So one more week has passed! This is the start of medical school. My first year of residency is actually spent like this: I start off on OMS service (meaning I work in the clinic, surgical suites, operating room, and take my turn with being on call) I do this until the medical school starts. Then I am in medical school only and do not work in the OMS service until winter break. During winter break, I am back to the OMS clinic or wherever the chiefs want me. Usually the upper residents want a vacation during this time so that means the lower levels work over the holidays taking call at the hospital. At the end of the school year, I will take the USMLE step 1. That is part 1 of 3 of the medical boards. So that is how the first year of my residency is run at this program.
As an OMS resident, the medical school accepts my dental school education to cover the basic sciences that were done in the 1st year of medical school so they only require the 2nd and 3rd year of medical school to be completed and then they will count the rest of the OMS service of residency as 4th year of medical school and my intern year for medical licensing. Right now, I am just starting the medical school portion. So I am in year 2 of medical school (1st year of OMS residency)
I am in my dental residency which includes 2 years of medical school to get the MD training as well as my certificate in the specialty of OMS. Does this make sense? Because this does not make sense to most people I encounter at the medical school: medical students, staff, faculty, and admin. I try to explain it in as few words as possible but it is just difficult.
I get comments like, "So you are in dental school AND medical school?"
----No, I graduated from dental school, now I am a resident in oral and maxillofacial surgery.
"Wait, you are starting your residency and treating patients before finishing medical school? That is impossible. You are not allowed to do that."
----I know it sounds confusing; I am in a dental residency and going to medical school as part of the residency.
"No that is not allowed, you must be mistaken. Come back when you know your case better."
----It's ok, the medical school dean and I have spoken and the associate deans as well know about my situation now. Every year you have OMS residents do this. The dean sent me to you to take care of my registration, enrollment, financial aid, and schedule. They said you can call them with questions."
*Phone call made.
"My boss says to help you with what you want."
"So you are taking medical school classes so you can prescribe drugs...?"
----No, I can already do that. I already had the pharmacology and pathology.
"What is it that you do?"
----Right now, I am a medical student, when the school is off for breaks I do oral and maxillofacial surgery at the clinics and hospital.
"Oh so you do like chipped teeth, root canals and fillings."
----No we don't do that stuff. That is for general dentists and endodontists"
"...???..."
----Someone who specializes in root canals will do that. At the hospital, we treat traumatic patients with fractures of the orbital bones, midface and mandible. For soft tissue, we do any lacerations of the head and neck including ears, scalp, tongue, nose, lips, eyes, cheeks, chin... anything on the face, head and neck. We also do infections that have progressed into the fascial spaces that come from the teeth. But in our clinic we mostly do the scheduled stuff like wisdom teeth, dental implants, tooth extractions, orthognathics, cosmetic surgery and a lot of consults and follow-ups.
"Do you take call?"
----Yes.
"But not like a real doctor..."
----Hahaha...Yes like a real doctor.
So this is the conclusion that I have come to embrace: OMS is somewhere in between Dentistry and Medicine. I believe it has a foot in both realms and we can pick and choose when to play either card. When fully trained, an OMS can do cosmetic surgery like face lifts, skin peels, and augmentations of the lips, nose, chin, eyelids and cheeks. But an OMS can do more of the traditional dental treatments of extractions of teeth including wisdom teeth, benign pathology of the head and neck, and dental implants. The list of procedures that an OMS can do is long and is partly in medicine and partly in dentistry. Instead of narrowing down what I can do like most specialties, OMS opens me up to a bigger, wider spectrum of surgeries. It is wonderful.
While in residency I have 3 cards to play: med student, doctor, and resident. This allows me benefits from all three areas. For example, parking: I get resident parking at the hospital which is covered and way closer than the student parking which is uncovered. I am a doctor when I walk into a private hospital and doctors eat for free! Private hospitals have great food and I can eat as much as I want. Medical students get great discounts on books, organizations, and they even get a free membership to an awesome gym which is open all of the time at any hour and has everything a gym could offer.
So in the end, hardly anyone knows what I do. This allows me to do as I please.
Saturday, July 16, 2011
Sunday, July 10, 2011
1st Week
A common sentiment around residencies in teaching hospitals is that you do not want to be injured in July because that is when all of the new docs are on call. Well, the day after the 4th of July I was on call for the first time. This was a bit stressful because people do not come into the hospital on the night of a big holiday, they finish partying and then come in the day after. So I was expecting a big day and honestly I had to say that I was nervous.
In preparation for my first on-call service on the Tuesday the 5th, I came in on Monday the 4th to shadow a more experienced resident. That morning, I rounded on patients that were on our service. I cleaned some facial wounds on a patient who had an accident and the face sustained some deep abrasions. The patient also had some deep lacerations. The lacs was sewn and now the patient was in the hospital trying to recover. To minimize the scarring the scabs would be scrubbed off with hydrogen peroxide and saline solution. This causes a lot of pain and so the patient would be given a dose or two of morphine just prior to starting the cleaning. This patient had to do this 2 times a day.
Another pt came in that day after falling and sustaining a laceration to the head. Her forehead was lacerated exposing the bone. The bones surrounding the eye were broken. The patient suffered an orbital floor blowout. This is when the muscle and other soft tissue surrounding the eye breaks through the bone and falls into the maxillary sinus instead of being in the eye socket. So ophthalmology was consulted on this case, as well, in order to assess her vision more closely. After I showered the gaping wound with saline solution and got rid of the rocks, dirt, pine needles and other debris I sutured together the deeper layers of the scalp and then closed it up. It was very fun to suture.
This was on the 4th of July. The 5th of July I was on call but luckily it was not facial trauma call. It was tooth call only. So no more facial lacs to sew up, just fascial space infections from rotten teeth. When teeth are broken down and get infected but do not get fixed with either a root canal treatment or extraction the infection can spread from the tooth and break through the bone and get into the head and neck spaces. This can be life threatening. Once the infection spreads to the face and neck, the treatment is to remove the source of infection (the tooth), incise and drain the pus, and then give the patient some strong antibiotics to help fight off the bacterial infection. Usually the patient has a huge swelling on one side of the face. Then you look inside their mouth to see if you can narrow down the source of the infection and I usually see multiple teeth that could potentially be the source. For examples see http://www.dental--health.com/
In preparation for my first on-call service on the Tuesday the 5th, I came in on Monday the 4th to shadow a more experienced resident. That morning, I rounded on patients that were on our service. I cleaned some facial wounds on a patient who had an accident and the face sustained some deep abrasions. The patient also had some deep lacerations. The lacs was sewn and now the patient was in the hospital trying to recover. To minimize the scarring the scabs would be scrubbed off with hydrogen peroxide and saline solution. This causes a lot of pain and so the patient would be given a dose or two of morphine just prior to starting the cleaning. This patient had to do this 2 times a day.
Another pt came in that day after falling and sustaining a laceration to the head. Her forehead was lacerated exposing the bone. The bones surrounding the eye were broken. The patient suffered an orbital floor blowout. This is when the muscle and other soft tissue surrounding the eye breaks through the bone and falls into the maxillary sinus instead of being in the eye socket. So ophthalmology was consulted on this case, as well, in order to assess her vision more closely. After I showered the gaping wound with saline solution and got rid of the rocks, dirt, pine needles and other debris I sutured together the deeper layers of the scalp and then closed it up. It was very fun to suture.
This was on the 4th of July. The 5th of July I was on call but luckily it was not facial trauma call. It was tooth call only. So no more facial lacs to sew up, just fascial space infections from rotten teeth. When teeth are broken down and get infected but do not get fixed with either a root canal treatment or extraction the infection can spread from the tooth and break through the bone and get into the head and neck spaces. This can be life threatening. Once the infection spreads to the face and neck, the treatment is to remove the source of infection (the tooth), incise and drain the pus, and then give the patient some strong antibiotics to help fight off the bacterial infection. Usually the patient has a huge swelling on one side of the face. Then you look inside their mouth to see if you can narrow down the source of the infection and I usually see multiple teeth that could potentially be the source. For examples see http://www.dental--health.com/
I do not know if this is the usual for all people in this area but for the patients that come into the emergency room this is pretty typical. So brush your teeth and see your dentist.
So far I feel I am a little lost in the hospital as I follow my upper residents. The patient I am watching over has a gun shot wound to the face. The bullet entered the cheek broke the mandible and now is lodged in the back of her head. The OMS team is in charge of correcting the mandible fractures. The patient is also pregnant and OB/GYN is over the fetus, neurosurgery is over the brain damages and the trauma team is the admitting service. That is how the hospital works: one service admits and is in charge of the patient while they consult other specialists to work on specific areas of the patients' charts.
Well, it is exhausting waking up around 4 or 5am and then getting home between 10 and 12pm. I am glad that I made it through the first week of OMS residency and I did no harm. I was even able to help a few people.
Saturday, July 2, 2011
July 1: First Day
After countless hours of filling out paperwork, completing on-line courses for orientations at multiple hospitals and days and days of orientation meetings July 1, the first day of residency begins. I got up at 4am and got ready for the day. I had my ironed scrubs, dry-cleaned white coat, pen light, pen, small personal notebook, badges, keys, stethoscope, tongue blades, quick reference guide, wallet, phone and pager. I was ready to go.
I show up to the hospital at 5am to pre-round with my upper resident. Pre-rounding is what the lower residents do in order to report to their upper residents and attending surgeons what has happened in the last 24 hours with the patients that OMS service has either admitted to the hospital or consulted. (Consult patients are not patients that OMS has admitted for procedures directly related to their specialty but patients that are in the hospital for other major reasons and also happen to need services rendered by OMS i.e. mandible fracture, tooth pain, infection of the head or neck, etc...) After visiting all of the patients on our list, we finished pre-rounding and met up with the the chief resident and other upper residents. We again visited all of the patients, but this time we would present the patient's history including chief complaint, history of present illness, past medical history along with the findings from the physical exam we did earlier that morning and all medical information pertinent to this patient. During the presentations the upper residents or attendings can "pimp" you, or ask you more specific questions about the patient or the treatment or literature supporting why we are doing what we are doing or any number of things. Hopefully you have read up on the patients and the patients' illnesses so you can be better prepared for those questions.
The culture of the hospital, especially in surgery, is such that there is pyramid or sort of pecking order. The first years and interns must walk in front of everyone else. They are then followed by the 2nd years, who are followed by 3rd years, then the 4ths, 5ths, chief residents and then finally the attending surgeons. This can be anxiety provoking since the interns get lost all of the time in their new environment and they are leading the group around the large hospital. Try to make a good impression there.
After rounding, we split into groups for the day and covered the different responsibilities of OMS in the different hospitals and clinics. One team went to the OR, another to the dental clinic, another team went to one of the other hospitals, and the last team went to a surgical center. Today, I went to the surgical suites and observed and performed different surgeries. These included IV Sedation, removal of tori (tori: bumps of bone found just on the tongue side of the teeth), full mouth extractions and single tooth extractions under local. I also did pre-surgery consultations for wisdom teeth and other extractions, follow-up appointments on past surgical patients, and admitted a patient to the hospital for a fascial space infection in the mandible.
For the patient admitted to the hospital, I was seeing him in the Emergency Department. The upper residents had already gone home. I was there alone. Luckily, one of the upper residents had shown me, the day before, how to do a quick physical exam of the major systems. So I listed to the patient's heart at the four different areas for the aortic, pulmonic, tricuspid and mitral valves. First, I listened for the normal lub-dub sounds of the heart and then I listened for any other sounds that could be considered a heart murmur... no heart murmur. regular rate and rhythm whew! That part ended up being simple. Then the lungs... 6 areas on the back for the lungs... ok all clear. whew! Another system down. Now bowel sounds. Abdomen... easy sounds there, and then palpate. Check eyes: extraocular muscles intact, PERRL. Neck: tender, lymphadenopathy. cranial nerves: facial nerve intact, trigem: loss of sensation to lower lip. Extremities: no edema, clubbing, or cyanosis. After completing the exam, I went to muddle around on the computer for the electronic medical record. I found an old note with another exam on it. I looked it over and made sure I covered all of the systems and wrote my note with the same format. Luckily, just then my chief popped up behind me and checked it out. Verdict: good enough work for a 1st year. I'll take what I can get.
By the end of the work day it was 7pm before I came home. I was at the hospital for a total of 14 hours on my first day. I did a little bit of what we had to offer that day so I chalk it up as a successful day. I think one of the aspects that I like about OMS and the hospital is that I don't know what is coming up next in the hospital. There is a variety and a myriad of things it can be which makes it scary and exciting to me. Hopefully I know what to do to fulfill my part. When that happens, I can rest easy.
Next: On-call for head and neck trauma the day after the 4th of July... yikes.
I show up to the hospital at 5am to pre-round with my upper resident. Pre-rounding is what the lower residents do in order to report to their upper residents and attending surgeons what has happened in the last 24 hours with the patients that OMS service has either admitted to the hospital or consulted. (Consult patients are not patients that OMS has admitted for procedures directly related to their specialty but patients that are in the hospital for other major reasons and also happen to need services rendered by OMS i.e. mandible fracture, tooth pain, infection of the head or neck, etc...) After visiting all of the patients on our list, we finished pre-rounding and met up with the the chief resident and other upper residents. We again visited all of the patients, but this time we would present the patient's history including chief complaint, history of present illness, past medical history along with the findings from the physical exam we did earlier that morning and all medical information pertinent to this patient. During the presentations the upper residents or attendings can "pimp" you, or ask you more specific questions about the patient or the treatment or literature supporting why we are doing what we are doing or any number of things. Hopefully you have read up on the patients and the patients' illnesses so you can be better prepared for those questions.
The culture of the hospital, especially in surgery, is such that there is pyramid or sort of pecking order. The first years and interns must walk in front of everyone else. They are then followed by the 2nd years, who are followed by 3rd years, then the 4ths, 5ths, chief residents and then finally the attending surgeons. This can be anxiety provoking since the interns get lost all of the time in their new environment and they are leading the group around the large hospital. Try to make a good impression there.
After rounding, we split into groups for the day and covered the different responsibilities of OMS in the different hospitals and clinics. One team went to the OR, another to the dental clinic, another team went to one of the other hospitals, and the last team went to a surgical center. Today, I went to the surgical suites and observed and performed different surgeries. These included IV Sedation, removal of tori (tori: bumps of bone found just on the tongue side of the teeth), full mouth extractions and single tooth extractions under local. I also did pre-surgery consultations for wisdom teeth and other extractions, follow-up appointments on past surgical patients, and admitted a patient to the hospital for a fascial space infection in the mandible.
For the patient admitted to the hospital, I was seeing him in the Emergency Department. The upper residents had already gone home. I was there alone. Luckily, one of the upper residents had shown me, the day before, how to do a quick physical exam of the major systems. So I listed to the patient's heart at the four different areas for the aortic, pulmonic, tricuspid and mitral valves. First, I listened for the normal lub-dub sounds of the heart and then I listened for any other sounds that could be considered a heart murmur... no heart murmur. regular rate and rhythm whew! That part ended up being simple. Then the lungs... 6 areas on the back for the lungs... ok all clear. whew! Another system down. Now bowel sounds. Abdomen... easy sounds there, and then palpate. Check eyes: extraocular muscles intact, PERRL. Neck: tender, lymphadenopathy. cranial nerves: facial nerve intact, trigem: loss of sensation to lower lip. Extremities: no edema, clubbing, or cyanosis. After completing the exam, I went to muddle around on the computer for the electronic medical record. I found an old note with another exam on it. I looked it over and made sure I covered all of the systems and wrote my note with the same format. Luckily, just then my chief popped up behind me and checked it out. Verdict: good enough work for a 1st year. I'll take what I can get.
By the end of the work day it was 7pm before I came home. I was at the hospital for a total of 14 hours on my first day. I did a little bit of what we had to offer that day so I chalk it up as a successful day. I think one of the aspects that I like about OMS and the hospital is that I don't know what is coming up next in the hospital. There is a variety and a myriad of things it can be which makes it scary and exciting to me. Hopefully I know what to do to fulfill my part. When that happens, I can rest easy.
Next: On-call for head and neck trauma the day after the 4th of July... yikes.
What is Oral & Maxillofacial Surgery?
Oral and Maxillofacial Surgeons care for patients with problem wisdom teeth, facial pain, and misaligned jaws. They treat accident victims suffering facial injuries, place dental implants, care for patients with oral cancer, tumors and cysts of the jaws, and perform facial cosmetic surgery. This is an excerpt for the web page of the American Association of Oral and Maxillofacial Surgeons.
Oral and maxillofacial surgeons are the only recognized dental specialists who, after completing dental school, are surgically trained in an American Dental Association-accredited hospital-based residency program for a minimum of four years. They train alongside medical residents in internal medicine, general surgery and anesthesiology, and also spend time in otolaryngology, plastic surgery, emergency medicine and other specialty areas. Their training focuses almost exclusively on the hard (ie, bone) and soft (ie, skin, muscle) tissue of the face, mouth, and jaws. Their knowledge and surgical expertise uniquely qualify them to diagnose and treat the functional and esthetic conditions in this anatomical area. The scope of oral and maxillofacial surgery practice includes, among others:
Continuing in my own words, in order to become an oral & maxillofacial surgeon (OMS), one must first complete the 4-year curriculum of dental school to earn their DDS/DMD. Upon receiving their doctorate, they can continue their post-graduation education in OMS. The 100+ residency programs use the National Matching Services in order to maximize the applicants' chances of getting into their most desired program and help programs get the best applicant they can. Each program offers between 1-5 spots in their program per year and will be from 4-6 years long. Some offer a dual-degree curriculum where a resident can also earn their medical degree during their residency and all programs award the oral and maxillofacial surgery certificate.
Residency starts July 1st of every year. I chose to do the 6-year, MD combined program and this will be the expression of joys and frustrations from the events and educational "ah-ha" moments of my residency.
Oral and maxillofacial surgeons are the only recognized dental specialists who, after completing dental school, are surgically trained in an American Dental Association-accredited hospital-based residency program for a minimum of four years. They train alongside medical residents in internal medicine, general surgery and anesthesiology, and also spend time in otolaryngology, plastic surgery, emergency medicine and other specialty areas. Their training focuses almost exclusively on the hard (ie, bone) and soft (ie, skin, muscle) tissue of the face, mouth, and jaws. Their knowledge and surgical expertise uniquely qualify them to diagnose and treat the functional and esthetic conditions in this anatomical area. The scope of oral and maxillofacial surgery practice includes, among others:
- Outpatient Anesthesia
- Dentoalveolar Surgery to manage diseases of the teeth and their supporting soft and hard tissues
- Surgical Correction of Maxillofacial Skeletal Deformities
- Cleft and Craniofacial Surgery
- Facial Trauma Surgery
- Temporomandibular Joint Surgery
- Pathologic Conditions, such as head and neck cancer
- Facial Reconstructive Surgery
- Facial Cosmetic Surgery
Continuing in my own words, in order to become an oral & maxillofacial surgeon (OMS), one must first complete the 4-year curriculum of dental school to earn their DDS/DMD. Upon receiving their doctorate, they can continue their post-graduation education in OMS. The 100+ residency programs use the National Matching Services in order to maximize the applicants' chances of getting into their most desired program and help programs get the best applicant they can. Each program offers between 1-5 spots in their program per year and will be from 4-6 years long. Some offer a dual-degree curriculum where a resident can also earn their medical degree during their residency and all programs award the oral and maxillofacial surgery certificate.
Residency starts July 1st of every year. I chose to do the 6-year, MD combined program and this will be the expression of joys and frustrations from the events and educational "ah-ha" moments of my residency.
Subscribe to:
Posts (Atom)