Could one (or many) of you esteemed OMFS residents walk me through a "normal" day that you encounter. I know that an omfs residency is tough, but I was just wondering what the day to day is like. What kind of hours to expect? I am doing an externship in august, and I know I will have a taste then, but I wanted a heads up on the daily grind.
A day in the life... OMFS res
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Reconabe said:
Everyone in the hospital rounding from 5:30 am to 7 am
To the OR at 7am (or to a quick breakfast for the rest)
work until about 4:30pm-5pm
if you are on call, you don't leave the hospital until the next day (afternoon at 4:30 pm).
Basically, the hospital owns you. It is residency, and you kind of "reside" in the hospital. See everything you can see. Push yourself until you can't stand it, just to see where your threshold is. See everything you possibly can.
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This reminds me.....someone needs to post a link to the old thread where TXOMS describes a day in his life as a dental student. One of the all-time best posts in my opinion.
In my program it depends on what rotation you're on. At the county hospital we (residents) meet at 6:30am. Whoever was on call the night before has already seen the patients and written notes. Then the rest of the team does a quick fly-by of the patients as a group. We usually only have 1-3 patients in-house at a time. You have to come in with your mandible in a paper sack to be admitted. Then you go to the OR if you have a case, or the clinic otherwise. Clinic gets done around 4-6 depending on how many residents are on service. When the work is done you go home unless you're on call.
Our VA hospital is a slower pace. We only have OR time one day a week, so we rarely have people in-house. So you normally come in around 8:00 for clinic or 7:45 if you have to round on a patient. Work all morning, go out for lunch, work the afternoon clinic, go home. The junior level resident is on-call for the entire 3-4 month period they rotate there, but they only get called in 2-3 times per month.
In my program it depends on what rotation you're on. At the county hospital we (residents) meet at 6:30am. Whoever was on call the night before has already seen the patients and written notes. Then the rest of the team does a quick fly-by of the patients as a group. We usually only have 1-3 patients in-house at a time. You have to come in with your mandible in a paper sack to be admitted. Then you go to the OR if you have a case, or the clinic otherwise. Clinic gets done around 4-6 depending on how many residents are on service. When the work is done you go home unless you're on call.
Our VA hospital is a slower pace. We only have OR time one day a week, so we rarely have people in-house. So you normally come in around 8:00 for clinic or 7:45 if you have to round on a patient. Work all morning, go out for lunch, work the afternoon clinic, go home. The junior level resident is on-call for the entire 3-4 month period they rotate there, but they only get called in 2-3 times per month.
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We're a little short on database hardware muscle at the moment, and running searches chews up a *lot* of resources. We're exploring options to fix it, but for now we figure the processing power is better used serving a lot of forum displays than running a handful of searches.tx oms said:
I appreciate the responses. I figured i would be owned. I just want to KNOW what I am getting into. I hate suprises. I have to prepare the wifey for how much I will be away. Do any of you that have families get to see them on a regular basis. for how much each day on average?
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I have a wife and at least 2 kids. There have been 3-4 times when I have gone a week without seeing my kids because they wake up after I'm gone and they go to sleep before I get home. The important thing for your wife to understand is that this is temporary and simply a means to an end.Reconabe said:
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If you come here, I'll add your wife to my "off-service rounds". It's sometimes difficult keeping up with all the wives of my co-residents, but with a little hard work and attention to detail, I can keep them all happy while daddy is on-call.Reconabe said:
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Heh.toofache32 said:
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Reconabe said:
Normal day for the Cowboy:
5:30 pre-round
6:30 Round
7:30-3 or 4 Clinic
4-6 Rub one out
If on call:
7-1am Wire mandibles/sow lacs/scutt work
1am = rondezvous with Nurse on night shift in laundry room 😀
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What kind of fertilizer are you using for your lacs?LSU-Cowboy said:
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toofache32 said:
sow the lac with fertilizer so you end up with an abscess to grain 
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LSU-Cowboy said:
Do you guys have formal rounds with attendings? Half the time at my place, we just tell the chief what's going on, and then we can all go talk about how perio sucks over breakfast.
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Doggie said:
No formal rounds. Used to have "staff" rounds once a week at Charity....not any more 🙁
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toofache32 said:
Buncha comedians.....
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aphistis said:
Maybe this is why doctors should stick to "doctoring", and not running computer databases. Why doesn't california boy just outsource this stuff and make it easy on all of us?
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Beats me. I just work here.north2southOMFS said:
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We get what we pay for. Oh wait, don't you do this work for free?!? 😱aphistis said:
I just can't pass up a good cheap shot.
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If you can call SDN work. Work, to me, would be something more like bailing an extern out on an arch full of tough (for him) extractions, on a patient who should've been sedated to begin with, when the only reason you came to the clinic at all was to get your camera back from another resident.toofache32 said:
Hypothetically speaking.
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aphistis said:
Work, to me, would be watching a guy who hasn't pulled a tooth in over a year trying to remember which forceps fits on which tooth...
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toofache32 said:
Work, to me, would be watching a 1st year general surgery resident trying to recall oral surgery facts while performing an extra-oral submandibular abscess incision and drainage...........hypothetically speaking.
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The neck bone is connected to the gallbladder bone is connected to the....Doggie said:
Interestingly, there are many OMFS residencies that take those to the OR every time.
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toofache32 said:
do you do a lot of submandibular space I+D's under local anesthesia/sedation in the clinic?
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I have yet to take one to the OR. It's either the ER or clinic. Usually ER. I've never used sedation because it's such a pain. Just hit your V3/buccal branch and Greater auricular and you're golden.scalpel2008 said:
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toofache32 said:
by the time they present, the majority of our submandibular space infections have masticator spaces involvement as well. so a lot of them get a thorough multispace I+D with drains in the OR.
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I'll do them in the clinic or the ER as long as the infection is confined to one side. Once it starts crossing over, we'll put 'em on the emergency OR schedule. Personally, I like doing them under local purely for the negative reinforcement of letting an abscess get out of control. Getting to go to the OR is too easy...scalpel2008 said:
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Why? Trismus? I use a Molt mouth prop and give them a couple clicks every twenty seconds or so. During the I&D, I'll always hit the sublingual, subman, submental, and masticator spaces regardless if they feel involved at the time. Then, each gets a nice shiny red rubber catheter.scalpel2008 said:
Do you all typically send them home or admit for IV abx? I tend to like sending them home on oral abx so they can flush their own drains, with specific instructions to come back if things get worse. Some of the other residents here always like to put them in-house. Just curious what everyone else thinks. Granted, when they get really nasty, I put them in, but for the majority, I think they respond well to going home after I&D, with oral abx.
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OMFSCardsFan said:
no, the trismus usually improves after anesthesia and manipulation. it's just that exploring the submandibular, sublingual, pterygoid, masseteric, and buccal spaces, breaking up all the loculations, poking your finger into the lateral pharyngeal space to open that up, followed by multiple drains snaking through these areas is more amenable (for both the operator and patient) to a general anesthetic in the OR. I've felt that sometimes when we do it under local we don't do a very good job because the pt gets too anxious and so we rush it. Once under GA, you can go to town, irrigate the **** out of it, place the drains exactly where you want them, etc. Do you not like like the OR because it's difficult to get on the schedule? Most of our infections that are bad enough to be drained in the OR stay for a night or 2 of IV abx. we can't rely on our pt population to get their clinda rx filled and comply with po QID dosing, let alone irrigate their own drains. I guess negligence compromised immune systems is why they get these sorts of infections in the first place. I don't think I'll be seeing many of these in private practice. I'll also add that another factor I use to decide whether the pt should stay is how quiickly the edema has progressed. I think you know what I'm talking about when I say that some of these infections just look "angry" and you know things will get worse before they get better. I've seen a pt progress from moderate isolated submandibular edema to a ludwigs in about 1 hour. i was writing orders and noticed that he kind of starting loking uncomfortable. I went over, flattened the bed, and his O2 sat dropped to 80, so we intubated him immediately. Kind of a scary progression.
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I guess I meant if it's localized I open wherever the patient happens to be sitting as long as I have a light. Multiple spaces, crossing the midline, potential airway issues and I call the OR. And, yes, it's a pain to get on the emergency OR list here because you're fighting with an abdominal GSW, a stat Crani, 2 appys, & 5 gallbladders. Then you have to explain to your staff why they need to get out of bed & drive in to work just for some pus.
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yeah, i agree on the localized infectons.
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I don't like the OR for infections for several reasons. Yes, the procedure is easier in the OR, but several other aspects are not as nice:scalpel2008 said:
1. Posted to the emergency schedule, I'm lucky if the infection goes to the OR before 3 or 4AM. In the meantime, I have a hard time getting to sleep knowing that I have to get up and "pop-a-jake" later on that night. I'd rather just get the misery over with.
2. It's harder for me to send them to the house if I take them to the OR. I've been pretty happy with how well patients do at home. Out of the 25 or so necks that I've cut this year, I've taken about five to the OR. The rest I've done in the clinic or ER. When I do it in the clinic or ER, I send them home on Clinda (150mg tabs are generic and a little cheaper) and Percocet, with a "Do not fill seperately" footer on the Rx. I'm always shocked by how people will get even expensive antibiotics when they have to in order to get the narcotics. Though twenty or so isn't a huge number, to this point I haven't had any come back two days later needing to be admitted. I've gotten increasingly more comfortable with sending people home. The five or so that I've taken to the OR were definitely angry looking. When I have the gut feeling to go to the OR, I go to the OR. I just don't get that feeling often.
3. In the ER, I'm not required to have my upper level or attending come in to share the misery. I prefer to bother them as little as possible.
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does your ER typically scan these pts before you get consulted? or if not do you all ask for a scan if the pt has trismus or do you just drain them? and curious whether you guys manage the PTAs? We don't have an ENT service so we end up with that also. Those are almost always I+D'd in the ED Regarding OR time, we are usually able to get a quick I+D on the board at a decent hour, even during the day, since we usually have 1 room running anyway. If it's the weekend, we usually end up going at about 10ish because ortho schedules weekend cases several days in advance and ob already has their stupid BTLs on the board even before the onset of labor. And that's about the time the general surgeons are walking out of the OR after treatig their overnight traumas and appys, cursing about how their life sucks. If it's at night then if it's not an emergency, we just admit them, iv abx, and drain them in the am.
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We rarely scan the patients prior to draining. ENT takes all paratonsillar abscesses, so we don't have to do those. Here, ENT is at one extreme, and we're at the other. ENT gets a CT scan for everything, including simple staph infections, and we virtually never get a CT unless we have an infection that doesn't resolve after draining (which is only once in a blue moon). It's usually due to inadequate drainage the first time, not so much because of an area we didn't know was involved.scalpel2008 said:
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We share the PTAs at one hospital with ENT and those usually get done in the ER.scalpel2008 said:
Regarding CT scans, a good clinical exam will go far, at least in my experience. It can be tough to see if there is pharyngeal swelling/deviation in a patient with trismus. And checking for tenderness at the angle of the mandible can give an idea if the lateral pharyngeal space is involved. I guess I could use the fiberoptic scope they have in the ER to get a look at the airway, but I haven't had to yet. Scanning is pretty mandatory around here for a suspected deep space infection, and I'm guessing this is true everywhere else.
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OMFSCardsFan said:
that's very interesting. i know physical exams go a long way but some severe odontogenic infections have atypical presentations especially those isolated lat pharyngeal and retropharyngeal ones. i guess if it has worked for you then more power to you. i just wish there were good pathognomonic physical findings like the general surgeons do with appys and gallbladders. The only things i've come across in multiple studies that consistently indicates that an odontogenic infection is severe is trismus, dysphagia, and fever (obviously dyspnea and dead also). i'm sure i will change my outlook on this several times during residency and my career when i get burned on something. i wish OMS had better resident exchange programs to get diff perspectives.
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We lived by a pretty simple rule....
In the ER if you drain something extraorally without permission from the Attending, "pack your bags". Nobody likes going to the OR, especially for pus, but I do think that you are able to do a better job there without having to fight the patient. Our hospital is pretty good about accomodating us in the OR...
As far as PTA's, I did about 15 of them last year. I hated doing them in the ER because the patients were so uncomfortable and I hate dealing with whiners! Most of them that came into the ER were young teenage girls who experienced this 1-2 times before. I filled their tanks with 2L of fluids, some IV antibiotics, and popped those puppies for some nice milky pus 😎 All of them got better, and 2 need a re-drain at follow-up. At follow-up, most of them got referred up to ENT afterwards.
In the ER if you drain something extraorally without permission from the Attending, "pack your bags". Nobody likes going to the OR, especially for pus, but I do think that you are able to do a better job there without having to fight the patient. Our hospital is pretty good about accomodating us in the OR...
As far as PTA's, I did about 15 of them last year. I hated doing them in the ER because the patients were so uncomfortable and I hate dealing with whiners! Most of them that came into the ER were young teenage girls who experienced this 1-2 times before. I filled their tanks with 2L of fluids, some IV antibiotics, and popped those puppies for some nice milky pus 😎 All of them got better, and 2 need a re-drain at follow-up. At follow-up, most of them got referred up to ENT afterwards.
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Damn. Is this a county or "private" hospital?Bifid Uvula said:
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toofache32 said:
it is called some residents who aren't that bright have drained branchial cleft cysts, dermoid cysts, necrotic lymph nodes etcetera and it gave ENT a stick to beat us with.... thus our rule is no extra oral draining in ED, not without a laborious work up including FNA, CT scans etcetera. 5 year survival rate of head and neck cancer if a resident drains a necrotic lymph node (thinking it is infectious because a tooth looked bad on a panorex) when the patient has nasopharyngeal carcinoma or base of tongue cancer or unknown primary, is very low compared to proper diagnosis and treatment of the cancer...lawyers just LOVE it. No shortage of expert witnesses to testify that maltreatment is the primary cause of poor outcome.... that is why we don't drain extra oral stuff in the ED and yes we are a "private hospital"/"country club"....except for the new residents' life which is hell cause I just want it to be ... 😀 I, on the other hand, happen to drive a golf cart to do rounds and putt down the hallways while sipping on my soda and lime....
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Does anyone know which OMFS programs are five year and which ones are typically six year programs but will cut you a year if you went to a school that had first and second year in lias with the med school students
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metalloprotease said:
as far as i know, case western and nebraska are 5. UCSF is 6 if you did 1st 2 years with MD students (3 schools total), 7 years otherwise (atleast when i interviewed in 2002)
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what about harvard, upenn, columbia, UCLA the reason I ask is most six years require that you spend 2nd, 3rd and a modified fourth in med school yet at some schools the dental students have completed second year with the medical students. Do any schools take this into consideration
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I guess it was 2001 that i interviewed at UCSF. Good thing they changed it, who the hell wants to do 7 when you can do 6.
