NPLEX Nastalgia

As Dr. Anderson's Naturopathic Physicians Licensing Examinations (NPLEX) prep course wrapped up here at CCNM for the 2nd year students, I clearly remembered last summer and a small part of me wished I could do it all again. Even though some of the same material was tested in my undergraduate, after 2 months of extensively studying the basic medical sciences, last summer was the 1st time I really felt like I knew what I was taking about!

In fact, last summer's studying was the highlight of my naturopathic journey until I entered clinic this May. I was my own boss, I could build up my weaker areas and dig deep into the areas that interested me the most.

Some words for the wise. If you are writing NPLEX 1 this summer (I write NPLEX 2 after graduation in August 2011), remember that no matter which one of the accredited schools you are in, the curriculum only sets a foundation to learn from. The exams are much, much more detailed and require extensive self study. The areas of anatomy, microbiology, immunology, food metabolism and pathophysiology are foundational to naturopathic primary care doctors and are one of the things that separate the accredited schools from the unaccredited schools.

Since the NPLEX format changed in August of 2009, there has been a heavy weighting on pathophysiology. Therefore a good pathophys textbook is a necessity. As a visual learner, another one of my favorite books is, "Metabolism at a Glance" by J.G. Salway (third ed). I also took Dr. Anderson's (systems based and focused more on Nutritional Biochemistry) & Dr. Grossman's (focused more on Anatomy & Microbiology) courses and enjoyed both. However, they are intended to remind you of the breadth of information required to know and indicate areas where you need extra studying. Furthermore, keep in mind that these review courses can not teach at the depth of knowledge required to pass NPLEX 1.

Just 3 study tips:

1. If possible with your school's schedule, take at least 2 weeks off after your final exams before starting to study for NPLEX 1.
2. Slowly build up to 8 hours of studying per day and take Sundays off to rest your brain (try for a minimum of 6 weeks of studying).
3. Take the day before the exam off completely. The NPLEX is a mental marathon, and like any athlete who has peaked for a performance, you need to rest the day before.

All the best!

A New Leaf

Today we completed the first of two days of clinic orientation. While biking to school this morning, the routine was so familiar, and our final exam marathon still so fresh in my mind, that I did not feel ready to be back at school. However, after the morning introductions, I realized that although the setting was the same, everything was different now. We are not only students, we are now health care providers. In fact, we were informed that 44% of the patients that visit the clinic here at CCNM reported that their ND intern was their primary health care provider. What a phenomenal responsibility!

We are turing over a brand new leaf in our journey. I understand that we are forever students and our next step is a 12 month long internship with 1035 clinical hours, case management documents, competency checks, more assignments, and still a few required classes. Even so, our focus has now shifted from excelling in class and passing exams to getting people to feel better. And, they do! We were shown some encouraging data that CCNM is accumulating, which reinforces what we all have known to be true: naturopathic medicine helps many people.

Quote of the Month

“We are indeed much more than what we eat, but what we eat can nevertheless help us to be much more than what we are."

Adelle Davis

One Last Push!

Six final exams down and 5 to go! The full-time 4-year naturopathic program at CCNM is not for the faint of heart and may not be advisable for anybody intending to keep one foot in the 'real world' and the other in naturopathic school (note: more part-time options are becoming available).

Focused curiosity is everything! Nearly every day I made a short list of things that were 'interesting' to me and I researched them. Also, I found that I had no choice but to live, breath, eat, talk, sleep, and dream naturopathic medicine for the last 3 years in order to keep the vast breadth of knowledge I learned applicable and current in my memory. This meant that my wife (and family and friends when I saw them) have had to put up with about three-quarters of the conversations ending up being something about medicine.

As a male, I will never be able to fully appreciate the experience of having a baby. Although, I have been at my wife's side twice (most recently two weeks ago) so I do have a better idea than some. As such, I am going to make a small leap here and say that I feel that there is just one last push remaining in this school year, with all the effort, the pain and eventually joy that accompanies the experience. Thank God for the joy!

Calm before the final storm

There is only a week and a half to go before the final exams of 3rd year. This will be the last set of final exams we will write. Sure, after graduation next year there will be licensing exams and provincial exams, which may be very difficult, but this is a huge mile stone. Beginning on April 19, our grand finale is 11 exams in 9 days.

I'm hoping to begin to live more of a balanced life once clinic starts in May. These past 3 years have been a tremendous sacrifice for my family and sadly my health to some degree as exercise was too often put low on the priority list. I really do understand now that becoming a ND is a calling and not just a profession.

Recently, I was talking with a prospective student who was debating between conventional medical school and naturopathic medicine. She told me her opinion of the strengths of each but explained that she had heard that naturopathic medical training was more difficult than conventional because of the additional types of medicine we learn. As such, she was concerned about the intensity of the program. Although I am unable to directly compare from personal experience, I can be fairly certain that if a person believes naturopathic medicine will be easier than conventional medicine, they may take a serious blow to their perceived academic ability. This is why I believe the "calling" has kept me going. If it was "just a profession" I would have stuck to my day job!

Quote of the Month

“Wellness is not a race but a journey."
~Unknown

TCM and Acupuncture Progress

As would be expected before entry into clinic, completing 3rd year means completing quite a few practical exams. Still remaining is our emergency medicine practical, in-office procedures practical, manipulation (chiropractic) practical, and the one that I am studying daily for, the Asian medicine acupuncture practical.

I did not know until recently that not all the accredited Naturopathy schools offer Traditional Chinese Medicine (TCM) and Acupuncture as part of the curriculum. Well, CCNM has a very intensive TCM and acupuncture program. Just to give you an indication, here is how the final exam will happen. First, we are presented with a case and need to determine a correct TCM diagnosis based on symptoms as well as pulse and tongue diagnosis. Then, we are required to select points that correspond appropriately to the case. We are required to know the actions and indications for about 225 of the approximately 400 total acupuncture points we have learned. Finally, we are required to locate and correctly needle 5 indicated points (within half a fingernail width of their specific location on the body) all within a 15 minute time frame. I would have never thought this was possible when I started in first year!

OSCE Follow-up

What an experience! If it wasn't for the nearly crippling anticipatory anxiety, I could almost say it was fun - the kind of exhilaration that happens during an important performance. Being sequestered in a meeting room for an hour, in a group of nine, prior to the official start of the exams did not help. However, I heard many other groups used much better coping tactics than mine did and they were able to laugh off some of the tension. I will never forget the walk down the stairs to the clinic. Our group walked in silence and I felt like I was in the movie Gladiator right at the scene where they were waiting to get rushed out into the Colosseum.

However, once I entered the first room and began talking to the patient, things began to flow more naturally. All the hours of preparation and studying pathologies, redflags for life threatening conditions and physical exams was integrated into somewhat of a smooth patient experience.

The OSCE's at CCNM consist of 3 patient visits that are each 18 minutes long. Then following each case we have 5 minutes to write up how the case would be appropriately managed and answer questions on our understanding of the patient's condition. Although 18 minutes is certainly not enough time to investigate the root cause of many diseases, it is sufficient time to rule out whether the patient has an emergency situation. As the first principle in our oath is, "First do no harm," having the ability to quickly evaluate the severity of a patient's symptoms and provide a medical diagnosis (Primary Care responsibility) and management plan is essential to every ND's training.

OSCE Time

Next week, the third year class will undergo the Objective Structured Clinical Examinations (OSCE). Passing the OSCE's are another one of those checks we require before entering into clinic in May...a really, really big check!

These exams were implemented 3 years ago as part of the continued progress towards ensuring ND's are ready for the field of being a Primary Care Doctor. The exams are the summation of all of our Primary Care knowledge up to this point and also tests our ability to clearly and effectively interact with patients. Although I am certainly under a lot of pressure right now, I can say that I'm proud that Primary Care is taken so seriously.

More on this topic after I pass!

The Learning Curve

As most of my colleagues in 3rd year at CCNM will be simultaneously pounding out the last details of their Relevant Clinical Inquiry Assignment (RCIA) due tomorrow morning, I have paused for a moment to reflect on the journey. Maybe I'm pacing myself, or still recovering from burn-out, but I just needed to take a moment and see the forest through the trees.

At this point in 3rd year, the focus is about checking off mandatory requirements before clinic in May. Number of clinic observation hours complete- check; number of patients - check; case management file - check; preceptorship hours - check; Gynecological practical exam - check; Male Genitourinary and DRE exams - check; RCIA - check. Check, check, check...It took a lot of planning ahead and coordination to get those checks while still managing to study and go to classes and I have certainly gained a tremendous amount of experience in the process.

Looking back, last year I needed to believe that 3rd year would be easier. Now it wasn't really easier, especially this final semester, but the learning curve was different. When I talk to my second year colleagues, I realize that the learning curve in second year is the steepest and sets a high standard of work ethic that just makes third year more manageable. Third year fills in the details and is the clinically relevant stepping stone that is required before we begin our internship in May. It is more practical and if I can relax enough to admit it, it is more fun! And, on that note, I have school work to get back to.