Wednesday, February 16, 2011

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.