Sunday, September 11, 2011

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.....

Friday, September 2, 2011

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 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’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.