Why do you think it is important for chiropractic interns to gain experience in at the VA?

My clinician, Dr. Christopher Sherman, told me to prepare myself to see some unexpected things on my first day at the VA. “Everyone is complicated,” he said. “Our job is to figure out who we can help or where we should refer them so they can get the appropriate care.”

I wondered to myself, after I heard that, how crazy complicated could these patient’s needs could be?

Well, three patients later that particular morning, a gentleman sat down for his initial visit. He stated he was there for thoracolumbar pain. I laughed to myself, “so complicated.”

During the interview he disclosed he had undergone a lobectomy due to lung cancer. Soon after that he lifted his shirt, prominently displaying his saphenous vein, which was shunting blood from his subclavian artery to his lower abdomen. This procedure was done following a thoracic aortic aneurysm. My jaw dropped.

Working in the VA setting challenges chiropractic interns to have a more in-depth look at chiropractic care and how it fits into the medical model. Not only have I been exposed to an array of conditions within my chiropractic work, I have also had the opportunity to shadow other specialty doctors at the hospital. During weeks two and three of my clerkship, Dr. Sherman was gone on a pre-planned vacation, which gave me the chance to do rotations in other areas to fulfill my hours. The first week I shadowed in the operating room while surgeons performed a discectomy, medial branch block and spinal cord stimulator implant. Decked out in my scrubs and feeling like I just walked on the set of Grey’s Anatomy, I awkwardly stood in the corner unsure where to stand. In every surgery I observed, the surgeon introduced himself, extensively explained the procedure and oriented me anatomically as the surgery was taking place. Not only that, the surgeons asked about my background, what chiropractic school consists of, what types of conditions we typically treat and, by the end, if we could treat employees because they felt they could benefit from our services.

Additionally, I spent time in physical therapy, the Chronic Pain Clinic, and with the physiatrist as she performed knee and shoulder injections. Each encounter was not only welcoming, but encouraging as well. I had in-depth discussions about current research, conditions that benefit from different forms of conservative care, and gained a better understanding of what each of these individuals and specialties has to offer the patients. Moving forward, I will be doing rotations in other departments to continue to be exposed to as many different aspects of health care available at this VA location, on top of the 40-50 patients I treat weekly in the chiropractic department.

The VA approach to care is evidence-based and has the patient’s best interest in mind. Although I spent a brief amount of time in these different departments, I am able to confidently say I have a significantly better understanding of what happens in many of the procedures I observed. This exposure gives me the ability to better explain treatment options to my future patients and offer guidance for individual situations. Chiropractors are one part of the expansive medical world, and for us to be effective in our positions, we must be willing to understand what else is available to our patients.

Stephanie Halloran is completing her 12th quarter at University of Western States (UWS). Rounding out her studies, she is currently on preceptorship at the Roudebush Veterans Administration Medical Center in Indianapolis, Ind. Originally from Aurora, Ill., she earned her Bachelor of Science in Kinesiology at University of Illinois – Champaign-Urbana. After earning her undergraduate degree, she moved back to Chicago to pursue a career in personal training. Frustrated with the medical and nutrition advice clients were receiving, Halloran decided to pursue her Doctor of Chiropractic degree at UWS.

Since then, Halloran has been actively involved with the Student American Chiropractic Association (SACA) serving as a representative on both the local chapter and federal levels. Halloran was awarded with SACA Member of the Year at the 2016 SACA Leadership Conference for her contributions to the organization, and under her leadership, UWS won Chapter of the Year. She is concurrently in the Human Nutrition and Functional Medicine Master’s program at UWS, as well as working toward her Diplomate in Diagnosis and Internal Disorders. When she has free time she can be found outdoors, in the gym, baking specialty cupcakes, or at local wineries. Following graduation, Halloran will apply for highly-competitive VA residency programs in hopes to continue her education and work with veterans.

Find more information on the chiropractic residency opportunities offered at the VA here.

October 13 at 12:40 – 1:30 p.m. in Hampton Hall 1, guest speakers Dr. Edward Bednarz and Dr. Mario O. Roybal will discuss career opportunities the VA has to offer, as well as the status of VA residencies.

UWS student and third year chiropractic intern, Stephanie Halloran describes her Preceptorship experience at the VA Hospital in Indianapolis, Indiana.

What drew you to internships with the VA, and what excites you most about the future of chiropractic in working with veterans?

Two years ago I attended my first Student American Chiropractic Association (SACA) Leadership Conference in Roanoke, Virginia. The conference focused on the Veterans Affairs (VA) residency opportunities at five locations around the country. The chiropractic physician at each location gave a short talk on the specifics of what their residents did, the benefits of the VA clerkships and residencies in integrative medicine and how the skills obtained there would transfer over to private practice. At the conclusion of that day, I knew I wanted to do my preceptorship at one of University of Western States VA-affiliate locations.

My goals during the VA clerkship are personal development and professional advancement. I knew I would benefit from the opportunity to practice under some of the best doctors in the country. So far, I have found that shadowing an interdisciplinary team of physicians has been an amazing experience in terms of professional development. As part of my work, I get to listen as they discuss they condition and management they choose based on clinical expertise.

In this VA clerkship, I have the opportunity to observe other practitioners that I would not otherwise encounter before I start practicing. I will rotate to different departments within the pain clinic such as pain psychology, physiatry and physical therapy, and I will be in the operating room as neurosurgeons perform discectomies and spinal blocks. These daily interactions will give me the chance to develop the skills to work with these professionals in my everyday practice, as well as thoroughly explain alternate treatment options to patients who are investigating routes outside of chiropractic care.

My second goal with the clerkship is the opportunity to advance the chiropractic profession as we continue to find our appropriate place in the health care system. Clerkships and residencies within the VA will prove invaluable in establishing ourselves as providers in chronic pain treatment and prevention for not only our troops, but for the U.S. population as a whole. In a country where opioids make up 60 percent of prescribed drugs, patients and primary care physicians alike are seeking alternate ways to manage pain. Chiropractic medicine is often misunderstood in the health care industry, but once other practitioners are aware of the specific skills chiropractic physicians have, it creates a paradigm shift and the opportunity for collaboration amongst MDs, DOs, PTs and DCs.

I am not one for sitting back and letting other people do the work to change the trajectory of this profession. The VA clerkship will afford me the chance to expand my understanding of other medical specialties and actively engage in conversations that change the outside view of chiropractic medicine. Along with this exciting impact, I will have the opportunity to treat a population of people who voluntarily risked their lives to give me the freedom to pursue my dreams. I have no doubt it will be a jammed-packed quarter that will significantly impact my future as a chiropractic physician for the better.