D-4 Official

As of 1 hour and 15 minutes ago, I officially became a D-4. This is of course pending grade posting (although barring some huge mishap, I'm just fine and dandy).

I really did burn out a bit by the end of this semester. Just no real desire to go to school at all. Tried to get some lab stuff done, but just found myself too drained to even be proficient at menial tasks. That and I my right eye has been twitching a bit lately. These are the symptoms of a man that needs a vacation.

Thankfully, it is time for one. With one week off, I hope to mentally and physically recharge for the final year of dental school. That's right, the FINAL year.

The other major decision is that I intend to take the national board dental examination (NBDE) part II in august during our break. I originally was going to do it later...but decided to just power through and get it out of the way. One less thing to deal with during all the other licensure crap. This will hurt my summer relaxing plans a bit, but not nearly to the same extent as part I.

HUGE final D-3 experience post on the way for next week.

Until then....

Rotations x 2

As promised, here is a little update on how my rotations are shaping up. I am a bit dissapointed that one of the sites I was told to be part of the 2x2 is not an option this year. Of course I was told this after they had already scheduled me...so now I can't exactly back out. I also was unaware that one of the sites requires me to live in rockford for five weeks until fairly recently. I feel a bit conned overall with the program directors. They lure you in with flattery and all this talk of opportunity, than you just get dumped in the places you didn't really want to go because the original places presented as options are no longer options? WHA?

I am of course exaggerating my complaining a bit. I still am glad to have the opportunity and I know I will learn a ton regardless of where I am. More importantly, I will learn how to interact in dental situations not regulated by the school.

So how does this work? Thirteen upcoming D-4 students will be partaking in this rotation block. We are divided into two groups (A and B). So going with the name of the rotation (2x2), while the A group is out on rotation, the B group is at the college and vice versa. I am in the B group. So I start the third week of June. It is usually a two week block, but occasionally it is only one.

We have four total blocks of rotation. Each block has approximately five weeks worth of time at a certain location.

This summer I will be at the Children's Clinic in Oak Park. Obviously this will be a healthy dose of pedo. In all honesty, I don't mind. One major objective I have going into this next year is to greatly enhance my technical speed. Doing so on pediatric patients is a great starting point because if you horribly butcher a primary tooth, it isn't the end of the world (unless you create an extraction scenario). Now that isn't to say that I'm going to do half-assed dentistry, but I'm not going to be crying if I overextend a wee bit on good ol' #I. Seeing as they will lose this tooth naturally, as long as the restoration holds, it doesn't have to be sparkling perfect.

Secondly, your pediatric patient will definitely appreciate faster appointments. So we will see...if I get an assistant..who knows how much I could actually get done.

So starting in September, I will be going out to Rockford IL to spend three weeks at the Crusader Clinic which treats a rural population. Not sure if it is mostly kids or not. My other two weeks will be spent at the Milestone clinic which caters to the developmentally disabled. This should be a great learning experience. This block ends in early Novemeber.

The final two blocks are not decided yet so I will update when the schedule is finalized.

Now it appears that we do get time off for boards related events. I will have a post dedicated to all the licensure crap I have to do in the future. Basically, I have to take the national board part 2 written exam, take the prostho/endo mannequin exam, and take the live patient exam over the course of the D-4 year. This does not include the 'mock' exams hosted by the school itself. This also does not include all the random clinical requirements I still am responsible for.

So there will be plenty to do...and I hope being away on rotation so much doesn't completely screw me over in terms of finding patients for the licensure exam next March. That is less than a year away. Crap.

But I will save that sort of complaining for another day.

1.5 weeks left until I wrap up D-3 year

...gulp.

Spring Update

Not dead yet folks, just busy.

The last few weeks have been full but I'll be blatantly honest - I got into the starcraft 2 beta test. If you don't know what that is, good - you are not a gaming nerd. It is my curse to bear. I am enjoying the bearing of it though. As a side effect however, this blog has unfortunately been tossed onto the backburner once again because I only have so much time for solo hobbies.

School has been great overall. I continue to improve in both my technical ability, as well as my overall confidence/comfort level in dealing with patients, students and faculty. I officially am going on this '2x2' rotation set-up and it starts in June. Unfortunately, I still have no idea where I will be going. I know which sites I 'could' be going to, but they have not solidified the schedule yet. I paired up with a classmate in my clinic and we both have POS automobiles...so hopefully between the two of us, we will make it through the year. Keeping the fingers and toes crossed on that one.

So today I just hammered out two case presentations. The first one was a restorative case and the second was pedo. They both went really well and I am happy to be done. Like most people, I am not a big fan of delivering presentations, it is simply uncomfortable getting stared at for so long. However, there is no greater feeling in the world than walking out of the building on a beautiful sunny friday afternoon and being done.

Ah yes, the weather is finally staying nice. I promise two in depth posts prior to my D-4 year. Expect a final D-3 experience as well as some sort of breakdown of my rotation schedule (assuming they provide it soon).

I am going to be a D-4 in three weeks.

Crazy? Yes.

Never Give Out Your Cell Phone Number

Simple enough title right? Yea, it makes sense as well. I know as a first year dental student, I never planned on giving my patients access to my personal phone number. You are just asking for trouble. Obviously though, it is easy to talk about this well before you enter the clinics and realize how difficult it can be to contact some people

I was desperate. A fresh naive D-3 with tons of open time slots, paranoid about experience and letting the faculty know I was doing something. The first semester of clinic life is a slow process. It takes time to weed out the good transfer cases from the worthless pieces of crap that should have been dismissed years ago. In the process, you end up having a lot empty timeslots because the transition of finding reliable patients takes a good two months.

However, when you first enter the clinics, you want to have EVERY time slot filled otherwise you feel like you aren't being a good student. Here in lies the problem. I gave my cell phone number to about five patients total (and they were all during the first month of my D-3 year). Why would I do this? Because it is impossible to contact some people otherwise. I would call, leave a message to call me back at the clinic. They would call back, leave a message with the secretary and I have to call back. You very rarely can answer a call while you are in the clinics because you are too freaking busy and half the time the secretaries just take the message down without asking (and I'm fine with this).

So you end up playing phone tag and trying to catch these people, it just becomes frustrating. After my first two weeks of the D-3 year, I maybe had filled 1/2 my openings. So in an act of utter desperation, I gave my cell number to several patients.

Yea it worked out for the time, but it has come back to bite me the ass hard. Take this spring break. I am on vacation from dentistry. I don't want to go the school, here about projects, or talk about dentistry period. I want to enjoy other hobbies, see old friends, and just relax.

But no, I have been called a total of eight times (EIGHT) in the last four days by TWO patients. They call, leave a voicemail, call again 30 minutes later, leave a voicemail and so forth. I don't know about you guys, but when I leave one voicemail, that's it. If they don't call me back, they clearly don't want to talk to me and that's the end of it. But these patients just keep calling. It isn't an emergency either, it's about scheduling or rescheduling appointments.

This altogether isn't that bad. I wouldn't have posted until this morning's events. I was woken up at 6:30 in the A god damn M by a guy who wants to reschedule an appointment that isn't until next week because he has a birthday party to celebrate...good lord. Could this not have waited until normal hours? He also is aware that I am on vacation because I already talked to him YESTERDAY about scheduling this appointment that he already wants to reschedule.

The other patient called me saturday at 7:45 am and then followed up with sunday at 7:30 am followed with an 8am and 9am until I finally answered the phone to stop the insanity. Again, no emergency, just wants to schedule an appointment (for a cleaning mind you).

Good fucking god. There is nothing that pisses me off more than being woken up abruptly on a day I can actually sleep a little.

Moral of the story? NEVER give out your phone number to patients. If you absolutely have to communicate via some other avenue than your school, then buy a separate phone. Trust me, it isn't worth it with the same head cases pestering you on a weekly basis.

As a practicing dentist, I will have an emergency contact number. Key word though, emergency. And it sure as hell won't be my personal cell phone.

I will definitely be dumping this phone once I graduate, because sure as the grass turns green, these same people will be calling me until the day I die.

OK, raging over. Back to the rest of break!

D-4 Rotations

So as I may have mentioned in previous posts, we are required to do at least 60 days of extramural rotations during the D-4 year. Now I hadn’t thought much about this until the last month or so, mainly because I can’t see that far ahead. Another factor would probably be that I don’t really like any of the options at this point. Either way, it appears that I would be forced to live somewhere else for several weeks and that just cramps my style.

However, I recently received word that I have been selected to participate in the 2x2 program. What the hell is the 2x2 program you ask? Basically it is how the college eventually wants to handle rotations in the future. You spend 2 weeks in the college, and then you spend 2 weeks on rotation. Rinse, wash, repeat. This goes on your entire fourth year so you essentially spend half the year on rotation. All of the rotation sites are located in or near Chicago so there will be no up-rooting (at least that is what I’ve heard). It was started two years ago as a pilot program with maybe 8 students participating. This year I believe 12 participated. 21 students from my class were invited to participate – but I’m unsure how many will actually accept.

I have no clue how the faculty chooses who is eligible. It can’t be based on production, because I am probably slightly above-average if even that high. I’ve done a reasonable amount of phase III (crown, denture, etc), but not tons. So who know? Either way, it is satisfying to get the offer. It is sort of a validation knowing that the faculty place enough confidence in me to go off-site without their supervision for half my senior year. More importantly, this offer sort of makes my rotation decision for me. I already had no idea what I wanted to do, so I may as well do this right?

Speaking with a few others who have been invited, the pros seem blatant. It will be a TON of experience, period. It will get you out of the school, which at this point, can feel more like a hindrance to learning than an adjunct. I really have no idea though as I haven’t talked with current fourth years doing the 2x2…maybe I should get on that.

We have a meeting about the program at the end of March, so maybe that will answer some questions. However, I feel like it will be more of a sales pitch to get us to accept more than anything else. Again though, none of the other rotation options stand out to me, so I probably will accept regardless of what I hear.

Updates shall be forthcoming.

In other news, school is pretty calm right now. I have gotten most of my requirements finished or at least started. I am staying surprisingly on top of all the bullshit papers we have to produce, and I’m also starting to put together my two patient portfolio presentations that are coming up in April.

Spring break is literally three days away. Sweet.

The D-3 Experience IV

As I edge closer and closer to completing my third year of dental school, I find myself sad to see it end. Yea, I want to graduate and actually have an income, but once you hit your stride in the clinics, it becomes pretty damn fun. The fourth year will be wrought with the stresses of licensure and rotations..so I don’t intend to be in such a ‘stride’ ever again during school.

The summer semester you are a bit squeamish, scared if you will, because there is pretty much a ‘first time’ happening every day. The fall semester is a lot better because you are starting to do things you have already done. The spring semester is when it all comes together and you literally feel like a badass. This is because the instructors know who you are now and you are simply comfortable. It also helps to see the psychotic D-2s running around freaked out about doing a prophy or printing out a treatment plan. We’ve all been there.

You eventually get used to the ebb and flow of the controlled chaos that is any dental school clinic.

Today we had a lecture during lunch about the two licensure exams our school is considering for the class of 2011. The current class is taking the NERB, but most classes prior have taken the CRDTS. Believe me, I will be posting plenty on this stuff in the future, but for now I will leave it at that.

In the morning I took a class II amalgam performance exam. I swear dentin never looks the same when I get down into it – especially if there was caries. I’ve determined that the only REAL way to tell if the tooth still has caries is by feel – not sight. Pretty much anything not healthy and yellow looks like caries, and believe you me – I can see why so many people pulp out all the time. If you try to remove anything that isn’t ‘normal’ you may as well just remove the entire tooth. Case in point: my patient this morning had a radiographically simple class II; replacing a composite with a small bit of recurrent decay. Before I knew it, I was damn close to the pulp with a huge brownish-red circle still hovering around the axio-gingival line angle. Now when you are taking an exam, this becomes stressful because if you leave any caries in the prep – you fail. Well, I really poked around with my explorer and the spot felt firm. So I just held my breath, asked if I could place a liner, and had them grade the prep. Whew – no caries.

I find amalgam fairly easy to work with – aside from carving sweet anatomy. But as a clinical instructor I know is fond of saying: “Anatomy? You know what I say about anatomy? Anatomy (pause for effect) is over-rated.” Pure gold.

Finishing a performance exam is like finding relief after a bad burrito – it’s a battle going in, but the feeling of ‘passing’ is unequaled. Good wordplay yea?

So things are going well overall. Aside from the ‘RPD from hell,’ I feel as though I am getting a good deal accomplished overall. What is the RPD from hell you ask? Well, I plan on devoting an entire post to this beast at some point. Here’s a sneak peak. I took the final impression for the framework last July, and we still aren’t done. Yea, it’s that bad.

Aside from a crown performance exam, a couple of presentations, papers/ reports, and finals, I am about ready to mosey on into the D-4 year.

On the horizon decisions:
D-4 Rotations
GPR applications
Pre-order GOW 3 or not

Actually that last one isn’t really a decision, I already pre-ordered.

Schawing!

Syncope - Finally

As morbid and terrible at it sounds, I have secretly been hoping to see a patient go into syncope for the last few months. I realize the best chance of this would be in my OS rotation which finally wrapped up yesterday. I am glad to finally have more time in my normal clinic for my own patients but dissapointed at the same time because OS is fun.

So what is syncope? Simply put, it means to faint. Of all the 'emergent' situations in dentistry, syncope is by far and away the most common. It is also the easiest to treat if you follow a few easy steps.

Why does it happen? Most commonly, blood is not getting up to the brain which causes hypoxia (no oxygen) up there eventually leading to loss of consciousness. A great example is a young male patient who is super anxious about needles. He knows it is coming, so his body naturally goes into 'fight or flight' mode. This means the blood vessels dialate to get the blood pumping and moving (especially into the leg muscles). Most dental patients are in a sitting position which means that gravity is also kicking in so all that blood is just pooling up down in their feet.

So they pass out. And it finally happened to a patient I was working on. A classmate and myself were tag teaming this guy on an alveoloplasty and the attending surgeon was going over a few pointers just after I opened the flap . Suddenly, the patient's eyes just rolled into the top of his head and he sagged off to the right. The instructor had us grab the O2 tank while he brought the patient into a supine (or laid down flat) position. He technically brought him all the way into trendelenburg (head lower than feet) but either way, that is the first step. We hooked him up to the oxygen and the guy came back really quickly. His BP had dropped a bit, but it wasn't dangerously low (which ruled out cardiac issues). So we finished up and sent him on his way.

There really isn't much else to say. It was crazy to finally see it happen, and equally amazing at how simple it was to manage. Laying him back got the blood going towards his head and the oxygen just sealed the deal.

Obviously many things can cause someone to pass out, and many of them much worse. The surgeon recommended that we have an emergency protocol/practice day in our private practices once every six months to keep everyone up to date. I completely agree.

Quickie.