After three long years at the University of Louisville School of Dentistry, Eric Nunnally begins his countdown to graduation.
Junior year was tough, but it's over. Part II of the written National Boards was a horrible two-day, 12-hour exam but I passed, and now it's history.
Looking back at my time in school, junior year was very valuable in terms of my development as a dentist. My rookie jitters lessened, patient care was much more fluid and the stress of working in the mouth slowly disappeared. Clinical work became much more enjoyable once I gained confidence with the handpiece and competence with treatment planning. Patients definitely pick up on whether or not you're confident and, if you are and they feel good about you, it's reflected in their willingness to receive treatment.
Working directly with patients hasn't only made me a better dentist, but a better technician. For instance, during my junior year, I was both the dentist and technician for my patients and I now fabricate a much higher-quality diagnostic waxup because I no longer think of it as a "case" but as part of a person.
When all you see is model work and scripts, it's easy to become disconnected from the final goal: delivering a functional prosthesis that makes the patient happy. Working with the patient chairside is something every technician should experience; it gives you a new perspective and can have a positive effect on your work. The first time you see a patient cry because he's so happy with his new smile, it all comes together.
As I gain experience as a clinician, my respect for tech-nicians and the integral role they play on the dental team continues to grow. For the most part, fillings don't change lives, but dentures and C&B definitely do. Technicians make the difference between an acceptable restorative outcome and a fantastic one.
My Externship Experience
During the summer between my junior and senior years, I participated in a five-week externship in a private practice so I could experience a "real world" environment and get a taste of what it's like to be part of an established practice. I treated my own patients, had a great assistant and was overseen by two experienced dentists.
I did more work in five weeks than I would in a whole semester at school, maybe even a year: root canals, crowns, bridges, amalgams, composites, direct composite veneers, crown repairs, emergency patients with all types of needs, etc. I also helped diagnose and address patients' concerns regarding their treatment. The atmosphere was great; it was dynamic and hectic at times but I'd choose that over boring any day. It was the most beneficial experience I've had yet as a dental student and, by the end, I felt like I was part of the practice.
It was amazing how much more comfortable I felt in a private practice setting compared to school. In the school's clinics, every patient needs a comprehensive analysis which means multiple appointments and consults, diagnostic models mounted with facebows, perio charting, and a ton of hard and soft tissue charting. While I understand that's how the school must function to properly educate the students, this amounts to about 12 hours in the chair for the patient and many more hours for me. In contrast, in private practice most people are long-time patients or come in regularly for cleanings, so you already know what issues are likely to present and deal with their needs as they arise.
Senior year: No more hard science classes or spending weekends studying for brutal weekly written exams. From now on, it's completely clinical and school is a lot like going to work. Show up prepared, treat patients, do lab work and go home. I love it.
However, there's a new kind of stress associated with senior year: treatment of patients with more difficult crowns, partials, dentures and restorations, and a huge list of competencies in the various specialties, e.g. scaling/root planning for perio, stainless steel crowns and pulpotomies for pedodontics, splints for TMD, and root canals for endodontics. If I am not proficient, I run the risk of not graduating on time.
As upperclassmen, we get more respect when it comes to our decisions for patient treatment, but we also have a lot more on our shoulders now. In our specialty rotations, we aren't assisting anymore; we're the ones doing the work. In emergency clinic, we're the ones determining why the patient is in pain and what should be done. In oral surgery, we're the ones removing teeth, reflecting tissue flaps, reducing/smoothing bone and suturing everything back together.
This is when all that studying comes to life and we'd better remember what kinds of procedures are indicated for each patient. Last year, we relied on the seniors to double check our decisions and give us advice. Now we're doing that for the juniors.
The faculty oversees all we do and expects us to show that we can make the right decisions and explain why we made that decision—both to them and the patient. Every part of our work is treated like a live exam. It's stressful, but fun at the same time. Errors are very embarrassing. Believe me, when you make a mistake and feel like an idiot, you won't make that mistake again. I've learned that the hard way, several times.
My Final Semester
As I enter my last semester, I'm preparing to take the Regional Clinical Boards in April that consist of a written exam and two days of procedure-based clinical exams in different restorations, periodontal procedures and root canals. Some of the work is performed on actual patients (whom we're responsible for recruiting from our pool of patients at the school's clinic) and some is done on extracted teeth mounted in simulated patients.
These boards are yet another new kind of stress. Once you get a patient in the chair and start the procedure, you never really know what can happen. For instance, if you're doing a filling, there may be a lot more decay than appeared radiographically or a microfracture that causes a whole cusp to fall off. Even worse, your patient may not show up. I've heard all kinds of horror stories about the unknowns of the exam and how things can go bad very quickly. Since you can't really study for them, you just have to be prepared and hope everything goes well.
The good thing is that boards are my final hurdle. If I pass and fulfill my work requirements in the school's clinic, I'll graduate on time in May. (There's no limit to the number of times we can take the boards but we must pay $2,500 each time; I plan to take them just once!) After graduation, it takes about four to six weeks for my license to clear and, once I receive it in the mail, I can start practicing dentistry the next day. It can't come soon enough!