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.

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:

• 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.