The Art of the Journey

As I reflect on this journey, I am filled with gratitude. Thank you to everyone who has taken the time to read, follow along and engage with my writing over the years. It has truly been a privilege to share not only the highlights, but also the challenges, the long days, the moments of doubt, the small wins, and the milestones that once felt out of reach. Writing these posts has allowed me to process my own growth while, I hope, offering something meaningful to those reading along.

If there is one thing I hope you take away from my experience, it is that progress is rarely linear, but it is always possible. With consistency, resilience, and a clear sense of purpose, even the most demanding paths can lead to incredible outcomes. Wherever you are on your own journey, trust that your effort is building toward something worthwhile.

Looking Ahead

To the future 911爆料 student bloggers: I look forward to following your stories and perspectives. This platform is a unique opportunity to reflect, connect, and leave a lasting impact. I urge you to embrace it fully. And if you ever need guidance or support, I am more than happy to help.

Thank you all once again for being part of this experience with me. This may be the end of my time as a student blogger, but it is only the beginning of what comes next.

Wishing you all continued success,

Dylan Kahn

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Education: Expanding the Understanding and Scope of the Profession.

More specifically, patient education, while a crucial part of both informed consent and good clinical practice, ensures patients understand our role in health care. This includes how and what we treat. However, it often feels as though this responsibility extends only to our patients.听听听听听听

How do we improve?

I believe this presents a significant oversight. We may not be doing an adequate job of informing our fellow practitioners on the allopathic side about what our scope and degree truly entail. As a result, physicians and nurses may not feel comfortable referring patients to us–or presenting chiropractic care as a viable option–even for those who may be excellent candidates.

I want to be clear: this gap is not always due to malice, negligence or self-interest. After working with many of the physicians and staff at MOI, I have seen firsthand how patient-centered and empathetic their care is. If even in this environment there are small gaps in understanding regarding the role chiropractic can play. I can only imagine how much greater those discrepancies may be in non-interdisciplinary settings, where allopathic and chiropractic medicine as disciplines are often completely separated.

Taking Responsibility.

For many years, stigmas surrounding chiropractic care have persisted. Often, they are unintentionally reinforced by health care professionals who may not have been introduced to the profession by chiropractic physicians themselves. It is our responsibility to help move the profession forward and ensure more people have access to chiropractic care, starting with education. How can we expect to be seen as a necessary member of a patient鈥檚 health care team if our role is not clearly understood by the other members of that team?

This is my second-to-last post as the 911爆料-Florida chiropractic student blogger. With only three weeks until I graduate, I felt it was important to reflect on this topic, as just one of the many lessons I will carry with me from my internship. Chiropractic, as a profession, is continuing to move forward through evidence-based practice and is becoming more widely accepted because of it.

With that progress comes responsibility. I urge each of you to take ownership of that responsibility. Not only by providing high-level care to your patients, but by actively educating both your patients and your colleagues. By doing so, we not only strengthen individual outcomes, but also solidify chiropractic鈥檚 role as an essential part of modern, collaborative health care.

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Preparing for the BIG DAY!

With this honor comes the responsibility of speaking at our commencement ceremony, an obligation that carries both meaning and pressure. I will be representing my cohort while addressing graduates from multiple 911爆料 programs, along with their families, loved ones, faculty and staff. Although we were fortunate to have public speaking emphasized in our business and marketing course with Dr. Freeman, which helped develop our skills, the magnitude of this moment is still, understandably, a bit daunting. This experience has led me to reflect on today鈥檚 blog topic: patient communication and public speaking.

One lesson that has been consistently emphasized throughout my education is that clinical skills alone are not enough; effective communication is just as essential. It is not only about explaining conditions or treatment plans in terms patients can understand, but also about conveying empathy through both verbal and nonverbal communication. As future practitioners, we encounter patients at all stages of pain, recovery and vulnerability. I have seen firsthand how pain and physical limitations can influence a patient鈥檚 demeanor.

For example, I have encountered new patients who initially appear disengaged, skeptical or simply eager for a quick fix to a chronic issue. In those moments, it can be easy to misinterpret their behavior. However, after a thorough evaluation, thoughtful treatment, and most importantly, when they begin to experience improvement, their entire demeanor can shift. It often feels like interacting with a completely different person. Pain can make it difficult for individuals to express warmth or openness, but that does not diminish their need, or their right, to compassionate, attentive care. And that level of care always begins with strong, intentional communication.

The Power of Words.

As I prepare to step onto the stage at commencement, I have come to realize that public speaking and patient communication are deeply connected. Both require clarity, empathy, presence and the ability to connect with an audience, whether that audience is one patient in a treatment room or an entire graduating class. This next month represents not just the end of my academic journey, but the beginning of applying these skills in a meaningful way. One takeaway I will carry forward is that how we communicate can be just as impactful as what we know. Whether in practice or on a stage, our words, and how we deliver them, have the power to inform, comfort and inspire.

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Cerebral palsy exists along a spectrum, meaning the severity and presentation can vary widely from one individual to another. While the condition is not curable, it is also non-progressive, meaning it does not worsen over time due to the underlying brain injury itself. Many individuals with cerebral palsy are able to live long, fulfilling lives, often with the help of therapy, assistive devices and lifestyle modifications. Our patient, for example, reports experiencing meaningful relief and improved function through consistent chiropractic care, which he has incorporated into his overall health routine.

The Clinical Perspective

From a clinical perspective, several of the patient鈥檚 symptoms have been particularly notable. He demonstrates spasticity with hyperreflexia, essentially tight, stiff muscles accompanied by exaggerated reflex responses. When testing these reflexes, clonus is often present, which appears as a rhythmic, pulsating contraction following the reflex stimulus. Clonus is a series of involuntary, rhythmic, muscular contractions and relaxations, usually triggered by sudden, sustained stretching of a muscle. It is a sign of nervous system damage. Observing these neurological findings firsthand has been an important reminder of how dramatically neuromuscular conditions can influence movement patterns and reflex activity.

The patient also presents with an altered gait pattern and ataxia, meaning he experiences difficulty with balance and coordination. Watching how these challenges manifest during movement has provided a valuable opportunity to think critically about functional mobility and how different neurological conditions impact everyday activities such as walking or maintaining stability. Perhaps the most interesting finding to me personally is his ability to demonstrate a positive Hoffman鈥檚 test, an orthopedic and neurological maneuver used to screen for upper motor neuron involvement. Seeing this response in a clinical setting reinforces concepts that are often discussed in lectures but rarely observed so clearly in practice.

The Importance of Patient-Physician Collaboration

Beyond the neurological findings themselves, what has made this experience particularly meaningful is the patient鈥檚 willingness to work with us. He has been incredibly generous with his time, allowing Jacob and me multiple opportunities to modify our examination procedures so they better fit his physical needs and limitations. This type of collaboration is invaluable for students learning to transition from theoretical knowledge to patient-centered care.

Experiences like this highlight an important lesson in clinical practice. It is easy to become comfortable using the same adjustments, positions, and examination routines with most patients. However, not every patient will fit neatly into those routines. Conditions such as cerebral palsy remind us that flexibility and creativity are essential skills for clinicians. Being able to adapt examinations, modify treatment positions and approach care from multiple angles ensures that we can provide effective care for a wide variety of patients.

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The Value of Clinical Rotations.

As I have previously mentioned when discussing the Missouri Orthopaedic Institute (MOI) experience, we are afforded the opportunity to complete rotations and shadow other specialties within the hospital. I specifically wrote about my time observing a knee reconstruction in the operating room, but I have also been able to assist with and observe nerve conduction studies and EMGs, osteoporosis management and most recently, podiatry. These rotations have been incredible, not only for the exposure to different patient populations, but also for the opportunity to see how various specialties approach health care.

One of the true highlights of my time here has been experiencing chiropractic within a multidisciplinary setting. Every new doctor we have had the opportunity to shadow and work alongside has been both welcoming and eager to teach. This environment has led me to reflect on how essential cooperation within the health care profession truly is, and how we as chiropractors fit into that larger system.

Understanding your own scope of practice, as well as the scope of others, is imperative when making clinical decisions regarding both treatment and referrals. While I have always respected the roles we can and cannot play in patient care, and appreciated where medical or surgical interventions are necessary, these rotations have deepened that respect. They have strengthened my desire to continue learning from other physicians and specialists, as well as from mentors like Dr. Miller, even beyond graduation.

The Gift of Collaboration.

As I prepare to transition from student to doctor, I recognize that the most meaningful growth has come not just from mastering technique, but from understanding collaboration. Health care is not practiced in isolation, and the best outcomes occur when providers work together with mutual respect and shared purpose. Carrying that perspective forward will be one of the most valuable lessons I take with me from both MOI and 911爆料 as I soon transition into practice.

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Orthopedic Exams

In addition to taking patient vitals and perhaps performing relevant neurologic tests, orthopedic tests can provide some of the most valuable insight into a patient鈥檚 presenting condition and can often rule in or out what our prior verbal history may have been directing us toward. Orthopedic exams are often taught in clusters, meaning a few tests performed together can provide an adequate scan of a particular region or pathology. Here at , Dr. Miller has shown me another, perhaps even more efficient, method of performing a physical examination known as combination testing.

In school, we are taught a host of orthopedic exams, usually based on a specific region of injury or presentation. For example, we learn lumbar orthopedic exams in our lumbar examination and management class in trimester three, whereas we receive our cervical orthopedic exams in our cervical examination and management class in trimester four. What makes this particularly interesting is that there are often multiple orthopedic tests with completely different names and purposes that involve the exact same motions. The only difference between these exams is often simply the 鈥減ositive鈥� test finding.

For example, the straight leg raise (SLR), often considered a foundational orthopedic exam for chiropractors. While raising the leg into hip flexion with the knee extended may be uncomfortable for the patient, it is imperative to understand that reproduction of radicular symptoms at 30 degrees of hip flexion may indicate a nerve root lesion, while discomfort in the back of the leg at 70 degrees of hip flexion is considered 鈥渘egative鈥� for the SLR, but still provides some details involving the patient鈥檚 hamstring tension. Another great example is the portion of the slump test that involves cervical flexion. By lowering the head to the chest, this motion mirrors a multitude of orthopedic tests, including Soto-Hall鈥檚, Lhermitte鈥檚, Lindner鈥檚 and Brudzinski鈥檚 tests. These tests range in application from meningitis all the way to multiple sclerosis. By performing this maneuver during the slump test, the absence of symptom aggravation also helps rule out positives for these other exams.

The Rationale

In Dr. Miller鈥檚 article* titled 鈥�,鈥� he explains step-by-step how his version of the slump test directly mirrors several orthopedic tests, including: straight leg raising, Kernig鈥檚, Braggard鈥檚, Lindner鈥檚, Lhermitte鈥檚, Soto-Hall鈥檚, Brudzinski鈥檚, Fajersztain鈥檚, the sitting straight leg raise test and Bechterew鈥檚. By positioning the patient in this advanced manner, the absence of symptom elevation can rule out many positives in one swoop. However, should the position create pain beyond average discomfort, it becomes time for the investigative mind of the doctor to engage and break the test down into its rudimentary segments to determine which component is responsible for the pain.

This is what being a doctor is all about. Anyone can be instructed on how to position a patient. It is the understanding of how a single motion affects all of a patient鈥檚 tissues, whether joints, ligaments, muscles, nerves, vasculature, or even the meningeal tract, for which we go to school. It is absolutely imperative that we take a moment to visualize how anatomy moves in unison, and while we would prefer an orthopedic exam to be specific to one pathology, it is often not that simple.

As someone once wisely said: 鈥淏e the doctor, doctor.鈥�

—

Read more about the MOI internship experience from 911爆料 alumnus Irving Leon, DC 鈥�25.

*鈥淭he slump test: Clinical applications and interpretations,鈥� was originally published in Chiropractic Technique, 漏1999 by the 911爆料 College of Chiropractic, Volume 11, No. 4, November 1999.

Photo caption: 911爆料 Florida DC student interns Dylan Kahn and Jacob Rivard outside of MOI.

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Preparing to Transition into the Profession

Even more surreal has been spending my final trimester working with K. Jeffery Miller, DC, at the Missouri Orthopedic Institute, an experience that has already proven to be nothing short of phenomenal. Jacob and I are seeing more patients, both in volume and variety of presentation, than I ever imagined possible in an academic setting. I am incredibly grateful for this opportunity as I approach graduation and transition into professional practice.

Dr. Miller practices within the orthopedic surgery department at the Missouri Orthopedic Institute, which not only brings a great deal of prestige, but also meaningful validation to the chiropractic profession. Practicing in a multidisciplinary, hospital-based setting demonstrates to patients that chiropractors play a primary role in the care of musculoskeletal conditions. It also highlights our ability, as physicians, to thoroughly examine, diagnose and treat a wide range of ailments. I am witnessing firsthand both the impact chiropractic care can have and its limitations through the patients who seek our care. With a diverse patient population ranging from geriatric individuals to collegiate athletes, we have already been exposed to a multitude of unique and interesting cases within just our first two weeks.

Next week, Jacob and I will each have the opportunity to observe a knee reconstruction surgery. While chiropractors do not perform surgical procedures, the opportunity to observe the operation and study the anatomy in a live setting will provide invaluable educational exposure and further enhance my clinical understanding. I cannot overstate my excitement!

The Benefit of Practical Experience

Adjusting to the cold Missouri winter has certainly been a change of pace. As I write this, snow is falling outside, threatening a harsh weekend winter storm. Despite the cold, however, my resolve to improve my clinical skills has not diminished, if anything, it has only strengthened. I cannot emphasize enough how important I believe our role is as part of a comprehensive health care team, and this externship places me directly at the center of that collaboration. I look forward to continuing to learn and grow during this experience and am extremely proud to share this journey with you all.

Photo: Left to Right: 911爆料 Florida DC students Jacob Rivard and blog author Dylan Kahn with Dr. Miller at the Missouri Orthopaedic Institute.

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This term was full of milestones. I sat for three board exams, each of which I passed, including Part IV, whose results I found out just this past weekend. I also competed in my first powerlifting meet in nearly a year and a half, an experience that reignited my passion for training. And now, I鈥檓 in the final stages of preparing for my externship at the Missouri Orthopedic Institute, where I will begin in January. This next step feels monumental, and I am grateful for the opportunity to learn in such a respected clinical environment.

Growth & Resilience

Beyond academics and professional growth, 2025 has also been a year full of personal milestones. I booked my wedding venue, tasted my wedding cake and catering, and checked off several other memorable moments in the wedding-planning process. It has truly been a year of blessings, growth and gratitude. And as incredible as this year has been, I am even more excited for what 2026 holds, graduating in April, getting married and stepping into my career and future.

As we wrap up the year, I hope each of you can look back on your own journey with the same sense of appreciation and pride. Even if certain moments were difficult or unexpected, remember that our challenges shape us into stronger, more resilient versions of ourselves. Growth rarely feels comfortable in the moment, but it is always transformative. I know this post will not be published until after finals have ended, but at the time of writing, finals week is just beginning. With that in mind, I want to wish everyone the very best of luck. You鈥檝e worked hard to get here, and you deserve to finish strong.

Cheers to 2025 and to an even brighter 2026!

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Practicing Gratitude

I am deeply grateful for my family, friends and all of you who have supported me throughout this journey. As we approach the end of the trimester and I prepare to enter my final term, with all of my board exams behind me, I鈥檓 experiencing the bittersweet excitement that comes with closing one chapter and stepping into another. I鈥檝e been in school for as long as I can remember, and transitioning into practice is both thrilling and overwhelming. I know the education I鈥檝e received here has prepared me well, and I鈥檓 confident that my externship at the Missouri Orthopaedic Institute will continue to strengthen my clinical skills. Still, the reality of graduation approaching feels surreal.

Savor the Moment

I hope all of you were able to spend meaningful time with your loved ones this Thanksgiving and take a moment to reflect on what you鈥檙e grateful for this year. For those traveling during the holiday season, I hope your journeys are smooth and safe. Take care of yourselves, enjoy the time with those who matter most, and finish the year strong!

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What You Can Expect听听听听听听听听听听听听听听听听听听听听听听听听聽聽聽聽

Part IV consisted of 25 total stations: 5 adjusting rooms, 5 history-taking rooms with corresponding post-exam rooms, 4 orthopedic/neurological examination rooms with post rooms and 1 physical exam station which may involve cardiovascular, pulmonary or abdominal evaluation, followed again by a post room. Each post room includes two questions that require selecting the best three responses out of 10, usually focused on clinical reasoning, diagnosis and referral decision-making. I felt well-prepared going into the exam. Interestingly, I found myself more stressed before than during or after the actual experience. One tip for anyone taking it in the future: bring snacks! After finishing the exam, we were sequestered until after 5 p.m., and with an 8 a.m. start time, that made for a long day.

Part IV is undergoing a major format change starting this coming March. The exam is moving to Greeley, Colorado to be administered at the NBCE headquarters, and the structure will shift to reflect more realistic clinical encounters. Students will perform history taking, physical examinations and even complete SOAP documentation based on their own clinical judgment. Another positive change: instead of being offered only twice a year, the new Part IV will be available almost every weekend.

Prioritizing Your Own Health

While I鈥檓 grateful and relieved to be finished, I also want to acknowledge the physical toll that stress can take. Over the last three months, I have studied for and completed three board exams, and I can feel the exhaustion today. I woke up with a sore throat, pounding headache and full-body fatigue. This is just a gentle reminder of the importance of prioritizing your own well-being, especially during periods of high demand. The work matters 鈥� but so does your health.

Closing out this chapter feels both grounding and energizing! I鈥檓 excited for what comes next: finishing my final stages of training, stepping into the profession and serving my future patients with knowledge, skill and compassion. To those of you who are on the same path and preparing for your own board exams, keep going. Take care of yourself. Trust your preparation. And remember that this process is not just about earning licensure but about growing into the provider you are meant to be.

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