IMPRESSION - vol.6Late - American Student Dental Association
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IN THIS ISSUE volume six, late fall UBImpression 04 editorial Official Newsletter of ASDA Buffalo sumaya ibraheem ’18 Editor-in-Chief Stephen Rogers ’18 06 bitemark analysis: giving the wrong impression Contributing Editors lauren lewandowski ’18 Francis Gomez-Chaves ’19 Sumaya Ibraheem ’18 07 group function: UBIA Lauren Lewandowski ’18 summar amin ’19 Staff Writers Jesse Adamson ’19 08 asynchrony becomes 20/20 Chelsea Gerace ’18 Ashleigh Maciejewski ’19 dillon feigenbaum ’18 Andy Wagh ’19 10 q&a Graphic Designer Dillon Feigenbaum ’18 dr. joseph deluca ’07 Photographers 12 faculty profile: dr. josé luis tapia Mina Makram ’18 Danielle Niderman ’20 sumaya ibraheem ’18 Recruiter 15 primary impression: IDPs in buffalo Abby Scanlan ’18 shafinaz ali ’17 ASDA Buffalo 16 cantina28 Executive Board lauren lewandowski ’18 President Sara Perrone ’18 18 photography President-Elect mina makram ’18 Jesse Adamson ’19 robert davis ’18 Immediate Past-President Jordan Telin ’17 douglas levere Treasurer Rob Davis ’18 24 direct-to-consumer dental services Treasurer-Elect dr. timothy scanlan ’02 Alex Sikora ’19 Secretary 25 blog spotlight: the mutualism of video games Krunal Shah ’19 and dentistry stephen rogers ’18 26 impress me: chelsea gerace ’18 typeface lauren lewandowski ’18 credit 28 district 2 and why we’re organized Avenir: Adrian Frutiger Axis: Jean Wojciechowski lizzy lenchner ’19 Canter: Christopher JH Lee Dual: Fonarto: Charles Daoud Arwan Sutanto 28 comics Ostrich Sans: Tyler Finck Sinkin Sans: K-Type chelsea gerace ’18 29 residents’ corner dr. salina suy ’16 photo credit (cover): douglas levere 2
theUBIMPRESSION Attending the ASDA 2016 National Leader- dental school. He referenced Malcolm ship Conference in Chicago afforded me Gladwell’s 10,000-hour “rule,” which, to adversity in some new things. Along with the free swag and new friends, I came away with me, suggests that spending six to seven hours a day in dental school for four years diversity newfound inspiration. Adam Kreek, Cana- will make you a world-class dentist. In- dian rower and Olympic gold medalist, deed, tireless efforts for four years means gave a keynote speech about failure. As I something: it means that dedication and sat in the Continental Ballroom of the Chi- perseverance will lead to eventual suc- cago Hilton, still groggy at 9am on Friday cess. by Sumaya Ibraheem ’18 morning with the coffee slowly seeping its way into my vasculature, his words hit me The other, perhaps more powerful, claim hard. Kreek made was that if what we do is not so large to make us uncomfortable, we Kreek made two key points I hope not to aren’t doing it right. If we do not possess forget. The first was put forth as a ques- a fear of failure just enough to drive us, tion: why do many great things happen but not so much that it cripples us, we every four years? Kreek mentioned the will not succeed. Dental school has Olympics and the presidency as two ex- pushed me and forced me to question my amples, but my mind immediately went to abilities. It has made me sweat and 4
theUBIMPRESSION stress, cry and students, I would not have to hear racist remarks pro- and consume. claimed loudly by tenured professors regarding Colin Kaeper- But we must re- nick in the clinic. Indeed, maybe more diversity could also pre- member not to let vent one professor, whose criticism I took well, from saying, it make us question “It’s good you’re tough. Not like those Asian girls. They’re too our worth. We all face sensitive.” This race- and gender-driven comment is one to obstacles in the path which I can relate. Although this statement was meant to com- toward graduation, and pliment my strengths, it relayed the message by undermining some, like myself, will face a large group of people. I did not shy away, and when I re- more obstacles in the form sponded that this kind of stereotyping is unacceptable, he of microaggressions from pa- doubled down with, “But, it’s true!” tients, (“So, are you studying to become a hygienist?”) and even faculty (about a patient who But these three strikes have not put me out. requires an interpreter, “If they can’t learn the language, they shouldn’t be here.”). The difficulty of dental school can often For every difficulty I face, I gain unprecedented strength. I will be magnified as a minority student, an immigrant, and a come away from dental school, as I have from NLC, with tre- woman. mendous personal growth and empowerment, knowing I can come out on top. I encourage all my peers not to let these For some, it’s easy to hide from the identities that make us four years pass us by. I am not merely encouraging extracur- different, that make us targets. But my skin color, my foreign, ricular involvement, but mental and psychological awareness Muslim, Arabic name, and my gender are not things I can shy of what it means to experience these four years. To be aware away from. Specifically, being the only African American stu- and self-aware in our encounters, academic or otherwise, is dent in my class, it is easy to stand out and perhaps not in the to reach a consciousness that helps us improve and reshape most positive way possible. I struggle with tokenism. And I our surroundings and our experiences. I had to realize that the struggle with the feeling that I must, or that I, without choice, comment made to me was intended to be positive, but it was do represent my people. A white student, simply by virtue of at the expense of Asian American women. And this particular there being many others, cannot understand what it is like to moment is important because it shows me that no “others” be the only one. I also struggle in that I see no administrators are excluded from discriminatory statements. We must all find and almost no faculty members of color. Their absence makes what is important to us and fight for it. Diversity and the my experiences difficult, and it makes it harder for me to find a power of personal struggle are crucial to me. I must not only mentor that can relate to me or who faced the same struggles celebrate diversity, but foster and empower it, at all costs. I face. Perhaps with more underrepresented minority faculty 5
theUBIMPRESSION bitemark analysis: giving the wrong impression by Lauren Lewandowski ’18 A fractured central incisor, a lingually- asked to match teeth to photographs of the forensic community. In February 2016, positioned maxillary lateral incisor, a bitemarks made after 24 hours, experts the Texas Forensic Science Commission sharply-worn mandibular lateral incisor and were wrong nine times out of 10. recommended a moratorium on the use of flaring of the maxillary anteriors. A dentist bitemark analysis in criminal prosecutions may see this as a simple restorative case. Bitemark analysis as a means to convict in Texas until the practice could be sub- A jury said it was a case for conviction. was propelled into the spotlight during the stantiated by sound scientific research. 1979 trial of serial killer Ted Bundy. Bundy According to the publication UB Reporter, In 1985, Robert Lee Stinson was sen- violently murdered over 30 women. This Peter Bush hoped that this decision will tenced to life in prison. The prosecution’s led the public at the time to view bitemark “start a domino effect for much needed case relied heavily on bitemark analysis. specialists as “heroic scientists who help reform.” Dr. Johnson, a board-certified forensic put dangerous people behind bars,” ac- odontologist, concluded that the bite- cording to a historical overview by a Febru- The Innocence Project, an organization marks found on the victim belonged to ary 2015 Washington Post article. By 1992 dedicated to exonerating wrongfully con- Stinson with “no margin for error.” Yet over 193 criminal cases in the United victed individuals through DNA testing, upon re-opening the case and instead States used bitemark analysis as evi- comments that the findings “call into doubt evaluating DNA evidence, Stinson was ex- dence. convictions that rest entirely on bitemark onerated on Jan. 30, 2009, 24 years after evidence” and “underscore the steady his conviction. Admissibility in court continued unimpeded drumbeat of wrongful convictions based despite deficient research and under- on bitemark evidence that are later over- Bitemarks are not uncommon to find on whelming proficiency test results. Accord- turned based on DNA evidence.” They victims of violent crimes. They have a his- ing to a December 2015 New York Times also state that “over 25 people have had tory of being used as forensic evidence. Its piece, dental experts in 1987 could not their convictions reversed or indictments use as evidence is based on the unique- “even consistently agree on whether dismissed based on discredited bitemark ness or specificity of human dentition and wounds were caused by bites at all.” testimony.” the ability of human skin to record denti- tion patterns, according to a January 2009 Calls for concrete research were answered According to forensic experts like Dr. report by the Journal of Forensic Science. by Dr. Mary Bush and Mr. Peter Bush, re- Bush, statements such as those made by Bitemarks are interpreted to identify perpe- searchers at the University at Buffalo the Texas Forensic Science Commission trators, a process that falls under the um- School of Dental Medicine. The Bush’s are “a big step in trying to assure that only brella of forensic odontology. were among the first investigators to con- scientifically valid forensic evidence is used duct human cadaver studies and found in the courtroom.” Judges that make deci- Separate from bitemark interpretation is that bitemarks can be distorted by the vic- sions about the admissibility of bitemarks the use of DNA tests on surviving teeth tim’s movement following the incident. A as evidence in criminal cases can set a and periodontium made possible by the bitemark made on the lateral thoracic wall precedent for their use in either direction. durability of human dentition. These appli- with the arm initially raised above the head Until research supports the validity of bite- cations are backed by scientific research showed marked differences in intercanine marks as testimony, reliance on bitemarks and have undergone extensive testing distance, mesial-distal width and rotation could threaten the livelihood of defendants prior to use in criminal investigations. In angle when the arm was made straight or in the courtroom. However, “the right steps contrast, bitemark analysis is a compara- flexed and medially rotated. The conclu- are starting to occur,” Dr. Bush continues. tively unstandardized practice reliant on sion was that “no two bites were visually or Awareness and clear initiative for reform human interpretation and susceptible to measurably identical,” exhibiting up to 80 are evident, and it is now up to the legal subjectivity. A lack of scientific scrutiny and percent distortion. From a legal standpoint, community to catch up to the scientific history of wrongful convictions has raised the study recommended that every bite- community. questions to its legitimacy. A September mark be evaluated on an individual basis 1975 study by the International Dental due to dramatic differences between Journal produced a 24 percent error rate marks from the same dentition. Editor’s note: this piece originally appeared in the August when analysts attempted to match bite- 2016 edition of ASDA News (asdanet.org). The text has marks made in pig skin to teeth. When Results of the Bush study reverberated in been reprinted with permission of the author. 6
theUBIMPRESSION group function UBIA: global insight / local influence by Summar Amin ’19, UBIA President-elect UB Dental for Intercultural Awareness is a group of multi-ethnic students focused on promot- ing interest in and awareness of various cultures between the School of Dental Medicine and the Buffalo community. Formerly known as the Asian Student Association, UBIA underwent this transition in order to accommodate more students and acknowledge the diversity of both our school and the community we serve. Our educational and culturally-focused organization hosts the Cultural Spotlight series on how to appropriately treat different patient populations in an effort to make us more competent health care providers. In the past, we have presented about Islam and Hinduism, Syria and the refugee crisis, and dentistry in Egypt. Other events held throughout the year include dental education outreach events, oral screening events, Mission of Mercy trips to provide free den- tal care through the America’s Dentists Care Foundation (ADCF), and collaborations with non- profit organizations such as Journey's End Refugee Services and Jericho Road Community Health Center. But that is not all we do through UBIA. One of our main goals as an organization is to build a sense of community within our school. One of our most recent events, the International Food Festival, gathered many of our students and faculty to explore cuisine from all over the world. Students volunteered to make dishes to represent a wide array of different countries, and we fundraised enough money to provide local refugees with school supplies for their ESL classes. The purpose of this event was to celebrate the diversity we have in our faculty and student body. We also have a tradition of holding a mock waxing practical in the Fall for the new first year students, as well as a mock direct restorations practical in the Spring. Being evaluated for the first time on psychomotor skills can be very nerve-racking. In preparation for their first practical, we gather the D1 students in the preclinical laboratory and follow the traditional practical examination procedures. Upperclassmen, who generously volunteer their time, then provide feed- back to identify potential areas of improvement. This brings together first-year students with the upperclassmen to show them that they are not alone, and there is help when needed. This is one of the things we take pride in here at Buffalo. UBIA hopes to continue to reach out to more diverse groups and spread intercultural awareness and empathy, bringing us closer as one united community. 7
theUBIMPRESSION Members of the Class of 2020 are all here for the same reason and at the asynchrony same time. But their roads to UBSDM derive from different backgrounds, countries, and even career paths. These journeys foretell a standard truism becomes of dentistry: our profession mandates a multifaceted skill set. There’s no perfect way to prepare for a career in dentistry. Engineers, researchers, and 20/20 even chefs are prequalified to carve tertiary anatomy in milliscopic detail. Follow the paths of five future dentists and discover the roots of your future colleagues. MR Matthew Reuscher BK Borah Kim A native of Spencerport NY, Reuscher has trav- From Huntington, NY, Kim studied psychology in eled the globe. Although his interest in dentistry began undergrad, leading her to research in psychology and at age 13, he wanted to explore other options and collaborative healthcare. She then began working to- make sure he was ready for the commitment of dental ward a PhD in neuropsychology in Salt Lake City, UT. school. He attended culinary school at Le Cordon Bleu Kim soon realized the graduate program, and the field, in London to learn French cuisine. Reuscher also wasn’t for her. Reflecting on her skills, dentistry was spent ten weeks backpacking through Europe. Upon something she envisioned doing on a daily basis. returning to the States, he worked as a full-time assis- These experiences were instrumental in inspiring her tant in an orthodontist’s office. As a dual-degree stu- to seek out a career she would truly enjoy. dent, Reuscher completed the first year of his MBA at UB before joining the Class of 2020. This challenging, but rewarding experience has taught him effective lead- ership and how to work in a team environment. 2008 Psych and Collaborative Health Care Research 2013 Le Cordon Bleu Cooking School 2014 Orthodontic Assistant CS Claire Sesson From Wilkes-Barre, PA, Sesson attended Univer- sity of Pittsburgh and majored in biology. Wanting to take some time off from school, she became a flight attendant, which allowed her to concurrently travel and save money for dental school. As a reserve flight attendant, Sesson was on call for any irregular opera- tion, sometimes only getting two hours’ notice before a flight. Working with a multitude of people, encounter- ing different personality types, and creatively solving problems that arise on flights are experiences she will draw from when working with classmates and interact- 2015 ing with patients. Flight Attendant - American Airlines 8
theUBIMPRESSION PF Peter Finch IVA Isaline Vanessa Alhy Out of Freeport, NY, Finch completed his under- Originally from Paris, Alhy’s studies and career graduate and law degrees at Hofstra University. After ultimately brought her to New York. After working as a three years, taxing tax seasons, and a pep talk from a financial administrator, she realized that she wanted to friend, he decided to go back to school and pursue a do something positive on an individual level, with peo- career in science. The work ethic he acquired as an ple walking away from her office with a smile. Dentistry attorney prepared him for the intense study regimen of aligned with her values, skills, and interests. Her previ- dental school. Finch expects his experience in manag- ous experience has provided her with the maturity to ing legal cases and dealing directly with clients will fully dedicate herself to dental school and has given her lead to less anxiety during initial patient encounters. a deeper appreciation for everything she is learning. 2009 Juris Doctor 2009 Tax Attorney 2009 Financial Administrator post-bac. studies 2012 Began PhD in Neuropsychology 9
& theUBIMPRESSION A Q with Dr. Joseph DeLuca ’07 Q: In your view, how has ASDA changed locally and nationally in the last ten years? Ten years ago, Buffalo's ASDA chapter was very different. more. The national leadership and vision of ASDA Prior to 2003, the chapter’s only responsibility was Executive Director, Nancy Honeycutt, along with the organizing a few parties, and there was no national dedication of the students, has built ASDA into something involvement. The changes that happened in the four years I very special. I was extremely fortunate to be on the ground was in school transformed UB from a non-existent chapter floor for the rebirth of ASDA, both nationally and at our to one that was nationally recognized. Recent classes have local chapter. taken the chapter I left and improved upon it even Q: Who brought you into ASDA? What were your first impressions? The reason I volunteered to be an ASDA representative As the chapter grew, so did student involvement and my (that's right, no one cared enough at the time to make responsibilities within the chapter. Growing the chapter was ASDA-rep an elected position) was because the D2 difficult because we had to build everything from scratch. I assigned to my row in B28 during orientation was part of really enjoyed the transformation process and worked with the team of students trying to rebrand the chapter. I really some amazing classmates. Even though I had fun working didn't know what was involved with the position or what on the Buffalo chapter, my involvement on a national level, ASDA was at the time. My only real contribution was as District 2 trustee, was the most fulfilling time I had in organizing the Bills Tailgate event in D1 Fall. organized dentistry. 10
theUBIMPRESSION Q: What do you miss most about dental school? The response I always give to this question is, “the horrible. It's hard to find the time to do the things you want collective joy and misery of 85 other people.” When you are with the people you want. In dental school, everyone was out in private practice, your life doesn't mesh with your free at the same time, happy at the same time and friends as well. Sometimes I'm busy, and my friends are stressed at the same time. I enjoyed that sense of free. Sometimes I had a good day at work, and theirs was community. Q: How has ASDA helped you in your career goals? ASDA introduced me to many people that I still collaborate honest, I never really had my resume or career in mind with personally and professionally. When I have questions when becoming more involved with ASDA. I always did about dentistry, I have a network of ASDA friends across more for the chapter because I enjoyed helping my the country that I can go to for help. ASDA also allowed me classmates, and it was a great distraction from the stress to become more involved at the school, which helped me of school. when applying for a part-time faculty position. To be Q: What’s your current involvement with organized dentistry? Right now, I am not as involved with organized dentistry as taken a back seat to my family and work. I recently joined I was in school. I am still an ADA member and attend many the Alumni Committee and enjoy any chance I get to 8th District events. However, my leadership roles have interact with students through ASDA. Q: What advice do you have for current students? Editor’s note: Don't worry so much. I worried all the time in school about loans, ASDA Buffalo extends its requirements, and grades. Life will be great after graduation, and you'll most sincere gratitude to forget what you worried about in school. Why stress out about it now? Dr. DeLuca for his continu- Enjoy your time in school, learn as much as you can, and have fun. ous support for the stu- dent voice and organized dentistry. As a former District 2 Trus- tee, Dr. DeLuca helped to establish the rich history of Buffalo's national pres- ence and impact on the association. Mentorship is a critical component for the suc- cess of our profession, and Dr. DeLuca is a per- fect example of how that holds true right here at our chapter. 11
theUBIMPRESSION FACULTY AN INTERVIEW WITH DR. JOSÉ LUIS TAPIA PROFILE interview and transcription by Sumaya Ibraheem ’18 SI: Why dentistry? tional Autonomous University of Mexico project in oral pathology in order to learn (UNAM). more about it and be more exposed to what JLT: When I finished high school, I had good oral pathology is. But interestingly, when I grades so I was able to select any career No one else in my family is a doctor or den- was making the decision on what specialty that I wanted. The thing is, when I discussed tist. My mom and dad completed primary to study, I also had to consider my economic that with my parents, my father suggested school, and my two sisters finished high future. As I was number one in my class that I study engineering. “Computer science school. I was the first one in my family to get when I finished dental school, I could go is the future of the world,” my father said. a degree. But, my family has been my big- wherever I wanted. On one hand, I liked oral So, I thought, maybe I should try it. I went to gest support throughout my career. pathology, but on the other, an economic engineering school for a month. I noticed future working in the field of oral pathology that I didn’t like the environment. The group SI: How did you become interested in did not look promising. was so big. I was not happy, and I thought, I pathology? don’t think this is what I want. I decided first to study something that would JLT: While studying histology and oral pathol- improve my economic situation, and I went I had always wanted to be in the medical ogy, I really enjoyed viewing cells through the into pediatric dentistry. I was there for a field. In order to change careers in my univer- microscope. I found it interesting to try to month when the same thing happened to sity, you have to take an exam to transition identify the clues that determine certain dis- me as before. I began to realize the program from one career to another. You are allowed eases. It was like playing detective. I found was not what I was looking for. In part be- to select two options. I chose medicine and the challenges in every case exciting. During cause it was school-based, and I preferred dentistry, and I was accepted in dentistry. I my last year of dental school in Mexico, I working in a hospital setting. So, I decided studied at the Faculty of Odontology, Na- decided to do my social service and thesis not to continue in pediatric dentistry. I still 12
theUBIMPRESSION health of the Mexican people. CONACYT from all my mistakes, and I feel that I have accepted my papers. Finally, I was granted a become a better teacher every year. I have scholarship to pursue a master’s program in twice been selected by the D2 students as Buffalo. Teacher of the Year. I am humbly apprecia- tive of this great recognition by the students. I came to Buffalo to study a M.S. program in Currently, I am teaching dental students and Oral Sciences and the Advanced Oral and graduate students. Maxillofacial Pathology Program for three years. The problem was that the scholarship SI: When did you complete your U.S. was only for two years. The last year of my DDS? program without economic support was diffi- cult. My mentors Dr. Alfredo Aguirre and Dr. JLT: I did it when I became a full time faculty. Mirdza Neiders worked together to help me It was one of my goals. I needed it if I find a way to get through the last year with- wanted to practice oral pathology. Being a out the scholarship, and I began working in dental student again was difficult after ten the School of Dental Medicine. I finished my years without touching a patient. My col- program and received my M.S. in Oral Sci- league, Dr. Yoly Gonzalez, was very helpful ences and went back to Mexico. Two through this process. Her guidance helped months later, I came back to U.S. to take the me to understand and accomplish the re- American Board in Oral and Maxillofacial Pa- quirements for the DDS program. thology exam. An unusual situation developed while I was I went back to Mexico and stayed there for doing the DDS program. During the day, I two years. During that time, I was invited by was teaching dental students, and later, really like pediatrics, by the way. Dr. Aguirre to come back to the UBSDM to those students were my teachers in the lab. teach as part time faculty in the Advanced They were both my students and my class- After that experience, I realized that it was Oral and Maxillofacial Pathology Program. mates and we graduated together. It was a best for me to study what my heart wanted. I The employment situation in Mexico wasn’t great experience. continued on with my studies in the oral pa- easy for me. It was very difficult get a good thology program in Mexico (UNAM). job and apply what I learned during my train- ing in the U.S. Therefore, I decided to take a SI: How did you come to study in Buffalo risk and take the opportunity to come to the after that? United States to teach. rapid JLT: I had two great mentors in Mexico, Dr. Elba Leyva and Dr. Beatriz Aldape, who opened my eyes to other things. One day, When I first arrived, I taught in the radiology clinic, on the clinic floor, and in the oral pa- thology program. I was willing to do many fire Dr. Aldape asked me if I ever thought about things at the same time to prove that I could Favorite city: studying pathology in the U.S. I said, “Why be useful to the school in several areas. After not?” She asked me if I knew English, to that, there was an opportunity to work as a Chicago, IL which I answered, “No.” That was when I full time faculty, and I was fortunate to get decided after I finished my oral pathology the position. Favorite food: program, I would study English. After I gradu- Mexican, but I like to try different ated, I was hired by the school in Mexico to SI: You mentioned being a teaching as- foods teach as an assistant professor. In the morn- sistant in Mexico and then getting the ing, I studied English very hard in order to position at Buffalo, but how did you ini- pass the TOEFL test, and I worked in the tially get involved and interested in Favorite sport: afternoon. teaching? Tennis, American football After that, another problem came to light: I JLT: During my oral pathology training in Mex- Favorite restaurant: didn’t have the economic support to study in ico, I was asked if I wanted to teach. I said, Rue Franklin the U.S. I met Dr. Alfredo Aguirre in Mexico “Why not?” and I started teaching histology giving a lecture, and I asked him, “What do I in the lab at the dental school (UNAM). And I need to study in the U.S.?” He said, “Do you thought to myself, I think I can do this. I Favorite film: have the TOEFL?” I said, “No, but I’m going started to enjoy teaching. The important part “The Intouchables” and to study and I will get it.” He asked me if I about teaching is that when you teach, you “As Good as It Gets” have the economic support to pay for the learn more. You are more prepared. If you’re oral pathology program in the U.S., to which involved in teaching, you’re always updated. I answered, “No.” His advice was to get a I also liked learning from my students. Stu- Favorite music genre: scholarship. It took me three years to get a dents are a great source of knowledge. This Classical and pop or salsa for dancing scholarship. reciprocal learning process is a great experi- ence. In Mexico, I taught Histology, General If you could be any cell, In Mexico, the government doesn’t give Pathology and Oral Pathology. which would you be and scholarships for medicine or dentistry like they do for other disciplines. When I went to Teaching in the U.S. has been a great experi- why? the Mexican government institution (CONA- ence. Teaching in a different language and The dendritic cell because it’s a cell CYT) to submit my papers, I had to explain teaching with different methodologies has that multitasks. I would really like to be to them what I wanted to study. I told them I been a challenge. My first big course was that cell because I want to be a multi- would study something related to oral can- ODS825 (Oral Pathology I). It was not easy tasker. Sometimes I fail at it. But, I like cer. I wanted them to understand that I in the beginning, but I was well guided by it because it has different functions. would study something important for the Drs. Neiders and Aguirre. I have learned 13
theUBIMPRESSION SI: What’s your favorite or most memora- goals has been a great satisfaction. It was a SI: What are some of your hobbies? ble teaching moment? privilege to be her teacher. JLT: One of the things I enjoy is dance. I love JLT: The most important moment as a SI: You mentioned some of your men- to dance. After exams in Mexico, I used to teacher is when you see your students suc- tors before, can you speak to that? go out and dance with friends. The good ceed in their goals. A great example is one of thing is I don’t really drink, so I can dance all my graduate students, Dr. Rana Alshagroud. JLT: I have always had mentors and each of night. Unfortunately, here in Buffalo, I do not Dr. Alshagroud is from Saudi Arabia. She them has been a fundamental part of every have a lot of opportunities to dance. finished her oral pathology training this year. accomplishment in my career. In Mexico, She was the best resident from all programs two of my professors: Dr. Aldape and Dr. I also like to read about history, travel, and in the national fellowship exam by the Ameri- Leyva. Here in Buffalo, I don’t just have good visit museums. I like to play tennis, but I can- can Academy of Oral and Maxillofacial Pa- mentors, I have very good friends: Dr. Al- not do it as much as I want. I have ruptured thology (AAOMP) and in the national Ameri- fredo Aguirre, Dr. Mirdza Neiders, Dr. Yoly both Achilles tendons, one when I was a can Board of Oral and Maxillofacial Pathol- Gonzalez, and Dr. Louis Goldberg. These are student at UB, and the other one two years ogy (ABOMP). Seeing her accomplish her friends that I still learn from. ago. Write for Write for ASDA Buffalo National ASDA ASDA Buffalo was presented this year with a Gold Crown award for publishing the Contour and Mouthing Off are ASDA’s national most improved newsletter in the country. publications. Buffalo Editor-in-Chief, Stephen Become part of our movement for continued growth and feature your work on Rogers, also serves as a national editor. both a local and national stage. Contact a member of Buffalo’s Editorial Board if Each month we seek students from across the you’re interested. country to write on a wide range of topics. We are always looking for new ideas. If you want to write but don’t know what to If you are looking to present your writing to over write about, we can help there, too. Find your creative outlet, support your 22,000 students and expand your CV, contact colleagues, and enrich your future profession. Stephen today. Check your email inbox for our electronic offering, SUPERNUMERARY. UBISN brings you more up- SUPERNUMERARY to-date information, including pieces on advocacy, an ASDA event calendar, wellness tips, and satire for all to enjoy. IMPRESSION 14
theUBIMPRESSION primary impressions IDPs in Buffalo Q&A with Shafinaz Ali ’17 1. Have you noticed a different philosophy 2. What did you find was the most differ- 4. What resources have been most valu- of teaching techniques, procedures, or the ent aspect about the city of Buffalo com- able to you in your time at UBSDM? use of materials at UBSDM compared to pared to your hometown? your previous university? Faculty are the most valuable resource avail- The people. Buffalonians are extremely down able to every single student at UBSDM. They There are unique teaching techniques in each to Earth. In heavy snow, drivers still give way are passionate about teaching, very approach- country. Every academic institution attempts to for others to go first. People here are kind, gen- able, and extremely patient. This resource is offer the best available resources to its stu- erous, and selfless. priceless. As we all know, dentistry is neither dents in order to mold them into world-class white or black, it’s grey. Approaching different providers. The dental materials available at my One snowy day, I drove to a gas station to fill faculty members to get their opinion on how home institution and those at UB are very differ- up my tank. I almost didn’t have enough gas to they would approach a case will give you a ent. Have you ever experienced making a pri- make it home. A woman at the pump across whole new outlook on a situation. These differ- mary impression with impression compound from mine had prepaid for her gas. She filled ent points of view will increase your understand- for complete dentures? It’s not easy. In this her tank and had $8-worth remaining. She told ing and help you become a great practitioner sense, we are spoiled at UB. The materials me to use the remaining gas so I could make it by graduation day. made available to us here make our lives as home safely. Before I had the chance to repay students very easy. Another difference is the her for the gas, she sat in her car, rolled down 5. What is one thing you wish you would approach to treatment. At UB, a student treats the window and told me, “Pay it to someone in have known before beginning your first a patient more comprehensively, which mimics need,” and left. This occurred just a few days year at UBSDM? the outside world. Back home, a patient would after I had moved to Buffalo. Of course, this is be limitedly assigned for the treatment. It is only one example, but I have yet to experience I wish I knew that there are so many ways to similar to having a “comp oral” rotation. The anything to the contrary. be involved in so many different organizations. student on comp oral rotation would treatment As soon as you start your first year at UB, you plan and then students on other rotations 3. What has been the biggest challenge should start getting involved. This helps you would provide the remaining necessary treat- you have faced in adapting to UBSDM? build a network of colleagues, discover new ment. Lastly, access to a vast array of research passions, and it allows you to give back to our articles is an unparalleled advantage that UB The paperwork. There is a lot of paperwork to community. offers. complete. 15
CANTINA 28 menu Hors d’oeuvres Baked Brie with Rubber Jam lauren lewandowski ’18 Wheel of brie topped with raspberry jam, wrapped in puff pastry. *Latex free and radiolucent Gouda Percha with Assorted Crackers Antimicrobial selections of goat’s milk, smoked, and Contributing Editor Lauren Lewandowski is insatiable, and she has the puns to boot. Lauren is aged obturating points. serving up a full menu for this edition of Cantina28. Each recipe is salt and peppered to perfection, and the results are consistently spectacular. From endo files to tertiary anatomy, Appetizers these odontological creations will keep you sated for months to come. Buccal-nut Squash Soup Creamy butternut squash soup topped with sour cream and chives. Spinach and Articaine Flatbread crumb/frosting mixture to start shaping Mouth-numbingly delicious combination of spinach, artichoke hearts, and cheese. Cuspcakes cusps on top of the cupcakes. Put the cup- Ingredients cakes in the fridge for about 30 minutes to 12 baked yellow or white cupcakes, cooled help them set. Entrée completely 4. Roll out fondant to 1/4″ thickness and cut 1 can vanilla frosting out circles slightly bigger than the diameter Pasta al Dente Garlic butter white wine lingual-ine with fresh herbs. batch of white fondant (either homemade or of the cupcakes. Drape fondant over cup- with a side of from a craft store) cake cusps and trim the excess with a sharp knife, tucking in the edges with a spatula or Roasted Root Vegetables Directions your fingers. Cider vinaigrette dressed parsnips, carrots, golden beets, sweet potatoes, and lateral canals. 1. Prepare a batch of cupcakes in muffin liners. To make 6 molar cupcakes, you’ll need a total of 12 baked cupcakes. Desserts 2. In order to build up the cusps, break up 6 Cuspcakes cupcakes into crumbs with your fingers. Mix Vanilla cupcakes with enamel shade A2 icing. these crumbs with a few spoonfuls of frost- Choice of #19 or #30 occlusal tables. ing until you reach a consistency that is eas- ily malleable, but not too wet. Gingiva-bread Cookies Features a scalloped margin and healthy stippling. 3. Cover the 6 remaining intact cupcake tops Choice of thin or thick biotype. with a thin layer of frosting. Then use the 16
theUBIMPRESSION Spinach Artichoke Flatbread Ingredients pre-made flatbread, pizza crust, or naan (or make your own, gunner) 3 tbsp. cream cheese 1 garlic clove, minced 3 cups baby spinach ½ cup marinated artichoke hearts, chopped roughly ¾ cup mozzarella cheese, shredded 2 tbsp. Parmesan cheese, grated Directions 1. Preheat oven to 350 degrees. 2. Place bread base onto a parchment lined baking sheet. 3. In a small bowl, combine cream cheese and garlic, mixing until well com- bined. Spread on top of bread. 4. Add 1½ cups baby spinach to the top of bread, then top with artichokes. 5. Add mozzarella cheese, and then parmesan cheese. 6. Sprinkle salt and pepper over the top. 7. Place in center of oven, bake for 10-14 minutes, or until cheese is melted. Roasted Root Vegetables Ingredients 4 medium parsnips, peeled and sliced 4 medium carrots, peeled and sliced 3 medium sweet potatoes, peeled and sliced 2 beets, peeled and thickly sliced 3 tbsp. extra virgin olive oil 1 tbsp. fresh thyme, chopped 1 tbsp. fresh rosemary, chopped 1 ½ tsp. kosher salt ¾ tsp. freshly ground black pepper 3 cups apple cider 1 cup white vinegar 1 tbsp. sugar 1 tbsp. fresh flat-leaf parsley, cilantro, or chives, chopped Directions 1. Preheat oven to 425 degrees. 2. Toss together first 4 ingredients in a large bowl. 3. Add thyme and next 3 ingredients. Toss. 4. Arrange vegetable mixture in a single layer on 2 lightly greased pans. 5. Bake at 425 degrees for 35-40 minutes, or until vegetables are tender and browned, stirring after 20 minutes. 6. Meanwhile, bring apple cider and next 2 ingredients to a boil in a medium saucepan over high heat. Boil, stirring occasionally, 30 minutes or until reduced to 1/3 cup. 7. Transfer roasted vegetables to a large bowl, and toss with apple cider mix- ture. Sprinkle with fresh herbs. 17
squire in autumn photo: mina makram ’18 18
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shade guide photo: robert davis ’18 20
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pillars photo: douglas levere 22
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$ theUBIMPRESSION direct-to-consumer dental services timothy scanlan | ’02 Dr. Timothy Scanlan graduated from UBSDM in 2002. He served five years as a dentist in the Army and completed a one-year AEGD program at Fort Benning, GA. In 2009, Dr. Scanlan re- ceived his M.S. and certification in orthodontics from the Mayo Clinic in Rochester, MN. He cur- rently owns his own practice in Asheville, NC. It has been 14 years since graduating from spent on tuition, something that you need what we do clinically. This means focusing dental school. I have seen changes in the to consider is who will consume these on quality dentistry that does not cut cor- economy, medical and dental insurance, services. According to the Centers for Dis- ners. Ever. Period. Every root canal you and an increased interest in dentistry by ease Control, 64 percent of the United do, every restoration you place, every venture capital and entrepreneurial dollars. States population has visited a dentist in tooth you align, grafting you perform, tooth the past 12 months (this is your market). you remove, should all have care and ex- If your stomach turns at the thought of a This means 36 percent of the country pertise written all over it. Second, you corporate clinic opening across the street hasn’t used dental services within the past must, without a doubt, operate at maxi- from you, or people buying dental services year. This 36 percent either doesn’t see a mum efficiency. This means looking at your on the internet and not from you, you’re need, cannot afford it, or does not have practice as a business. After all, it is! not alone. The most important thing to con- access to care. This is a very appealing Lastly, and just as important, you must sider is who will consume these services opportunity for venture capital dollars or offer a second-to-none experience to your and will they be the patients you currently corporate dental services, or whatever you patients. This means, “Customer Service serve? want to call it. 101.” Look at the leaders in customer serv- ice and you will learn volumes. The Ritz Dental services have been part of the econ- This should make us all breathe a sigh of Carlton, Disney, Nordstrom, and countless omy for ages. What motivates the pur- relief. The 64 percent of the population others are doing just fine. chase of a dental service or product de- won’t decide overnight, or even over a pends on a few factors: (1) availability of longer period of time, to wake up and I’ll leave you with one final thought. Don’t dental services, (2) affordability of services, change providers to a corporate dental worry about direct-to-consumer dental and (3) the perceived need. All three must outfit, or to order their child’s orthodontic services unless you intend to compete in be met to have predictable consumption. care on the internet. Let’s call this what it that market. Offer a high level of customer is: investors looking for opportunities to service with a high level of expertise. Peo- What direct-to-consumer dentistry does is sell services to a population willing to buy ple have never based their decisions on simple: it markets the need for services, them. What do we do about it? It forces us price alone. If that were the case, every makes those services easy to access, and to stay at the top of our game. driveway would have a Kia parked in it and provides these services at a discounted everyone would stay at Motel 6. rate. Now, before you start regretting the I would consider three important factors. hundreds of thousands of dollars you First, we must be the absolute best at 24
theUBIMPRESSION BLOG ↑↑↓↓←→←→B A START the mutualism of video SPOT games and dentistry LIGHT written by Stephen Rogers ’18 design and commentary by Dillon Feigenbaum ’18 In 1994, I arrived home one day to my father sions are complicated by confounding, uncon- setting up a Super Nintendo Entertainment trolled variables that cloud definitive causal System (SNES). I stood motionless, elated. He relationships. But these studies raise a variety switched on the power and the Super Mario of other points about skills related to dentistry, World splash screen appeared on our 12-inch including contrast sensitivity, visual attention MAGNAVOX CRT. An empty backdrop yielded capacity and spatial distribution. pixelated white letters, “Nintendo presents.” Koji Kondo’s Mario theme began to loop as the What a gamer says: mustached protagonist jumped across the screen. Aside from scientific inquiry, there are innate benefits for dental students who game. Here’s my short list: DF says: 1. Improved critical thinking I’m adding #6 to that 2. Improved problem/puzzle solving list: improved concen- 3. Outlet for small groups of students that tration during high doesn’t have to involve alcohol stress tasks. The most 4. (potentially un)-Healthy competition intense video games 5. Narrative place players in anxiety Who cares? inducing situations To explain my last point is to also explain my where there is often answer to the dental school interview question: I do. Maybe you do, too. There’s very little time little to no margin for “What was the last book you read?” in our chaotic schedules to unwind and con- error. Kind of sounds sume entertainment (alas, a sixth reason on my like a direct practical. If you haven’t picked up a video game other list). Studies may not (yet) support it, but if you than Wii Sports, I would understand if you do want to take a break, I urge you to give wrote off video games as a chronic time sink gaming a shot. It may help you augment skills In 2015, sitting beneath a flat screen television without any educational or mature, developed that relate to your clinical and pre-clinical real- is that same grey, yellowing SNES with technol- storytelling. Now I ask, à la Bill Nye, please con- ity. At the very least, video games will bring you ogy more than twenty years the TV’s senior. I sider the following. In 2009, a role-playing both joy and an outlet- two commodities that seldom power-on the system, but its presence game (RPG) called “Dragon Age: Origins” was come at a premium during the pre-doc experi- is well respected by any dental student that released and sold more than 3.2 million copies ence. walks through my apartment door. Video while gathering accolades such as “Game of games occupy a very special place in the the Year” from several prominent publications. hearts of twenty-somethings. I’ve personally noticed, a disproportionate amount of dental According to Game Informer, “DA:O” featured “742,000 words of dialogue, and 202,000 DF says: students feel the same way. It caused me to words of non-conversational text.” For compari- It’s more than just wonder about a connection between video son, Encyclopedia Gamia lists popular literary words. Deeply moving games and people who will rely on psychomo- works with similar word counts: games like Shadow of tor skills throughout their careers. Is the con- the Colossus and Jour- nection real? Bible – 1 million words ney contain little to no Harry Potter (7 books) – 1 million words dialog or expository What science says: Twilight (4 books) – 591,434 words text, allowing their Lord of the Rings (4 books) – 550,147 gameplay, music, and words art direction speak for Much of the research on this topic relates to Iliad – 147,317 words themselves. the impact of video games on the psychomo- tor skills of surgical residents. A 2011 study in Odyssey – 129,443 words Ireland concluded that gaming enhanced psy- chomotor skills, but not visuospatial or percep- Other noteworthy games with extensive stories Editor’s note: this piece originally appeared on ASDA’s blog, tual ability in predoctoral medical students. include Baldur’s Gate II (1 million words), the Mouthing Off (http://www.asdablog.com), on December However, this study, and many others of its Mass Effect series (1.2 million words), and Final 16th, 2015. The text has been reprinted with permission of the author. kind, are correlational studies. That is, conclu- Fantasy VII (600,000 words). 25
impress me chelsea gerace ’18 by lauren lewandowski ’18 Chelsea Gerace’s creative talent became apparent when she was eleven years old, making dollhouses out of shoeboxes with one of her friends. The structure was finished, but being a fan of detail, she be- gan to make people and furniture out of baking clay. In eighth grade, Gerace took a home economics class, learning the sewing skills that can be seen throughout her creations. “I like to make pretty much anything that’s small and includes my hands.” From ceramic clay and jewelry making, to embroidery and felt crafts, Gerace is cer- tainly a prolific craftswoman. She draws her inspira- tion from the world around her. Ideas may come from the internet or eye-catching patterns found on a tissue box. In her opinion, the best thing about crafting is, “You can take your inter- ests, like Harry Potter or a movie, and make whatever you want from it. Then, you have your own memorabilia and some for your friends, too.” Gerace describes her style as free-form, citing her crafting philosophy, “I don’t know what I’m doing, but I hope it turns out okay!” Working with clay allows her to do just that. It’s the me- dium in which her incredible attention to detail shines through. Constructing with clay does present a few challenges, however. Avoiding smudging with fingerprints and incorporating dust particles was difficult at first. When working at such a small scale, forming delicate fea- tures like eyes that are the same size is quite the task. Gerace also cites a learning curve in mixing colors and coordinating shades. Crafting with felt enables this inventive dental student to integrate things like embroidery into the finished product. Contrary to working with clay, Gerace notes the careful planning process of making complex felt figures. Knowing which layer of color goes on top of another and how it will be sewn together to either hide or display the embroidery thread for design purposes is 26
a puzzle that must be solved ahead of time. She remembers the Harry Pot- ter characters as some of the most difficult, yet rewarding, pieces she has made. On the opposite end of the crafting table, Gerace recommends needle point to anyone seeking a creative outlet (once D4 rolls around, obviously). “Anyone can needle point, especially if you keep it at a basic level.” Designs can be found online, or you can create your own. She says that people are largely impressed by these versatile projects. You can custom-make needle- points as gifts, designed specifically for the recipient (see: “Gunners Gonna Gun,” made with love for Yotom Rabinowitz ’18). Growing up, Gerace would always make her own greeting cards. Her work has since evolved from magic marker on pieces of computer paper, credit- ing the invention of gel pens for her current style. Every note card is unique, made up of layers of differently colored and patterned papers. Friends and family members alike sincerely appreciate the personal touch included in Top: taco earbud-holder (felt), middle: Nintendo characters (clay), bot- each greeting. tom: onigiri (felt). Like most, Gerace feels that she has less time for hobbies because of dental school. When she does craft, however, it’s a source of stress- relief. The positive effect continues with the flood of compliments she receives on her creations, leaving her with good feelings about her abili- ties. “I’m not used to having so much positive feedback. Everyone’s a lot more impressed than I thought they would be.” Gerace calls this “art- ist syndrome,” where every tiny error made in the process becomes apparent, but observers just see the overall product. To other artists, she advises, “Try not to be so hard on yourself!” Chelsea Gerace’s creativity can be seen around the dental school, proudly worn by students and helping to raise money for BOCA. Tiny felt teeth with goofy expressions bring smiles to children in the pediatric clinic and are great conversation starters with patients. Gerace’s imagina- tive talent is admired by all, and we hold on to the hope that an Etsy page will make her whimsical creations available to the world. 27
theUBIMPRESSION District 2 and why we’re organized by Lizzy Lenchner ’19 Who am I? Where am I going to be in 15 a profound feeling of pride and commit- do not stop trying until you reach them. years? ment in the air. A sense of family. Dental Learn and experience as much as you can students were learning from each other, during dental school, both in and outside Although we all have different answers to chapters shared strategies, and dentists of school. Remember that organized den- these questions, we share one feeling: a were moderating discussions on every- tistry is like a family, serving as a resource passion for dentistry. It’s crucial to remem- thing from advocacy to leadership. center, providing support, and working ber this in order to keep building, explor- together to advance the profession. Dental ing, and expanding our goals. Fortunately This was the first time that I truly realized professionals hold themselves accountable for us and our patients, the profession of the importance of being involved in organ- through review boards and advocate for dentistry uniquely supports our develop- ized dentistry. Our profession is strong be- measures that ensure the quality of care ment. We just have to utilize what’s being cause of our drive to protect it. Okla- that patients deserve. handed to us. homa’s Dean, Dr. Raymond Cohlmia, said in his lecture, “leaders become a part of It is imperative for dental students to take As students, that resource is ASDA. the problem to be a part of the solution.” an active role in ASDA. Our involvement is Organized dentistry reflects the combined intended to seamlessly translate into en- My most recent involvement (and re- efforts of many people, dentists and non- gagement with the ADA. The field of den- minder) was the District 2 meeting at NYU dentists, who are seeking to improve the tistry is changing, and we are at the fore- College of Dentistry. At 7:30 a.m. on a Sat- profession and better serve patients. front of determining how these changes urday, 150 attendees from the five schools will affect the profession. ASDA offers that make up District 2 (now six, including “Just do it” was the take home message many opportunities to learn more about Touro) came together to learn more about of Dr. Jason Watts’s (Nova Southeastern organized dentistry and to strengthen a dentistry, meet new people, and network ’15) presentation. When you are in class, student’s leadership path. ASDA and the with dental professionals. We engaged in think about how lecture material may apply ADA are here to support you. Utilize their round-table discussions after listening to to a clinical scenario down the road and offerings and support network to get you dentists involved in organized dentistry at ask questions. Practice in preclinic as if moving toward the next stage of your ca- local, state, and national levels. There was you are with a real patient. Set goals and reer. C O M I C S Chelsea Gerace ’18 28
theUBIMPRESSION residents’ corner dr.salinasuy16 didn’t learn enough to feel confident quite eight patients a day with intent to move yet. Despite UBSDM providing general upwards toward 10 to 12. So, I started out knowledge in all areas of dentistry, there is with eight when I was used to having two. still so much we couldn’t cover or that we The need to learn quickly is essential. For- did not get a complete understanding of. tunately, attendings have a strong pres- And that’s OK. ence. When you’re in a pickle or need that extra opinion, they are the best people to Under the guidance of faculty at UB, I felt ask. Not only do attendings want to teach confident in basic restorative work, fixed you, they are usually very understanding of crowns, and removable partial dentures. If our learning process. Four months in, I you put a complete denture in front of me, have seen several traumas, felt more confi- I still can’t really tell you what I’m looking dent in oral surgery techniques, and am at. My weaknesses were clear to me: medi- not afraid of complete dentures any longer. cal emergencies and complex patients, While my weaknesses were strengthened, complete dentures, and oral surgery. To be my strengths have also been sharpened. a confident dentist, I needed to improve in Foreward: Dr. Salina Suy is a UBSDM graduate and a my weak areas. This made a GPR a clear Insurance restriction is the most frustrating current resident in the General Practice Residency choice for me. The GPR I found had every- aspect of the residency. We want to save Program at Faxton St. Luke’s Healthcare. thing I wanted: call experience with dental every tooth, but in reality, we just can’t. emergencies, a hospital-based program Despite this, we do help a lot of people Approximately one year ago, I was in the with complex patients, a decent salary, who need us, and we are grateful for that. process of applying to residency pro- and a high population of underserved pa- One of the interesting aspects of being in grams. The decisions I made led me to my tients with needs in oral surgery and remov- the hospital is anesthesia and ambulance program now, and I couldn’t be happier. able. rotation. It really makes you appreciate the D3 is tough. With the crazy clinical require- other health care providers around you ments that no one seems to make, or the Faxton St. Luke’s Healthcare’s General and what we all collectively do as health million quizzes and exams, they expect us Residency Program accepts five students professionals. to prepare for what is going to happen af- every year. The program is over 35 years ter you (presumably) pass. It all seemed so old. One of my favorite things about the After residency, I’ll be ready to have my far away for me until people suddenly program is the diversity in knowledge own practice. I never wanted that until I started asking questions like, “What are among the residents. In my year, all five started D4. The idea of having an office of you going to do when you graduate?” residents came from five different schools: my own is alluring. I can cover the walls Buffalo, Detroit Mercy, Marquette, Howard, with my paintings, treat patients with de- So, what is it you think you want to do and Gainesville. Having five different per- cency, and have a supporting team that when you graduate? The first time some- spectives during treatment planning semi- will maintain this environment. It’s not an one asked me, I didn’t know what to say, nars and on a day-to-day basis allows me easy decision, so I am starting my search and that really got me thinking. What do I to learn in a supportive environment. early. want to do? What are my options? Depending on where the hospital is, the Private practice is a very real goal. I encour- Generally, you know by D3 if you want to GPR experience will vary widely. In gen- age everyone to at least consider opening specialize or not. If not, you really have two eral, however, most hospital programs will their own operation and avoid passively basic options: residency (GPR/AEGD) or involve a call schedule with medical rota- gravitating toward a corporate-style of de- work. It helps to at least have your priori- tions, seminars and lectures, busy sched- livering care. By this time next year, I will ties straight before making a decision. ules, and low SES patients. It has been have my own license and practice, and Some students have families they need to about four months into my residency pro- nothing is more empowering than that in support, and others want to pay off their gram and it’s incredible how efficient my our profession. loans quickly. I personally didn’t feel ready training has made me. At the beginning of to just get out there and start working. I my program, I was eased into it. I had 29
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