Clinical tips: Surviving placements

Your final years are not the same- be curious yet cautious 

Stepping into clinic is one of your first big feats. You're no longer just a student but a health practitioner who is seeing patients. There is an expectation to think independently and make live decisions that can carry consequences. All the theory starts to come together quickly, but there is always still more to learn. Risk management, professionalism, and confidence in your abilities start to matter as much as the skills you have gained. 

Placement rotations can be exciting and intimidating at the same time. You're meeting new people everyday, guided by different supervisors and staff, but still under the safety net of a University. It's normal to feel underprepared as there is something different each time. This is something we eventually learn to embrace. With the right mindset, placement end up being quite rewarding.

Skills and knowledge matter but clinical judgement is more important 

Most students by the final few years should be competent. The whole purpose of our institutions is to ensure this is the case so we are capable practitioners when graduating. This is more than about placing fillings, saving teeth, taking them out, and trying to do all the other treatments. It's not necessarily about how to do Dentistry which should become second nature to us, it's about knowing when and when not to do it.

During your studies there will be patients from all different backgrounds and with different histories. Become adept at managing medical histories and patient expectations. There is less time pressure compared to the real world so fine-tune basic skills such as patient communication, diagnosing & treatment planning, consent, note-taking, etc. This will make your transition to real practice a lot smoother. From a medio-legal perspective this is essential. Poor non-clinical skills are some of the most common reasons for complaints. 

Sometimes there will be varying opinions on a patient or clinical matter. It can become overwhelming when it feels like you don't have as much control as a student. It's important to stay professional and strong-headed during these moments. There isn't one way to do things in Dentistry. Open-mindedness is key. This is actually a great way to learn different ways to manage a patient which will expand your toolbox eventually.

Informed consent is not just a tick-box - don't take it lightly 

During Dental school, you will occasionally have sessions on consent. A lot of the time, this may be through partnering companies such as Dental Protection Limited (DPLa). It is one of the most crucial aspects of training and so make sure you attend these sessions. Because there is more of a focus on teaching and clinic, it may feel like this is a topic that just gets brushed over. However, it is part of every conversation you have with a patient. Written, verbal, non-verbal - all cues matter. Obtain as much information as you can and don't forget that consent can be withheld or overturned.

The patient must be made aware of what you are doing and your findings in a way they can understand. They will be provided with a range of options to manage their condition as well as risks & benefits. We often don't need to talk about cost at subsidised clinics; nevertheless, it's a good habit to start getting into. Patients may need more time to come to a decision and organise their finances. They may also choose not to go ahead with treatment. This is all part of what we do. Remember, if you were a patient and would not be happy with something it's most likely they wouldn't either.

Your notes are your safety net - do them well 

Furthermore, everything you have done in the sessions will be documented. If you attend different placement sites it may be difficult to adapt to the various software used. Generally, they tend to be outdated and not particularly user friendly. Try your best to incorporate as much detail as possible. Utilise the different tabs such as patient information, medical history, charts, x-rays, photos, documents, etc. Update these each time so there is an accurate record for the session. It's important to also stay up-to-date with new technologies since there is now artificial assistance to cover these bases.

Your notes are legal documents. Patients may require you to release them which must be done correctly. If there is an investigation, it is one of the main sources of evidence. For that reason, it should be clear and thorough, but also succinct and easy to read. There may be supervisors that don't necessarily read them before signing you off. In the real world, the responsibility is on you to make sure they're done on time and to an appropriate standard. Learn from those around you - everyone has a few little variations that can be incorporated into your own records. A lot of practitioners have to further their note-taking skills as a result of absent or poor documentation habits. 

Managing people and expectations is not easy

This is something we learn the hard way. We have to go in everyday and learn to handle different situations with different people. It is often underestimated how difficult this can be and the toll it can have on us as practitioners. There is the pressure of the College and lecturers, the placement site and staff, and each patient and their individual needs. Being able to jump around between all of these and maintain a high standard is quite an achievement in itself. Often, it is a good idea to utilise our non-clinical skills for this. The more we can experience outside of our learning environment, the better suited we will be in this aspect. Make sure to look after yourself so you can do it day in and out.

Furthermore, patients on placement may expect certain things from you. There will be cases where someone doesn't agree with you or demands specific treatments. Some may think you're already a fully-fledged Dentist, others may take advantage of the fact that you're not. It's important to be careful in these situations and ask for help if you require it. Don't promise patients a lot but also deliver the best care you can with best practice in mind. Your team, colleagues, and our networks are here for you if needed. 

On the contrary, there can be patients who expect low-cost and low-quality work. This may make it seem like you can just go into appointments and come out without a worry. However, it is ideal that you keep your work and thoughts consistent. Often, it can be a trap to fall into bad habits. Be honest to each individual and go through all of your standard procedures. If you are unsure about something don't continue alone and obtain a second opinion early. Taking initiative to make shared-decisions and demonstrating clinical reasoning can prevent problems from arising.

Final thoughts - you will be ready 

With all of this in mind, you will progress towards competence and autonomy. Don't be afraid to make mistakes - own them and learn from them. Be kind to your team who helps you each and every day. Start thinking like a registered dentist and you will become one in no time! This article was made in partnership with DPLa. If you would like more information about student requirements or key clinical matters, please visit our member portal. You can also find useful learning materials for some of the topics discussed above as well as support to build confident and independent practice. Make sure to sign-up now for your free student indemnity protection!