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Transition from student to foundation dentist

Alexander Holden, a former foundation dentist in the South Yorkshire Deanery, gives advice about the transition from student to foundation dentist.

Finding out you have passed your final exams and are a bona fide dental surgeon is an unforgettable day for every foundation student.


Dental Foundation Training comprises of a mandatory year in practice (Dental Foundation/DF1) and a voluntary second year working in hospital.


The evolution of the training has undoubtedly eased the transition from student to fully qualified dentist. However, there are pitfalls at each corner and the management of a team is something which most new dental graduates have little or no experience of.


At dental school, dental students are spoilt by the security to which they are afforded. I have much experience of fellow students and colleagues commenting to me when I was at dental school about clinical tutors whose attitudes had been patronising or draconian. It isn’t until you get into practice and realise that if you make any omission or mistake, it is your head on the block, just as theirs was in jeopardy when you extracted the wrong tooth!


When I took my first steps into clinical examinations on patient clinics, the daunting nature of the task made me forget the methodical protocol I had been instructed in. Once I got to my fifth and final year, I found that these protocols had well and truly sunk in, not just with examinations but with every aspect of the profession I felt competent and comfortable in.


However, my first patient as a foundation dentist was deprived of their extra-oral tissues being checked, something I later rectified, but only realised towards the end of the appointment. After reflecting, I put my mistake down to the slight apprehension planted by the knowledge that the safety net of dental school had been withdrawn.


Eleanor Roosevelt stated, “Learn from the mistakes of others. You can’t live long enough to make them all yourself.” The sentiment is humble and displays a certain charm. I think it takes a very wise person to be able to learn from others’ mistakes without making them for oneself. Even seasoned clinicians would have to admit they make mistakes themselves on occasion, perhaps not as frequently as an FD might make however!


The making of mistakes is in itself not a crime, so long as they are not through negligence or dishonesty. It is important to be honest with patients, as well as yourself about why a mistake has been made.


If clinical decisions are challenging, then the non-clinical decisions are even more so. In the five years spent learning about cavo-surface angles and lichen planus, dental students are given precious little teaching on business running and team leadership. This is not a criticism of the dental syllabus, more a statement of the way things are.


I think it is important to make sure dental students have as much clinical experience as possible; after all they are to leave dental school primarily as dental professionals not business men and women.


The issue with teamwork is one of muddled order. As a dentist, you are top of the professional tree, you run the team and have the final say in decision making. In contrast, as a dental student, you have no definitive say in treatment planning and you are not afforded the same assistance from other members of the dental team as a dentist would be.


Knowing how to interact with other members of the dental team after such a differing experience in dental school is difficult. I remember being looked at with abject horror after offering to help my nurse to tidy up after seeing a patient. I maintain that offering to help with other tasks outside the stereotypical team roles is healthy and pro-active.


What are difficult to manage are the expectations of your behaviour of other members of the dental team. My approach to dental nurses has been very casual and informal. As a student this seems to be perfectly acceptable, if not preferable. When a student qualifies, there is an expectation to become more formal and assert one’s seniority. I have found that managing a dentist-nurse relationship without the obvious hierarchy is quite challenging as it can lead to resentment when the dentist is required to ask for something to be done in a way that the nurse may not naturally find to their liking.


Becoming a dentist after five long years at dental school is a relief. As a transition it certainly shouldn’t be feared or evoke anxiety, but it should evoke a responsibility to do what is right by your patients which is something all the more important when there is no clinical tutor breathing down your neck. Foundation training is an excellent way to ease this change from student to professional.