9th Trimester: Reaching Out
Preface: Ten months ago, I graduated and noted that “there is still much more to write!” Yet, the last time that I updated this record of my studies was for my 8th trimester, which I finished in May 2015. I’ve seen the same thing happen with many other blogs by future doctors, and though I swore it wouldn’t happen to Hands in Training, here we are. I kept good notes (including three independent drafts of this post), so let’s resume where we left off, shall we?
Chief among the advantages of attending a rural college is the peaceful and uncomplicated setting. College ratings will tout the connection with nature, the quiet to think and the space to stay fit and healthy. Seneca Falls is one of those rural places, and it turns out that a town of few diversions (and an early finish on Fridays) makes for the ideal blogging conditions. During my final two trimesters of school, I lived in Rochester, NY and Providence, RI, respectively, and there were enough exciting attractions (and obligations) after class and clinic that blog updates fell by the wayside. Ironically, these were some of the best stories of my education!
The summer of 9th trimester was a wild time for me. Much to my excitement, I successfully applied for a special preceptorship where I would spend my trimester 10- but that required completing all graduation requirements a full ten weeks before all of my classmates. To keep up with that accelerated pace, I signed up, showed up, or schmoozed my way into EVERY opportunity to see patients over the summer. That took me all over the state.
On a sunny summer day, 8 students and a doctor pulled up to the Xerox headquarters lawn just west of Rochester, and began setting up chiropractic tables under the shade of a stand of huge sycamores. Soon, cyclists started finishing their 25, 50 or 100 mile rides as part of Tour de Cure, an event to support the American Diabetes Association. Riders and other volunteers lined up at our shady copse for musculoskeletal care to aid in their performance and recovery. Joint manipulation, soft tissue manipulation including stretches and trigger point work, and guidance on movement were some of the most common interventions administered in our outdoor clinic space.
Each patient “visit” started with a history of the chief complaint. In the athletic arena, many don’t have a particular complaint, but instead want to generally compete harder or recover faster. Often, that leads us to focus in by asking about common soreness, stiffness, or limitations instead. Then again, athletes also have a tendency to present with the craziest, most unique injuries. So reviewing medical history and performing a neurologic screening (muscle strength, reflexes, sensation) is the next step in ensuring the patient is a good candidate for care. Then we used physical exam and orthopedic tests to learn more about the patient and their complaint. Finally, as mentioned, we got into treatment. And of course, we documented all of this. Pretty good, right? Let me tell you, handling this all in a lively, outdoor setting is hard to beat.
It was well-received by the athletes and so enjoyable we did it another half dozen times over the course of the summer, traveling to a variety of events throughout Western NY. An outdoor basketball tournament that took over the downtown streets of Hornell. A sweaty, muddy half marathon and 5K around the wetlands of Montezuma.
Each time, we met the people who came out for fitness, for fun, for competition, for their cause, and to be a part of their community. We got to support those people and temporarily become a part of those communities and that was awesome.
As for me, I mentioned my own motives for my constant involvement: getting those patient numbers up. So, back to looking at the more immediate and official version of my last summer of chiropractic college. Here’s the schedule:
- Clinical Service Phase II – 16 credits,
- 28 hr/wk clinical, 2 hr/wk lecture
- Chiropractic Office Management Simulation – 0.5 credits
- Getting Into Practice – 2 credits
- ConnecTX Therapy II: Upper and Lower Quadrants – 1 credit
- Integrative Chiropractic Geriatrics (Audit only)
Those two online courses sought to provide some practical guidance on the non-clinical side of being a doctor of chiropractic. The office management simulation worked with the details of using SmartCloud, the electronic health record software employed in the NYCC clinics [update: now a ChiroTouch product]. Getting Into Practice loosely covered a range of topics related to joining or starting a business. The content value was pretty mixed, and really depends on if you study business at all (or maybe obsessively consume books and podcasts related to business, like one of my favorites, StartUp). ConnecTX II was the second in a series of courses on soft tissue treatment using instruments, which also incorporated movement principles to improve the effectiveness of treatment. Geriatrics provided excellent guidance on co-management of patients with other health professionals, special considerations for treating this group of individuals, and overall best practices in conservative health care. Dr. Dougherty provided very valuable content, and I highly recommend it, but be prepared to work.
I, myself, worked hard during T9 to plan for my departure at trimester’s end. If you set your sights on a preceptorship or externship, allow my experience to guide you here. Make a plan on how to achieve all the requirements, with benchmarks of how close to finishing you should be at various points in time. Advocate for yourself; nobody else is as invested in your plan as you, and while nobody in administration can keep track of your readiness, they will need you to constantly communicate if you want to finish. Your extra work and attention to detail will ensure your plan comes to fruition.
In mid-August of T9, I hit my goal. I had managed the hundreds of patient visits required for graduation, with the assist of our encampments at outside events and other extra clinic opportunities. I had done all the paperwork, sought out all the signatures. I would be off to the clinic which I had noted two years earlier as my goal. More on that when I write about 10th trimester, coming up.