Tuesday, December 7, 2010

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.