One Week At County

A musical interpretation.

Currently, this is my personal soundtrack whilst jumping from room to room during the morning sessions at Cook County.

By the end, I hope it sounds more like this

We shall see.....

The GPR Experience I

OK. So I’ve been slowly scrapping this post together over the last few weeks..but now I find myself with a four day weekend, so I really have no excuses.

Two months in and things are going well. I will briefly outline the program here at Masonic with an obvious disclaimer: NO TWO PROGRAMS ARE ALIKE – especially in regards to GPRs. Masonic is probably the best option in Chicago if for no other reason than pure stability. It has been around for a long time and most of the attendings were residents themselves. It also boasts the largest number of resident positions. Some may be turned off by this, but you’d be surprised how much you learn from your co-residents either through their own experiences. Collectively it ends up being quite positive.

So a GPR generally lasts one year, at Masonic, there is an optional second year. The squad we have this year consists of eight first years and one second. Most of the year is spent in our dental clinic which is literally across the street from the hospital.

However, we are sent on various rotations:

Anesthesia – One month: in the hospital, the goal is to get adept at placing IVs and learning as much about anesthesia as possible. I’m on this rotation in January.

Oral Surgery – One Month: at Cook County, working the OS clinic with all of the OMFS residents. I literally just started here, will be spending September shucking teeth.

Emergency Room – 2 weeks: Literally hang out in the ER

Dental Van – 7 weeks total (whenever I’m on second call, I spend that week doing dentistry in a van)

There used to be a 2 week block for the oral medicine clinic at UIC, but that is currently defunct as that department is seemingly being dismantled. We may actually end up in the OS clinic at UIC as well, but that is still up in the air.

OK, so those are the big block rotations, we do take call and this can be light or insane depending on the week. The crappy part is that when we are on call it is for an entire week, so if you get slammed one night, there is no recovery period. However, the calls we take generally are fairly basic and if it isn’t, we punt the case to OS or ENT. By basic I mean simple dental traumas and intraoral drainage.

I take first call 6 weeks the entire year, second call is 7 weeks. The first few weeks of call we would go in as pairs, but after the initial fear of stepping into an ER and making decisions on your own subsided, we generally go in alone.

Now aside from actual clinic, we attend various lectures ranging in all kinds of dental topics. One of the best is anesthesia which is taught by a dental anesthesiologist who generally is around on Thursdays for all of our SPC IV cases. He will also come in on the occasional Tuesday for normal patient IV cases. I have yet to do an IV case yet but have been assured, my time will come. Two residents see two cases (sometimes three) apiece on Thursdays.

Now bear in mind, the majority of our IV cases are on special needs patients. IV placement can be pretty damn hard if the appendage is flailing about, but it gets done. Sometimes, just getting the patient into the chair is challenging which makes me appreciate the effectiveness of ketamine. Generally use midazolam and propofol once the IV is set, and it is pretty dramatic how well this stuff works. I will talk more about this when I start working through some cases.

Here is the basic schedule:

M: 9-6

T: 8-4

W: 9-6

TH: 9-4

F: 9-4

I listed our clinic hours, we generally show up anwhere from 1-2 hours early depending on what the lecture schedule is like. We may also stay 1-3 hours after, again variant on the lecture schedule.

Thursdays is special needs day, elsewise we are seeing standard patients. However, a few AM/PM sessions out of every month we will have a specialist in as an attending. This is when we do procedures most dentists stay away from (Impacted thirds, Implants, Crown Lengthening, Osseous surg/bone graft, etc.) We end up with a pretty nice amount of variety.

So what have I done so far? The biggest exposure for me 2 months in is definitely endo. I have done more RCTs in 8 weeks here then I did in four years of dental school (including pre-clinical extracted teeth practice). I also never did any molars in DS, and have already completed four here. I still don’t see myself jumping into molar endo in private practice, but I’m no longer really scared to try either. Regardless, every general dentist should feel comfortable accessing any tooth in the mouth, if for no other reason than to perform an emergency pulpotomy.

Perhaps the next most significant gain for me is in my OS skills. I felt UIC prepared me pretty well for basic exodontias, but I definitely love to get more efficient. I’ve also gotten to try my hand and full bony impacted thirds (well at least #32 and #17 were). It may have taken me 2.5 hours and I may have sweated like a pig because I’ve never extracted a tooth that I could not SEE prior to the procedure. But hey, it worked out and the patient did fine, no lingering parathesia (woohoo!)

The coolest part is that I did exactly what the textbook said to do, and it WORKED. The key is ACCESS. If you think your flap is big enough, it probably isn’t.

Speaking of OS, I began my month rotation at Cook County for the month of September. Pretty much a revolving door tooth extracting machine is what I must become. I felt like I did ok on my first day, the hardest part is actually just figuring out how documentation is handled because I’m already used to the system in my home clinic. We have to ‘dictate’ all of our notes here as well which is new for me.

But as an aside, there is an amazing blog crossover going down here that I just have to mention. It seems I will be a henchmen/minion/lackey to Ben from DMDstudent.com for the next month. He’s a second year at cook and is the chief resident of the general clinic this month.

So I will shamelessly plug his site again because it actually has tons of good info, where as my site is really more for the cheap thrills..it’s ok to admit it. DMDSTUDENT.COM. Pre-dents, dental students, aspiring oral surgeons – Go there. Hell, there’s even a link over to the right if you are too lazy to type it in.

So I expect my dental extraction prowess to increase dramatically over the next four weeks.

I think I have sufficiently outlined the deal here.

I am starting to put my resume together for the dreaded job hunt. Planning to work in a few offices, but need to feel it out first.

Sigh. At least I’m not going into more debt at the moment.

Cheerio!

Let Me Count The Ways

Three full weeks into a GPR and I can already definitively say that this was a great idea. The amount of pure learning going on at this place is absolutely staggering. I probably learn more in one day here than I was doing in a month during my final year of d-school.

Unfortunately, the scheduled is pretty damn intense so I get home exhausted on a daily basis.

Real quick:

On call: got called in on a trauma case, replanted/splinted #9 and sutured facial lacerations. Scarring turned out pretty damn nice considering I'm not in plastics and had never sutured skin before.

OR case: Oral Squamous cell carcinoma , full mouth EXT prior to radiation therapy. Surreal experience to say the least.

Special Needs Thursdays: A brand of dentistry that many dentists never experience or are simply to frightened to try (with good reason). Exhausting and satisfying all at once.

IV sedations: Coming soon! One resident per week at the moment, eventually more. 20+ cases by the time I'm done (not including my month in anesthesia).

Implant dentistry: Free CE all year from nobel biocare once a month, new system at the office, will definitely be placing some soon.

Plenty of stuff I forgot. The attendings and co-residents are all great.

Sorry for the brevity, but time is not my friend anymore.

OFF!

End of The Trilogy

It was bound to happen eventually. I have graduated for the last time. This was my ‘Return of the Jedi,’ my ‘Last Crusade,’ my ‘Die Hard: with a Vengeance,’ my…well I think you get the point.

Now in this brief window of opportunity prior to continued graduation festivities, I can take a second to capture the moment within this dusty old blog that I have managed to stay at least somewhat active with over the last 4+ years. I don’t know what is more amazing to me, the fact that I am finally done with school or the fact that I have had a ‘blog’ for this long.

Yes indeed, I have graduated. The big fat DDS can now be plastered at the end of my name. Much like all graduations, the experience is surreal. However, this one is particularly strange to me. It has not sunk in yet, but I will probably not see many of these people ever again. These people who I have endured with, stressed with, laughed with, shook my fists in the air with, I could go on forever. I spent four years with the same 60some faces. We all went through the same experiences, the same classes, the same everything. This is what defers Dental School from college, or from high school. A small group of people are in it together for four straight years.

It really is a bittersweet moment. The faces I never really was friends or talked with much, I will miss them all. Even the people that would annoy the ever living crap out of me nine times out of then, I will miss them as well. We all go down different paths now. I hope to keep in touch with my closest friends but am realistic that even those relationships will no longer be the same.

Life goes on, as it always does. And I’m sure some of you may be wondering - where does this blog go from here? I have done my best to maintain it and I know my initial intentions got muddled along the way. However, I hope that I have provided inspiration, insight, along with an edge of light-heartedness that we all need every once and while. I know I haven’t always kept up with email queries, but I have tried!

So does this blog end? I really haven’t decided yet. I can’t imagine myself throwing in the towel yet, but I can’t make promises of regular posts either (not like I do that now anyways).

I’m off to a one year general practice residency that starts July 1^st, but before that, I plan to take some vacation, relax and just appreciate life for what it is.

I would like to do one final post on dental school in the near future, a final D-4 experience of course, but with a kind of summary of everything.

I’m sure it won’t end, but it will be different. I mean, I can no longer be the whiney bitching student I have been for the last three years can I?

As an aside, I have to say, despite all that bitching, I am genuinely satisfied with the education I received here at UIC, ESPECIALLY from a clinical standpoint. I feel extremely competent with meat and potatoes dentistry and hope one more year of essentially free CE, will push me into a great realm of practical confidence regarding what kind of general practioner I plan to be.

I appreciate all the positive feedback (and even some of the negative) I have gotten over the years. It has really kept this blog alive.

Good luck to everyone applying to school, in school, graduating, or just living life in a world unrelated to dentistry.

Adieu

21 Days Left, Again

What are the odds. I just randomly was thinking about this post I did approximately four years ago when I had 21 days left prior to graduation. As the blog gods would have it, I am in exactly the same position today. This was NOT pre-planned which is what makes it awesome. Twenty-one days stand between me and doctor-hood. So in the spirit of that original post, here are 21 things I will absolutely NOT miss about dental school. In no particular order:

1. Only learning dentistry for about 1 hour a day, the rest is spent cleaning up chairs, gopher running lab scripts, calling patients and checking out instruments.

2. Going into debt more and more each and every month

3. The pre-clinic

4. Studying power point presentations for hours on end

5. Cockroaches

6. Dental students, good lord we are an annoying bunch

7. Being treated like a 12 year old despite being 26

8. Calling my own patients and setting up appointments

9. Setting up my chair

10. Breaking down my chair and returning instruments

11. Having 1 out of every 3 units present with some malfunction (leaky water spray, broken hose, etc.)

12. Having 1 out of every 3 hand pieces not work, requiring me to go back to the window for seconds

13. Having to suck-up to pretty much everyone from the janitor on up

14. Being constantly hounded about collections as if I can actually get any of these patients to actually pay. What do you want me to do? Break their thumbs?

15. pre-clinic students leaving rotten smelly endo teeth in open jars all over the school. Pick that crap up please.

16. Having to coordinate with program directors that have NO cooridination in terms of what I have and have not done or when I'm on and when I'm not on rotation.

17. Having to mount every case as if the world would explode should I not

18. Having a crappy lab do all the work

19. Having to get everything swiped or signed (approved)...and I do mean everything

20. Attendance taking (again, I'm 26 years old here)

21. Being a student!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I AM DONE!! and just like that original post... GO BULLS!

Exit Interview - Loans

Hilarious and disturbing at the same time!

"You are generally obligated to repay your student loan(s), even if you do not complete your program of study, do not complete the program within the normal timeframe for completing it, are unable to obtain employment after you complete your program, or are otherwise dissatisfied with or do not receive the educational or other services that you purchased from the school. However, there are a few situations in which your loan may be discharged and your repayment obligation canceled or forgiven.

- You die

...

...

...

Well at least they aren't beating around the bush.

CRDTS?

Perio: 100.00
Restorative: 96.21

I'm going to be a dentist.

Get Me Outta Here!

Great email this morning:

"Mandatory Phone-Triage sign up for D-4 Students."

So basically I have to come in at 8:30am and be an amazing dentist...and by dentist I mean secretary. Yes folks you heard correctly, I will be 215,000 dollars in debt for this education and what do they have me doing?

Answering phones. Not diagnosing, just setting up appointments. I'll just leave it at that.

In other news. My girlfiend (who is also about to become a dentist) just had her first job interview. A word of advice to dentists looking to hire associates. Look at their resume before you invite them for an interview. Or better yet, actually read the email/letter of interest that they send you.

Basically she got invited to an interview and the potential employer didn't seem to realize she was a dental student until she got there. I mean, it isn't like that sort of thing isn't advertised on her resume and job-inquiry email. The dentist was looking for someone to start next week and take over for another associate going on maternity leave.

Poor form, really poor form. Seeing as I drove, that was a wasted 2 hours of my life. That is definitely a practice I won't be looking at in the future. But hey, we all learned a valuable lesson. Actually look at someone's resume before you consider interviewing them. Not that I already didn't know that...but I guess a real life reminder doesn't hurt.

Bleh.

CRDTS!

It's over...hopefully.

Barring some unforseen miscalculation or hidden blunder, I believe I have officially passed the final test required to legally practice dentistry in the state of Illinois. Rumor has it, the grades should be posted sometime this week, so we shall see.

So how did it go?

Started rough, but honestly, I think the day in general went VERY smoothly. EVERY one of my patients showed up 15 minutes early. I cannot emphasize enough how important this is. Find the perfect patient, not the perfect case. If they show up late or are unruly or just a PIA to work on, you will be stressing terribly. Secondly, get an assistant you are familiar with. Their importance goes far beyond just suctioning and gopher running. They need to keep you calm and focused, treat it it like a normal day....even though we all know the day isn't normal at all.

So let me break it down:
Wake up a 6am. At the school by 7am. Gather all my crap from the locker (forms, loupes, goggles, etc) and begin wrapping my unit. I walk out to check out my instruments for the first procedure around 7:30 and see my first patient already sitting in the waiting area...big sigh of relief.

My first procedure of the day was my class II amalgam, also the most technically demanding procedure of the day due to the less-than-ideal case selection. Basically you want a class II with caries just barely tapping the dentin (that perfect little triangle from all the D-1 lectures). You want good occlusion, and you don't want their to be an adjacent filling.

Well, my class II was a good millimeter past the DEJ with caries which already scares me because radiographs tend to underestimate the extent of decay. There was also a big bulky adjacent amaglam restoration to contend with. So while not ideal, this still is not a difficult procedure. What makes these procedures difficult for the day is the ENORMOUS amount of pressure you have to, putting it mildly, not fuck up.

My assistant showed up at 7:30 as well. I actually hired a real dental assistant from one of my rotation sites. More expensive than a D-2, but I felt comfortable working with him and knew that he would keep me focused while maintaing a sense of levity that helps SO MUCH when you are stressing.

So we seat my patient and get all the forms ready to go by 8:00. All the examiners come in and it is a mad house of students rushing to get the start check. By about 8:15 I'm set, the case gets approved, and I'm off to races...or am I?

It is now 8:45 and I still have not gotten the rubber dam on. I'm doing #3 MO, so I'm trying to clamp #2. This tooth is bulbous and I try about 12 different clamps. None will stay on long enough to withstand any sort of dam stretching. I can feel my face flushing, the sweat beading, thinking oh crap, I'm never going to get this damn thing on (pun intended).

Eventually, the practical voice inside of me says "Hey, remember you don't actually need the dam on for your prepration, just put it on #3 for the prep-check." Good job practical me.

I quickly cast my clamps and dams aside and just started preparing the tooth. Now here comes the next debatable topic. Modifications. I am of the thought group that if you aren't going to pulp-out, don't ask for a mod. You waste about 20-30 minutes per request. And believe you me, this exam may seem like you have lots of time...but you most certainly don't. With a minimum of 6 examiner checks a good 3-4 out of your 9 hours are spent waiting around. Add another 1-2 hours seating patients/eating something/administering anesthetic/breaking down/setting up/etc. You can run out of time fast.

So my thought, don't get the mods. Yea you will lose points for overextending, you may even get a substandard or two in there. WHO CARES, you fail if you run out of time. Case in point, my class II preparation was bigger than ideal. I chased stain and caries further than is ideal. But I got it all out and the prep didn't look bad at all from a realistic standpoint. Was I in failing range for overextension (2.5mm beyond DEJ)? Don't think so. Again, I haven't gotten the scores so maybe this choice to not mod will backfire, but I still feel like it was the right choice.

The dam is applied easily by clamping #3 and I send him off for a preparation check around 9:30. Now here is by far the worst part of this exam. Waiting for something to get graded. Oh my. It takes a good 30 minutes each trip and I felt my pulse just skyrocket each and every time. I literally couldn't just sit, I had to pace around, constantly doing laps around the clinic.

My assitant brings him back and gives me the thumbs up from far away, good news. I remove the rubber dam, place my matrix/wedge and fill 'er up with amalgam. The contour was awesome, the anatomy mehish but not terrible, but my contact was too damn tight. The adjacent restoration just had a HUGE broad contact area to work with so it was tough to get perfect. Floss was passing, but not as easily as I would have liked. This may be a sub or simply an acceptable..depends on the mood of the evaluator. The occlusion was mondo high, but I brought it down with round burs to an acceptable level. I sent it off around 10:30 and let my second patient know we'd be ready in 45 minutes (he also showed up early). So again, waiting is the worst part. Patient comes back with no instructions. I thank him profusely and send him on his way.

Class II thoughts:
Wasted a lot of time with the damn dam
Overextended pretty much everywhere without requesting a mod (hoping the point deduction doesn't ruin me)
Prep didn't look half-bad
Fill was nice overall with a slightly too heavy contact.
As you will shortly see, if I fail anything, I think it will be this.

My second patient is for the deep-cleaning. By the time he is seated with all forms completed it is about 11:15. So I send him off to get my treatment selection approved. The difference between perio and restorative on this exam is that you need to physically send your patient to the examiner station before you start perio. For restorative you only need a floor examiner to sign your sheet.

So believe it or not, it takes about 45 minutes for them to see and approve my treatment selection. Thankfully, I truly lucked out and got a PERFECT patient in terms of case simplicity. He had lots of calculus, but it was fairly light and not too difficult to remove. I was finished around 12:45. Now I may have missed the distal of #2 a little, but overall, I think this was one of the best SRPs I have ever completed in terms of results and speed. Now watch me somehow fail perio. Hopefully not!


Perio thoughts:
Great case selection helped
Compliant patient who could keep his mouth open HUGE for long periods of time
Feel like I smoothed pretty much all of the surfaces (maybe missed 1-2 sites)
Feeling pretty confident...but again..until those grades come up...

It is now 1:30, I go talk to my third patient (who has also arrived early!) and let him know we will be ready around 2:00. Could have gone around 1:45 but decided to wolf down a few power bars/drinks with my assistant. I had been too nervous to eat in the morning and hadn't had anything since 8:00pm the previous night...ugh.

After the quick breather we get my third and final patient (class III ML #8) seated and all paperwork cranked out. Now when we talk ideal case, this is about as good as it gets. Radiographically you can't see anything, but there is definitely a small shadow viewed clinically. I get the case approved and finish the prep around 2:30. Comes back with no instructions..I'm on the home stretch. Here is when the final terror ensues. I placed the composite and contour is great, but there it no/extremely light contact. How is this even possible? I didn't have to break the incisal contact during my preparation and didn't wedge the teeth either (for fear of displacement). The problem was that he has some serious perio (which is currently being treated). So his incisors exhibit a bit more mobility than most. So I tried wedging the distals of #8 and #9. Definitely got contact...but it would immediately vanish as I removed the wedges.

After some brainstorming, I finally end up removing some of the composite, rebond, and place new composite WITHOUT a mylar strip. This seemed to do the trick as I got that perfect little click when flossing the contact. I removed the flash/excess, polished quickly and send him off at 3:45 for the FINAL CHECK. As fate would have it, this final check was also the LONGEST.

The patient came back with no instructions around 4:25. DONE! DONE! DONE!

I immediately got all my stuff turned in and fled the scene.

Needless to say, the day lived up to my expectations in terms of sheer stress. And this was with things going relatively well, I feel terribly for my classmates that got screwed over in any way, shape, or form during this outdated and restrictive exam. The only final note I will add because I'm getting tired of typing is that all of the floor examiners were extremely nice. I was so worried they were going to be a bunch of hard-asses constantly nitpicking and docking us infection control points. Not at all. They would chat with us during waits and in general, were just unbelievably friendly. So that definitely helped relieve some of the stress.

Now back to enjoying spring break and praying that they post these scores ASAP so I can let out one final sigh of relief.

Rotation Vs Clinic

Another post? Hot damn. So as I’ve just started my fourth (and final) block of rotation, I have decided to follow up on old promises and discuss rotations in general. I participated in what is known in these parts as the ‘2x2’ rotation. Basically I spend about the same amount of time offsite as I do in the school during my final year. This has been an overall wonderful experience. My only major gripe is that I truly don’t want to be gone anymore at this point. Three blocks was enough. Now my presence at the school is pretty important because I have requirements to finish and boards patients to find.

However, the topic here is what’s the point of rotation? Now all the muckiddy mucks up top will say that the primary goal of extramural rotation is to help you develop a sense of how crappy health care is in this country and how many people are lacking dental care. I understand that is important. But let’s be realistic. As a student, all you care about is experience. You want to get as much dentistry under your belt before you get booted out into the real world. Your paying out the ass for it, why wouldn’t you? And honestly, while I have seen a lot of great people on these rotations that truly appreciate what they are receiving, I have definitely seen plenty of the ungrateful dregs of society that are abusing the system for all it is worth. Eye-opening either way.

So have I gotten a lot of experience? Of course. Has it all been as technically complex as some of the things I get to do at school? Hell no. So you still need both. At school, I am pretty much doing all my fixed and removable work at this point (crown, bridge, partials, etc). On rotation is almost exclusively directs, EXTs, exams, emergency. Now I have done the odd endo and crown off-site, but these are exceptions, not the standard.

My stance is that my overall experience is pretty damn well-rounded. I wouldn’t mind some more crown/bridge, but honestly, at the rate things get done at the school, I’d rather just continue to learn with my own materials and getting to choose my own lab.

So here is what I have completed on rotation to date (not everything, but most)

Total patients treated: 330

POE: 101

Emergency: 31

Prophy: 71

Sealants: 62

Amalgam 1 surf: 19

Amalgam 2 surf: 33

Amalgam 3 surf: 2

Resin 1 surf: 120

Resin 2 surf: 41

Resin 3 surf: 13

Resin 4 surf: 5

SS crown: 11

Pulpotomy: 12

Anterior Endo: 2

PFM crown: 1

EXT: 75

Surgical EXT: 5

Ok so that is most of it. This is over approximately 14 weeks of rotation (with a few short weeks in there due to holidays or school business). Now as a DENTAL STUDENT, this is a pretty meaty chunk of experience. I don’t know many dental students at other schools that have pulled 80 teeth by the time they graduate (I am around 150 by now including all my in school rotations). And I’m not saying this to brag or pat myself on the back. I’m saying this to put it in perspective. I am a practitioner that will want to do most of my own extractions without spending 6 years in an OMFS program. Getting as much experience before I graduate will only enhance this plan. More importantly, it allows me to see which types of EXTs I should refer. Same applies to working on kids. I plan to do a lot of my own pedo work, but I know the signs/symptoms of the cases that NEED to be referred. This knowledge is just as valuable as any of the technical skill I have amassed offsite.

Another extremely valuable asset to rotation is working with different people (assistants, hygienists, dentists). You begin to figure out what makes an assistant good, and conversely, what makes them absolutely worthless. You will find dentists that were not trained at UIC who will teach you techniques you never knew, or how to use some instrument that makes your amalgam carving look like a DaVinci. Again, you will also disagree with some of them, and while you can’t be some cocky-ass student, you make a mental note of what and why. While frustrating at times, it is intellectually stimulating as hell and ultimately makes you better because you can further define what you are as a dentist. When is staining no longer staining? When is all the caries truly gone? Does this need a crown? Would I want to even attempt this RCT? Again, the cognitive developments I have gained throughout these rotations have been equally important to any technical accomplishment.

Now rotation isn’t all sunshine and roses. Some days are truly unhelpful. Like the day you get stuck doing 6-9 prophys and zero restorative. But these are not as often as people claim (at least in my experience). The other issue again is managing what little time you have at the school. You find yourself giving your patient’s shorter leashes in terms of leniency. If they fail an appointment during one of my precious days left at the college, I pretty much instantly dismiss them at this point. You also get frustrated during boards time. I really need to be at the college to look for patients either via screening new or my own, all while squeezing my own patient pool in for their own appointments.

So like most everything in life, there are pros and cons. Overall, I feel these rotations have helped shape me quite a bit into what I hope will be a great general dentist.

MOCK?

As you may recall, or may find out by simply scrolling down a bit, you will see that I recently completed the MOCK CRDTS patient-based exam last tuesday. Well, in stark contrast to the mannikin exam, our grades were provided today.

Good news to all, I passed all three procedures. While perio was a bit of close call, I still survived. Most of my mistakes were actually clerical and not clinical which is ok with me, that is why we did this exam, to learn the process. I am going to make a checklist for the real exam to make sure I don't miss any signatures or leave any information blank.

For all my loyal readers, you may note that this the first MOCK exam that I didn't fail. NICE! It would be a real pain in the ass to remediate portions of this test because we essentially would have to do another performance exam in our home clinic prior to graduation. Rumor has it that about 1/3 of the class failed something which is a better percentage than our mannikin exam (about 1/2 I believe), but it still is a high number. Usually a number of people do indeed fail CRDTS, but I don't think it ever comes close to 1/3.

I definitely don't agree with a few remarks on my gradesheet..most notably the gingival contact not being broken on my class II (when it indeed was broken and passable with an explorer), but hell, even with a substandard grade on one section, I still got a reasonable score on the procedure. I even pulled out a hundo on my posterior composite restoration, not to pat myself on the back or anything, just sayin'.

The bottom-line is that despite being extremely stressed and having several things go wrong, the day ended up panning out positively. It was a great experience to have and knowing I can survive a MOCK exam that is graded tough no doubt, all while using less-than-ideal cavities. I'm feeling pretty good assuming I get patients for the real deal.

Speaking of which, I actually won a patient in the lottery this last saturday. So now I only need perio for the real thing. Of course, this is assuming the guy calls me back. Otherwise all bets are off.

So today was allright, despite having an implant crown delivery require re-fab due to the occlusion being MONDO off....bleh.

Allright, that was a quickie but I gotta run.

The light at the end of tunnel is beginning to shimmer!

MOCK!

A major post for a major day. As I D-2, I assisted a D-4 during her CRDTS exam. I remember the intensity, I remember punching holes in the rubber dam faster than I have ever punched before or will ever punch again, and I remember praying not to screw up the simple task of suctioning or mixing amalgam. More specifically, I remember seeing the absolute terror and anxiety amongst the collective soul of all the poor bastards taking the exam.

As a D-3 I was not allowed to assist for the real exam. Instead, we were forced to assist the current D-4s with the mock exam. Basically this exam is identical to the real deal and is sort of a dress rehearsal. That didn’t make it any less stressful. I remember the student I was assisting pacing about anxiously when her second patient was late and then didn’t even show. I remember watching instructors harshly critique preps and restorations. Again, I remember the collective tension of the entire day.

So here we go. I finally am not the assistant, but the unfortunate guy taking the damn thing. The Mock exam was held yesterday for me and I can say without hesitation that it was probably the most stressful day of my life in the category of ‘school.’ I was extremely calm and serene in the days leading up to the exam, consistently reminding myself that this was the Mock exam and not the real thing. However, the day before the exam I just felt crippled by anxiety and paralyzed with trepidation. I couldn’t function. I just sat around like a convict waiting for his last meal. I’m sure many people can relate with this feeling. A BIG event in your life has been approaching and the waiting just becomes unbearable towards the end. The night before you wedding, the night before a big presentation, and the night before whatever - it all ends up the same. You just want the waiting to end.

So let me preface with a quick summary of this exam for those not in the know. I have already done an overview of the CRDTS exam in a THIS post. However, I will outline this final portion now. As you may recall, I took and passed the National written exam (part II) back in august. I also took and passed the manikin portion of the CRDTS exam. What is left? The patient exam: this is what I took a ‘practice’ version of yesterday.

For the patient exam we are required to do three procedures:

Periodontal: Extra-oral, intra-oral exam, calculus detection/removal, probing depth/gingival recession accuracy. All-in-all, we must select a patient with at least 14 surfaces of calculus located within mostly one quadrant of the mouth (with the possibility of using 4 additional teeth from another quad). Three of those 14 surfaces MUST be interproximals of MOLAR teeth while only 5 can be on incisors. So simply finding a patient is a pain in the ass for this exam because you don’t want them to have rampant perio, but they need to have ‘just enough.’ Believe me; the patient pool at the college is mainly of the rampant variety.

Restorative: We must complete two procedures for the restorative portion. A class II amalgam or composite, and a class III composite. Less complicated than perio in terms of selection, but still a pain to find that perfect cavity. Again, you want it to be small, but large enough to warrant treatment.

The hardest part of this entire exam is the fact that we are responsible for finding all of our own patients for both the mock and real exam. As a class, we have held free public screenings on 4 Saturdays over the last few months. Afterwards, all procedures are raffled off. Guess who hasn’t won any raffles despite attending every one of these things? We still have two more, so keeping my fingers crossed.

So up until last Thursday which was the final day of class before the school pretty much shuts down to prepare for the mock exam, I still didn’t have a patient for the perio portion of the mock exam. No patient equates to immediate failure..joy. As fate would have it, I happened to be discussing my quandary with a classmate when another of my peers overheard and graciously allowed me to use one of his patients that he was no longer planning to use. Not an ideal case, but better something then nothing. So it may have been last minute, but I got all three procedures lined up for the mock exam JUST in time. As for the real one which is happening in mid-March, I still need to find two of the three procedures. Five weeks feels like it should be a lot of time, but it isn’t…

OKOK, enough unorganized blather, let’s get to the actual experience I had with this mock exam yesterday. As previously mentioned, I was nervous as I think most people are at this point. The culmination of your LIFE of education hinges on passing this exam. Yea this was just the mock, but it does a decent job emulating the real thing, so it serves as a decent gauge.

So I woke up at 5am, unable to fall back asleep I just got up, showered, and trudged to school at around 6am. 10 degrees, windy, still dark….great start. I arrive at the school around 6:30 and start setting up my assigned unit. At 7am, the sterilization window opens so I get all my instruments for my first procedure – perio. We are allowed to seat the first patient at 7:45am, I told mine to arrive at 7:30, and she arrived at 8:00. I’m not complaining, considering I got this patient a few days ago and had never seen her before, I should be thankful, and I was. So I sit her down and proceed to go through this enormous medical history which I had already reviewed but needed some clarification. What makes this exam even tougher is the volume of paperwork that must be processed and filled out correctly with signatures from varying parties at varying points during the exam. As you might imagine, it is VERY easy to forget to do some of these things in the heat of battle.

All patients require a consent form signed, a medical history form signed, and then there is a procedure progress form that you must get initialed at various points during each procedure. I’m not going to try to outline everything; this is just to give you a basic idea. In short, there is a lot of shit to keep track of all while maintaining your own nerves and not freaking out and projectile vomiting all over the place. So I quickly complete my extra/intra oral exam, and check her teeth for calculus. Remember, I haven’t seen this patient yet, and I need to fill out a big old treatment submission form with all the teeth I plan on cleaning. If there is no calc on the tooth, I had best not put it on the treatment submission form. So once this is all done, I get a start check from a central floor examiner or (CFE). He pretty much reviews the medical history and makes sure it is good to go. I forgot to put one of the meds down from her laundry list of conditions, oops, the first of many tiny mistakes. Next, my assistant takes her off to the evaluation room to see if my tx selection is approved. Here comes the first of many long waits. I can’t emphasize enough how stressful this portion of the exam is. And the funny part is that it is not when you are actually doing anything, it is when you are just sitting on your ass praying the powers that be don’t reject you patient or fail your prep/restoration.

Well she comes back in 15 or so minutes and everything is good to go. I complete the procedure fairly quickly (by dental student standards) with no real noticeable complications. I send her back to be evaluated at around 10:00. At this point my second patient had arrived. My assistant and first patient come back with the “feedback” form which is unique to the mock exam for perio only. Basically I missed a ton of calculus. Now I am not one to bitch (well, maybe just a little), but feeling around the sites they said I missed, I really wasn’t convinced on SEVERAL of their observations. I am now positive that periodontists think the CEJ qualifies as calculus. Basically if the surface isn’t as smooth as glass, it isn’t done. Now the only reason I am not upset really is that EVERYONE for the most part was getting similar feedback. So either the perio faculty is trying to scare the crap out of us, or we all just suck at SRP (probably a little of both). Either way, general dentists will be grading the perio on the real exam, so I’m hoping for more realistic SRP expectations for someone who will most likely never do an SRP again after this exam. So I missed 5 sites (I think) total. I assume this is failing but have heard from several classmates that you can miss 6 and still pass. I also understand the case I was doing was pretty difficult overall and not exactly ideal (really tough to clean 7mm pockets on #16). Whatever, it wasn’t how I wanted to start, but you need to really be able to move on during this exam…as it is a LONG day.

After re-wrapping the chair, I get my second patient seated (#4 DO). Again I will mention that I had a D-3 assisting me throughout the day which was extremely helpful.

So here is where things get interesting. This patient needs to make a phone call at a certain time and also needs to pee every hour. Why? I don’t know, but it annoyed the crap out of me. I get the class II lesion approved, numb him up and attempt to place the rubber dam. Problem! The dam won’t fit in the interproximal surface that I need to clean. Upon further examination, I realized that this was a TERRIBLE tx selection because the adjacent tooth had a huge composite on it with a flat long contact. CRAP! So I start prepping without the dam (only needs to be on during evaluations officially). I soon realize that I am gouging the shit out of the adjacent composite because its bulky ass is getting in the way of my gingival box prepping. Now in real life, I would recontour the composite without question simply to create a better contact when I place the restoration. But I’m not allowed to do this without requesting a modification on the exam. What is a modification? Another piece of paper that requires signatures! So at this point, I realize that I also will need to extend my preparation beyond ideal to get rid of the caries as well as recontour the tooth. Three walls need to be extended/deepened. So I have a total of FOUR mods filled out. I send him over. He comes back 20 mintues later with a piece paper that titles: Instructions to candidate. NOT a form you ever want to see on this exam. This form is the one that comes when you fail. It also comes for other reasons, and this was thankfully one of those. The rubber dam MUST be placed whenever the patient goes to the examiner station. I didn’t have it on and hence wasted 20 minutes. So after a 15 minute phone call and another pee break, I get the dam on and send him back.

At this point it is nearly 1:00 and my third patient has arrived. I am feeling extremely stressed and assume I will probably fail this procedure. Basically, if they don’t allow me to recontour the adjacent tooth I cannot complete the procedure acceptably. He comes back in about 10 minutes and like night a day, things get better instantly. ALL four of my modifications were approved! I instantly recontour the crap out of the adjacent tooth and remove all remaining caries. The prep looked very nice in the end and if rotations have taught me anything, it’s how to detect caries and do directs. So I send him back for the prep evaluation. Yet more anxious waiting ensues. Back he comes…with another instructions to candidate sheet. Crap? Apparently I didn’t break the gingival contact. But wait, when I hold the mirror and look, the contact is passable with an explorer…I’d say that means broken..but hell, I’m just some plebian dental student. So this is not a fail, but a big point deduction - very deflating after feeling very nice about the prep. So I must show the floor examiner the instructions, he looks and the confusingly asks, “It’s not broken?” HAH, at least somebody agrees with me. Bah, I don’t need to prep anymore, the CFE signs without additional prep that I ‘broke’ the already broken contact. So now I fill using composite. Nothing to report, easy fill, good contact, nice margins, no occlusal interference. Send him for the final eval. Comes back, no problems – nice. I forgot to complete my anesthetic record and forgot to have a CFE initial my modification completion…two more whoopsies. I am normally a pretty organized person..but in the chaos of this exam and this particularly difficult case, I just forgot to do some pretty simple things. And yea I’m bitching about the patient a bit when I should be thankful that he took the time to show up. And I AM! Despite the phone calls and hourly urination, I’m glad he was there.

Note to everyone – DO NOT do a restoration that will be touching a poorly contoured adjacent restoration…it sucks.

So this patient took me 3.5 hours. I get my third patient seated (#7 ML) and all paperwork filled out around 2:45 (deadline to start final patient is 3:30). I get him numb and run to the locker room to pound a power bar and bottle of water (5 minute breaks!). The patient was one my cousins and pretty chill and thankfully isn’t peeing every hour. Again, the rubber dam is giving us trouble and requires replacement after I finish the prep. The problem this time was that we made the holes too small and it was stretching and getting small tears. I start the prep, the patient is having difficulty getting numb and I am getting stressed because I don’t exactly have time to wait around for more anesthetic to settle (+ get the signed approval to use it). Luckily, the patient declines additional anesthetic and we press on! This prep ends up being large due to caries and I must send him over for mods. All of my requests were granted 6/6 on the day, not bad. Unfortunately time is becoming an issue, but I manage to remove the remaining decay and get him over to the evaluation station by 3:50 (deadline is 4:00 for preps). He comes back and all we have left to do is fill, easy right? I slide in the mylar matrix, wedge it and fill. Once I remove the wedge and mylar, I notice the contact is NOT closed. After using every profanity in the book as well as a few new improvised phrases (mentally of course), I start wedging the other teeth to push it back. I end up adding more composite and FINALLY get the contact back. After polishing, and smoothing the contours, I BARELY get him over to the evaluation station in time (4:50 with a 5:00 deadline). Christ. Now I don’t feel great about this filling simply because I didn’t have time to really look it over as I normally would. One of my favorite instructors was a floor examiner for the exam and sat down with me while I waited. He could tell I was pretty frustrated and really calmed me a down a bit with some jokes and practical advice. And wouldn’t you know it; my assistant comes back and gives me the big thumbs up, no problems. FINISHED! Forgot to complete my anesthetic record again…whoopsies x4.

So I get home around 6pm…about a 12 hour day no real breaks. I was so exhausted mentally and physically it is indescribable. Hell, I’m actually pretty sore today from doing dentistry..muscles I didn’t even know I had are screaming in agony. I’m just glad it’s over. Besides perio, I’m pretty sure I passed everything which is awesome considering how crappy my treatment selection was. But hey, you don’t want to waste the really perfect lesions on the mock exam anyways.

Grades will be provided next week I believe. Either way, it was a well-organized and beneficial, albeit stressful exam. I applaud the faculty on their organization in running everything so smoothly.

The bottom line is that I got through it. One more Big hurdle (real CRDTS exam) and few small ones (endo performance exam, papers) are all that stand between me and that big fat DDS. The road has been long and arduous, but as my dad told me way back amongst my first year griping - at least there’s an ending. There sure is dad, there sure is.