not a G.V. Black inspired overextension through healthy dentin), and so forth.

School still does wear on you though. I spent a few Saturdays doing lab work (but nothing compared to D-2 year). Mostly you just get tired of having to schedule all your own patients and work around everyone’s schedule. I can’t wait to have people do that for me. Only by not having something do you realize just how important it is. RESPECT THE SECRETARY!

Spring of Bliss:

Perhaps the sweetest semester of dental school. The D-3 year is variable for everyone, but by the time spring rolls along, most everyone has hit their proverbial stride. Everything just starts feeling easy. Chatting up with faculty members is easy and fun, you also notice the leash getting loosened up a bit. For example, if I do crown prep, the faculty member will look at it, make a suggestion if necessary, and that’s it. They don’t need to see your modifications; they don’t need to see your temp. It is awesome. Now some of them are still pretty anal about everything, but you know which ones are like that by now and this helps greatly with stretching your own bounds.

This spring semester is also the first spring semester that doesn’t horribly suck, which is a welcome change of pace. My only real complaint is that I seemed to have less time in the actual clinic due to rotations and random clinic closures. I think I only saw five of my own patients the entire month of February. This is not me having tons of blank spots; this is me being too busy to see more.

The only real scare of the semester is assisting the D-4s for mock boards. Knowing this shit is less than a year away is already making my right eye twitch.

Otherwise I greatly enjoyed the semester. It is a fitting end to the best year of dental school (so far). Again, it is still school – but it is so much different from the first two years and all for the better.

Classes:

Comp care IIIc – same as same as above

Clinical Oral Pathology – Culmination of our rotations held throughout the entire year in the oral medicine clinic and a lecture class from last semester. This rotation was hit or miss. Some days were actually quite educational. There were plenty of duds though where I really really would rather have been elsewhere.

Intro to Geriatrics – A class that would be best suited as a lecture series in a different course. The director was easy on us though and made the class as enjoyable as it could have been.

Radiology Clinic I – Culmination of our rotations held throughout the entire year in the radiology clinic. This rotation was good for the first two semesters. I felt that my final 10-12 experiences were just an excuse for cheap labor to take FMXs as I really wasn’t learning anything.

Oral Surgery - Culmination of our rotations held throughout the entire year in the Oral Surgery clinic. This was by far and away my favorite in-house rotation of the year. We got about 9 weeks of OS rotation which is HUGE. I don’t know many schools that have you doing tori removal and alveoloplasty procedures. My confidence level in extracting teeth is fairly high at this point. I still know the limits of what I would do in general practice, but I’m definitely not sending everything off to the local OS.

Intro to Hospital Dentistry – This class was pretty much unhelpful. You could tell the course director didn’t really care about us or the course and was just filling out part of his job description. That aside, the lectures were all rehashes of random stuff we had seen before. There was also an inordinate amount of hospital privilege and function lectures. After seeing how crazy hospitals work – I can’t believe anyone is able to get anything done in those facilities. The class is clearly meant to engage your interest in hospital dentistry – but it does the opposite, and scares you the hell away.

Pediatric Dentistry Clinic I - Culmination of our rotations held throughout the entire year in the pediatric clinic. I enjoyed pedo far more than originally anticipated. However, I kind of got the shaft in terms of rotation schedule. I had every Friday PM session of the week scheduled for pediatrics. I would be fairly generous to even guess that HALF of those slots actually had me seeing patients. The patients would either not show up; or the clinic would randomly be closed for some reason or another. I would not have passed this class if I didn’t start coming in on Thursday mornings as well as Friday afternoons. This is rather unfair as it eats up another slot that I desperately require for my own patient pool, but alas, what’s done is done.

Surgical Periodontics – Best class of the entire D-3 year, hands down. Completely geared towards preparation for the NBDE part II. A great review course. The lectures were concise, well planned out, and even had practice questions at the end. Perio is rather unappealing to me, but this class was well worth it.

Restorative Dentistry II – This was a lecture class, not actual clinic. The course had a lot of potential, and I did learn a good deal. However, I feel as though a lot of it was just a bit too complex for me at this point. The prosthetic stuff seemed way outside the realm of this school and I was hoping for a little more practicality in terms of what can I do NOW as a dental student. The handouts required loupes to read as well which made for some gnarly eye strain. At least the director was completely chillaxed about grading and pretty much gave away ‘A’s for attendance.

Restorative Dentistry IV – I really don’t understand the titles of these lecture classes. This was a clever camouflage name for a dental materials course. They probably did this to make sure everyone still registered. Kidding aside, I actually found this to be a useful class. It reviewed a lot of basic dental materials knowledge that actually made sense the second time around. Not bad!

Perio Clinic II – same as last semester except NO performance exams. Only had to take a diagnosis/prognosis written exam.

Restorative Clinic VI – wait..what happened to III, IV, and V? Hmmm maybe a schedule typo, well this was similar to the other restorative clinics except the performance exams sucked. We had to do either a class II or III direct restoration (not so bad) as well as crown. The only reason this sucked is that we had to deliver the crown as well. This can sometimes take awhile (especially if you want to trim you own dye). I just squeaked by and delivered the last Monday of the semester. We also had to deliver a case presentation which went well for me.

Summary:

The spring is great semester overall. Your confidence is brimming by now and you get to revel in it quite a bit. I imagine the D-4 year will be similar with the giant exception of all the terrifying licensing exams and getting graduation reqs in.

Final thoughts:

What more can I say? This is already dangerously close to surpassing my orientation post way back when…maybe it even has. The D-3 year kicks ass overall. My only real experience shortcomings = lack of limited ortho case and implant cases. I don’t really care about the ortho (aside from doing enough to graduate), but I definitely am a bit disappointed with the implant situation. I do have one of my own patients on the horizon that will hopefully get going this summer…but everything still seems a ways away.

I have learned so much dentistry at this point that it is impossible to quantify. I can’t even begin to imagine how much more there is to learn throughout the rest of my life. While I feel confident in doing most basic procedures, I still feel quite crappy at the more complex stuff – or even treatment planning some of the crazy mouths I see coming in. I know another year will greatly reduce this deficiency, but I am realistic in knowing that there will always be ways to improve, regardless of how long I have been practicing.

So now I have turned the final corner. I am log-rolling my way down that huge mountain of dental school. The impossible and the improbable all coming to a front this year. I am going to be a graduate with a doctorate in dental surgery in twelve months. Just typing that out seems unreal. I can’t even imagine what it will feel like.

All I know is that I can’t wait.