another SIJ test – talk to your clinician. You then take about 25 minutes to write out an ROF (for the first time anyway) – talk to your clinician. You finally get to the treatment. But, this is necessary, as in the beginning we always miss little things in the history and physical exam-ination. Now, how applicable are these little details that we miss? That is up for debate, but overall this process is sup-posed to be lengthy and awkward, be-cause it is something we have never truly done before. Going through comps in 3rd year CE cannot replicate what you are about to experience in 4th year. In addition to this, the school internship does not necessarily prepare you for the real world. Especially with the COVID-19 pandemic, this only complicated things further. No class at CMCC can prepare you to send a ROF PDF over Zoom and then explain how the patient can down-load it, sign it, and send it back. Once I started my externship, I realized there was another layer to learn. How to be efficient in a 20-minute subsequent ap-pointment. How to get everything done – history, physical, and treatment in a one-hour initial appointment, and real-izing that these patients are paying real money for our services. I quickly learned from Dr. Klein how to identify and exe-cute a focused treatment plan. Test, treat, re-test, give active care advice. How he was able to do this over a 20 minute period amazed me at first, but I quickly realized that Dr. Klein, with his experi-ence, prioritizes certain aspects of each condition that he sees (These priorities can change depending on the patient, even if it they have a similar problem). Some patients in the short term truly only want pain relief, and some just want the ability to performed certain function. Dr. Klein does a good job at siphoning this out, and dictating the treatment to-wards the patient’s needs in an evidence based, and efficient manner. The test aspect is quick and to the point. I learned I don’t need to do every single shoulder impingement test to figure out if some-one has a shoulder impingement. Apply pertinent tests depending on the sus-pected condition, and go from there. inspire. I took this as an opportunity to learn, and develop myself both profes-sionally and personally. I fondly recall my internship at CMCC with Drs Decina and deGraauw and I enjoyed having the opportunity to “pay it forward.” My teaching goal for Jake was to en-courage the transition from academic assessment and treatment to real world assessment and treatment techniques while allowing Jake to make decisions on what he feels will work with his own ethos. My experience and my academic research has found that purely focusing on orthopaedic testing as a stand-alone assessment tool is largely ineffective, and frankly not evidence-based (Cox, de-Graauw, Klein; JCCA 2016). Having said that, it does form the basis of an assessment protocol that allows the prac-titioner to grow further, but they have to choose to do so. I gave Jake all of my clinical pearls, my algorithms, and “tricks of the trade” while keeping in mind he still had board exams to complete and encouraging him to keep his brain open to all angles. Find the keys, and address them with whatever tool you see fit. Using every test and treatment modality available simply is not practical. In the end of the day, CMCC gives you a lot of tools, but not all of them are practical in a real world setting. For whatever reason, I know way too much about Myasthenia Gravis, and not enough about how to manage a torn hip labrum. Its all about taking these tools, appraising them, and figuring out which are practical in a real clinical set-ting. This will not only make you more efficient, but it will save the patient’s time and money down the long run. Re-sults-driven solutions, in a patient cen-tered, time orientated, and costly manner. I saw so many things, from the nor-mal, to the abnormal, including ectopic pregnancy, severe hypertensive head-ache and neck pain, and rare neurolog-ical disorders. What was more impor-tant, was seeing all of the different subtle presentations and trajectories that low back, hip, neck pain and all MSK presentations can take so that I can make the best decision for the pa-You need to assess, educate, adjust, and do your rehab. Jake excelled on all levels, showing great competency, connecting with pa-tients, and really gaining traction on what will be required of him once he completes his training. He finished with 467 subsequent visits under his belt, which to me seems like it must be some kind of record! tient AND be effective for them. People aren’t cyborgs, they are people and we need to treat the whole person. DR. KLEIN JAKE ‘THE INTERN’ DR. ERIK It was an absolute pleasure having [the now Dr.] Jake in the clinic. There is a saying that in order to learn, you should first listen, then do, then teach, then www.Cndoctor.ca I learned to always keep red flags, yellow flags etc., in mind. I also became more aware of applying the KISS principle: “keep it simple silly.” What stuck with me was the following concept: Abnormal presentations of common conditions, are more common, than common presenta-tions of abnormal conditions. This has brought me a long way with my clinical intuition, and not fearing the worst, but yet being prepared for it. The treatments I have learned to execute are an expres-sion of what we find during the testing. Just because someone has PFPS, does not mean to do soft tissue passes over every muscle that influences the knee. For me personally, I definitely grew as a doctor. It was a lovely opportunity to teach, AND be taught. We docs out in practice for 15-20 years still have a lot to learn, and this was the best opportunity for me to do so. CMCC provided a great deal of training and they were very supportive and responsive. From a practical stand-point, having an extra set of hands and eyes in the office al-lowed me to spread the work a little bit, freeing me up to take care of some business matters which made me a more efficient business owner, and to support my teams. So as a doc in the field, if you’re wondering if this is for you, and you enjoy the idea of paying it forward. I also encourage CMCC to make this a permanent option for their clinical educational program. This is the most patient-centred path forward. September/October 2021 Chiropractic and Naturopathic Doctor 17
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