For the past five years, having worked on case reports, meeting clinical quotas and passing the hardest exams of my life, BDS finals, I finally reached the light at the end of the tunnel; dental foundation training.
Before I start this article, it is probably important to tell you all that working in the KSS deanery was not my first choice, with my preference being other deaneries closer to home. However, I accepted the deanery and scheme and have never looked back.
Many of you may face a similar situation, but it is important to realise early on, as I did, that your DF1 year is exactly what you make of it. I decided to embrace and research the area and found some great treks around the infamous 'Garden of England'. I also noticed that Maidstone Studios, where 'Take Me Out' is filmed, was only 10 minutes from the practice. Needless to say, I was sold after hearing of the potential to meet Paddy McGuiness!
With any area, you will never know if you'll enjoy it or not without giving it a chance. You may be surprised at how much you love chips and gravy, the nature and wildlife of the countryside, or even the hustle and bustle of city life.
Taking the plunge
The thought of working as an independent practitioner in general practice was as daunting as it was exciting. I was fortunate enough to have the support and guidance of two brilliant foundation trainers in my five-surgery practice.
On my first day, my schedule consisted of a meet and greet with the staff, an induction and a few routine checkups. After seeing my first patient, who was still seated in the chair, my trainer came in to review my check-up and findings. I distinctly remember the nod I received from him before he left the room, content with my performance. I was off the mark and it felt great.
Over the course of the week, I continued seeing patients and felt I was slowly finding my feet, albeit with a lot of help from my trainers and nurse. I remember trying to explain the NHS charges to a patient on the third day, after offering him a filling, but could not recall the correct NHS band. My nurse stepped in, subtly yet promptly, and explained the charges in a calm and confident manner.
Once the patient left, she informed me that all DF1s struggle to remember and explain costs to patients, recommending attaching a laminate copy of the NHS banding structure on the wall for future reference. Although I ensured I memorised these charges, this proved to be very helpful.
This experience highlighted two important things. First, having worked with previous foundation dentists (FD) and senior colleagues in the practice, my nurse was a superb source of guidance, offering suggestions and advice on ways I could improve, together with raising awareness of patients that were quite difficult to manage. Second, whilst dental treatment in the hospital is free, this experience put into perspective that the same is not true in practice.
Try to quickly become comfortable explaining treatment prices to patients. Remember, you are providing them with a service and more importantly, NHS regulations require you to notify them of prices. Informing the patient of charges when necessary ensures a healthy patient-dentist relationship, where the patient will most likely appreciate your transparency.
Ask and you shall receive
Toward the end of my first month, I had a discussion with a patient during the treatment planning stage where she wanted an immediate denture. Managing her expectations successfully proved very difficult, particularly where she expected the denture to last for the rest of her life.
The agenda for the upcoming study day was to discuss any difficult cases encountered in practice. Until this point, I had found study days were a great way to meet peers and refresh my BDS knowledge. I brought this case up, and by the end of the discussion learnt from this and the other cases discussed that everyone was finding the same situations difficult and making similar mistakes. I suddenly realised how peer reviews are invaluable in discovering alternative methods and approaches to managing these situations in the future.
Speak to others. Ever since that study day, I made a conscious effort to discuss cases with other FDs, senior colleagues within the practice or to speakers on study days to improve my clinical abilities and overall patient care.
Each learning experience can provide an opportunity to develop and grow, which in turn can help to build both confidence and competence.
Change is good
General practice brings many unexpected surprises. It is one of the things I have grown to love about it; the unpredictability. Working with my foundation nurse every day for the first six weeks allowed a routine to form, which I enjoyed until she called in sick.
Panic set in. Having never worked with any of the other nurses, I was wary and nervous that they would provide less support, yet I found the complete opposite to be true. The nurse measured the stoppers of the endodontic files to the working lengths and practised four-handed dentistry with me.
Such things are unheard of in the dental hospital, because in most cases dental students had to nurse for each other. I was able to learn several new techniques, highlighting that change can actually be a great way to develop.
Slow and steady
I ended up seeing and treating more patients in the first four weeks of DF1 than in my entire undergraduate career. This emphasised that there is no need to rush through appointments. Take your time. Each learning experience can provide an opportunity to develop and grow, which in turn can help to build both confidence and competence.
Self-confidence is an essential trait of a successful dentist. No matter how many courses you attend, there is nothing like doing it yourself and learning from your mistakes. I was encouraged to work on patients requiring procedures I found difficult, such as surgical extractions and perform them in practical-based tutorials with my trainer.
I found DF1 to be a very hectic year and my diary ensured I stayed organised and remained abreast of my roles and responsibilities. I ensured clinical notes were written after each patient, referrals were promptly completed and the electronic Personal Development Plan (ePDP) was kept up-to-date.
The clinical portfolio within the ePDP is important for the deanery, as well as potential future employers. Hence, it is imperative that it is updated at regular intervals and not left until the last minute. This will prevent you spending hours trawling through clinical notes at a later date, which is extremely time consuming and very tedious, as I found to my detriment early in my DF1 year.
Keeping on top of work-related tasks allows you to develop a great work-life balance and to switch off after a long day, without worrying about what needs completing tomorrow. Use the evenings to pursue a hobby or catch up with friends. Having some time for leisure outside of the profession keeps you refreshed and invigorated, and ensures you look forward to each day at work.
Dental foundation is an incredible year, so make sure you get the most out of it. There are going to be days with screaming children, teeth fracturing during an extraction, root canal perforations and many more complications; make sure you master managing stress.
Focus on what you’ve learnt as well as cherishing those incredible moments, from a child changing their oral hygiene and dietary habits to the tears of joy from a patient following the restoration of their smile and confidence, for which they will be eternally grateful. YOU make that difference.
In the context of your career, your foundation year is a drop in the ocean, and yet it can be the best year of your life. Make the most of it!
Chirag graduated from Cardiff Dental School in 2014. Having completed his foundation training (DF1) in the Kent, Surrey and Sussex (KSS) Dental Deanery, he went on to work for a year in Harold Wood, Essex as a Dental Associate. At present, Chirag works as a year 1 dental core trainee in the Surrey and Sussex NHS Healthcare Trust.
See more by Chirag Mehta