Thursday afternoon, several ninth and tenth trimester interns
left for Part IV Board Exams. National University of Health
Sciences does not hold Part IV on campus, so most students go to
Iowa or St. Louis for the exams. I went to Palmer College of
Chiropractic in Davenport, Iowa, for my final board exams. After
taking four other board exams, I walked into Part IV with a very
different attitude than the other ones. I'm not sure if it was
confidence having taken the other parts or just anticipation of
board exams being behind me.
Friday morning I had the first part of the exam, which was
diagnostic imaging. This exam consists of 10 stations with X-rays,
CT scans or MRI scans. After reading the films, I had to answer
questions about diagnosis, treatment plan, any needed referrals,
additional imaging, or additional diagnostic tests.
Saturday was the difficult day. Case management and chiropractic
technique exams were given that day. The case management exam was
very similar to many of the practical exams we had throughout
school. In the first few rooms, I took detailed case histories on a
simulated patient. Following these rooms, I went into a follow-up
room, which had more patient information, X-rays, and diagnostic
tests that added to the patient presentation. With all that
information, I needed to come up with a differential diagnosis,
treatment plan, any needed referrals, or additional diagnostic
Following these rooms, I went through several orthopedic and
neurologic testing rooms. In these rooms, I was given a list of
procedures to perform on the patient, I had to verbalize my
findings to the doctor in the room, and answer questions pertaining
to the case after.
The final portion of the exam was chiropractic technique. In
this section, I was given two chiropractic manipulations or
mobilizations to perform on a simulated patient. The chiropractic
listing for the patient and the name of the adjustments were posted
outside the room, which gave me time to think about set-up and
procedure. Once in the room, I performed all the steps up to the
actual thrust, and instead of thrusting I stated what my line of
drive would be to the doctor that was grading.
The entire exam on Saturday was about two and a half hours long.
So by the time I was finished, I was so burnt out mentally. The
worst part of the second day of the exams was the wait time after I
finished. In order to keep people from cheating or sending answers
to students taking the exam on the West Coast, we were sequestered
following the exam until all the West Coast students had checked
in. But, overall, I think the exam went well and fingers crossed I
passed. My scores are posted in late December. For additional
information about board exams you can go to NBCE.org.
It simply is the best time of the year! Between the costumes,
decorations, pumpkins, crisp fall air, trick-or-treaters, candy,
and the occasional scare--what is there not to love about
Halloween? Nothing, that's what I say. On Thursday, I went to the
17th Annual North Halsted Street Halloween Parade. I saw a lot of
repeat costumes of Miley Cyrus and Robin Thicke from the VMAs, Duck
Dynasty, and Walter White from Breaking Bad. But my favorite
costumes were Pepper from American Horror Story, the twins from The
Shining, and Oogie Boogie from The Nightmare Before Christmas. All
very well done.
At this point in the trimester, pretty much all the tenth
trimester interns are finished up with their patient care numbers
for graduation. Therefore, all the patient care has been turned
over to us ninth trimester interns, including any new patients that
come in. I was lucky enough to get a new patient this week that was
a National University of Health Sciences alumnus. As an alumnus of
the university, you are given free patient care at any of our
clinics, which I think is a pretty nice perk.
This week in my acupuncture elective we covered the spleen
meridian. This meridian runs from the armpit to the foot on both
sides of the body with 21 points a practitioner can use. Some
common aliments that can be treated using this meridian include:
enteritis, musculoskeletal pain, and disorders that increase
dampness. Another function of the spleen meridian is to cleanse and
'modify' the blood, and it also houses the body's Yi (wisdom
Any additional free time has been dedicated to studying for Part
IV Board Exams, which are the following weekend. I will be taking
Part IV in Davenport, Iowa, at Palmer College of Chiropractic. The
exam covers X-ray interpretation and diagnosis, chiropractic
technique, and case management. The diagnostic imaging section
covers cases that are commonly seen in practice and cases that
should raise red flags. The chiropractic technique section covers
cervical, thoracic, lumbar, pelvic, and extremity manipulations.
The case management portion covers orthopedic tests, neurologic
exam, case history taking, and physical examination. Currently,
every state requires Part IV boards to practice except
It's hard to believe that the trimester is more than half over
already. Once you are in the last phase of this program, the time
really flies. All your professors keep telling you that you need to
be prepared for graduation early because even though you don't have
class work to do you are still very busy. Busy with boards, busy
with electives, busy with numbers, busy with things outside of
school, and busy with planning what you will be doing
The patient load at clinic has been steady to busy most days.
This is great for all of us interns because we are getting more
experience and a good variety of patients. Also, there are little
to no worries about finishing our numbers for graduation on time,
which is a big relief. Being in a group setting with multiple
interns and a clinician to bounce treatments off and get second
opinions is great. It also has shown to be beneficial in that
everyone has a particular treatment or therapy they are very
proficient at. So we are all able to teach and help each other out
when it comes to treatment plans and patient care. This makes for a
very pleasant working environment at the NUHS Chicago clinic.
Treatment Room at the NUHS Whole Health Center
The past few weeks in my acupuncture elective course we have
learned the lung, large intestine, and part of the bladder
meridians. In Traditional Chinese Medicine, a meridian is the
belief about a path through which the life-energy "qi" flows.
Through needling these points, you are able to either tonify or
sedate the balance of qi in the meridian. The lung meridian
can be used for conditions such as cough, chest or shoulder pain,
asthma, shortness of breath, palpitations, fever, and many more.
The large intestine meridian is useful for symptoms such as
bloating, swelling, constipation, emotional stopping-up, headaches,
stuffy nose, or musculoskeletal pain. Finally, we learned a point
on the bladder channel called BL 13, which is useful for colds,
fever, cough, or flu-like symptoms.
The rest of my downtime has been dedicated to preparation for
Part IV board exams, which are the second weekend in November. With
Part I, II, III, and Physiotherapy now behind me, I am feeling much
more confidant going into Part IV. Part IV exams focus mainly on
skills learned throughout our chiropractic education including:
radiology, physical exam, patient intake, and chiropractic
manipulation. More details to come post-exams.
This week in clinic, I helped with a patient with a very
interesting presentation. The patient came in complaining of low
back pain that radiated down her leg all the way to her feet. Any
transitional movements increased the pain. The pain was described
as sharp and stabbing with numbness and tingling in her feet.
Bending forward or activities like coughing or sneezing would also
increase the symptoms.
All of these symptoms are a classic presentation of patient with
intervertebral disc problems. Therefore, our treatment began with a
McKenzie low back evaluation, which showed that extension would
help the patient. So, we started the patient with repeated, supine
back press-ups, which went well the first time. During the second
set of the exercises, the pain became very severe again and could
not be completed. From this point forward, we decided that pure
distraction (without flexion or extension) of the lumbar spine and
cold packs would be the best option while the patient was so
By the end of the treatment, we were able to get the pain down
significantly, but transitional movements still aggravated the
symptoms. So, we had the patient come in the next day so we could
continue treatment. The patient stated that the pain had decreased
significantly, and that there were no longer numbness and tingling
in the feet. That day we continued with the lumbar distraction and
cold packs, since the patient was still very acute. By the end of
the second treatment, we had the patient's pain down significantly
with no more radiation into the legs.
Saturday evening, Rob and I threw our Halloween Noir party. All
the guests were supposed to wear black and enjoy spooky music,
food, and drinks. Several of my fellow ninth trimester interns were
able to join in the fun including: Candace Gesicki, RJ Burr,
Jerrica Sweetnich, Ryan Meehan, and Bryan Robinett (all shown in
End of Week High
The week ended on a very high note. Exam scores were finally
posted for the September boards. I passed Part II, III, and
Physiotherapy Board Exams!! It's a very great feeling to have that
behind me. Now I only have Part IV to take in November, and then I
am finished with exams.
Last weekend was Part II, III, and Physiotherapy board exams.
Physiotherapy exams were on Friday afternoon. The exam covered
passive adjunctive procedures (thermo-, electro-, mechano-, and
phototherapy) and active adjunctive procedures (functional
assessment, exercise physiology, endurance training, muscle,
neuromuscular, and disorder-specific
Saturday morning was the two sections of the Part III board
exams. This exam covers case history, physical examination,
neuromusculoskeletal examination, diagnostic imaging, clinical
laboratory and special studies, diagnosis, chiropractic techniques,
supportive interventions, and case management. Each section of the
exam consisted of standard multiple-choice questions with extended
case vignettes questions at the end.
Saturday afternoon started the first exams of Part II, and they
finished Sunday morning and afternoon. Part II consists of six
separate exams that cover the following topics: general diagnosis,
neuromusculoskeletal diagnosis, diagnostic imaging, principles of
chiropractic, chiropractic practice, and associated clinical
sciences. Overall, I found Part II to be the most challenging exam
of the weekend. That fact might be due to Part II being the last
exam I took, and by Sunday afternoon I was completely physically,
mentally, and emotionally burned out. It was a very long weekend,
but it is such a great feeling have the exams behind me.
Now that board exams are finished, I finally have a chance to
start to get into a normal schedule for this trimester. In clinic,
things have been moving along very well, and I have been helping
out with patients plus seeing some patients as the primary intern.
Besides my clinical internship, on Thursday nights I am taking a
100-hour acupuncture certification course.
A meridian chart that I will be learning in my acupuncture
course. The chart
includes many of the traditional Chinese acupuncture meridians
that are taught.
As physicians, most states only require the 100-hour training to
practice acupuncture. Some states require 300 hours or a master's
degree in acupuncture, and you can find that information out on
your state association's website. For the state of Illinois, which
is where I plan on practicing, the website is www.ilchiro.org. The 100-hour course
consists of 20 weeks of five-hour classes and labs every Thursday
evening. The course covers everything from history to traditional
Chinese meridians to musculoskeletal acupuncture. It is a very
comprehensive course, and by the end of it, you leave with a large
set of protocols and procedures that you will be able to use on a
daily basis in your chiropractic practice.
• First Patients and Jurisprudence Class
• Ideas for the Future
• Part IV Board Exams
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