The expectancy of a dental core trainee (DCT) to be on-call in a busy hospital can be a daunting prospect for someone only used to the realms of dental practice.
Here are some of my tips for new DCTs, to ensure your on-call shifts are effective as possible and how you can make the most of your learning from the experience.
At the start of an on-call shift you are often faced with an overwhelming variety of tasks which are expected to be completed before the next handover.
A useful method to ensure they are dealt with in a sensible order is to use a priority matrix, such as Chapman & Rupured's to categorise them depending on their importance and urgency (see table below).
A copy of this table could be added to your handover sheet and revisited throughout the shift to reassess the importance of each job.
Complete these jobs earlier in the day in between other duties
Spend the most time on these and ensure they are done properly
Consider if these tasks could be delegated to a colleague or eliminated
Promptly responding to bleeps is an essential part of being on-call. This also plays an important role in maintaining the reputation of the whole team, as neither you nor your consultant will want to see "on-call very difficult to get hold of" documented in a patient's record.
If you are extremely busy, at the very least you should answer the call and advise that you will attend as soon as possible, giving a realistic timeframe.
A useful way of handling bleeps efficiently is to carry a ''bleep sheet'' with you, as shown in the table below. This ensures you are systematic in accepting referral information and you have a record of all correspondence throughout the day to help update your handover. The bleep sheets can also be audited to appraise the quality of referrals.
Example: "Bleep sheet" template
Head injury clear?
Signs and Symptoms:
Past Medical History:
Last Oral/Fluid Intake:
Events Before Illness/Injury:
Investigations (observations, imaging, bloods):
PLAN: (circle as appropriate)
Review Urgent / Non-urgent Admit
Book as outpatient Discharge
Handovers are vital to ensure patient care decisions are communicated through the team safely, as detailed in the DCT curriculum.
It is your duty to dedicate enough time to handover properly, even if this means a delay in reviewing a non-critical patient. It is advisable to arrive fifteen minutes earlier than handover time, to allow a calmer start to your shift and to show appreciation for your colleague, who will be more likely to do the same for you in return.
When handing over patients, use a systematic format such as the SBAR approach (Situation, Background, Assessment, Recommendation) to relay important information whilst staying succinct. During ward rounds ensure you are well prepared, having noted the patients' most recent observations, blood results, and with a tongue depressor and pen torch to hand.
Nightshifts are often stated as being one of the worst parts of on-call duties, and it is important to establish early who your night team is, so support can be requested promptly if needed.
Keeping hydrated and eating regular meals consisting of complex carbohydrates are easy ways to stay sustained throughout the night. In a busy hospital environment, it can be difficult to build working relationships quickly.
As nightshifts are often quieter, you can use this time to build rapport with colleagues on the ward or in A&E.
A downside of being on-call is there may be less opportunity for hands-on clinical activity. To overcome this, attend any emergency theatre procedures taking place.
It is also a useful time for developing practical medical skills that dental trainees may be less competent in. If you have spare time during your shift, visit the A&E triage area which often has an abundance of patients requiring venepuncture or cannulation, to gain more experience with these procedures.
Lack of medical knowledge is one of the main fears of DCT's, but equally the role has shown it can greatly improve confidence in medical management of patients.
A productive use of quiet time on-call is to revise medical topics within the context of the current inpatients you are caring for. Learn how co-morbidities can affect a patient's treatment then assess the patient clinically and review their investigation results - to contextualise the information and make it easier to remember.
A further positive aspect of working on-call and attending to duties all over the hospital is that it has been shown you are likely to meet your daily exercise requirements through the work alone.
In conclusion, there are a wide range of learning opportunities to be gained when on-call. Many dental trainees find it a valuable experience and whether planning to specialise or return to dental practice, working on-call offers a plethora of experiences not encountered in other dental roles.
Dental Core Trainee
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