DF1 Reflections

Alex Holden gives advice on how a young dentist should handle themselves when embarking on a DF1 (Dental Foundation Training Year 1) scheme.

For any students asking whether they should do DF1, my answer is always going to be yes. In previous years the numbers of UK dental graduates, not already destined for maxillo-facial surgery, who did not embark upon DF1 (or similar schemes) were but a handful. Since the numbers of UK graduates have increased, along with the increased influx of non-UK dentists applying for DF1 schemes, there have been more UK graduates considering not completing DF1. I feel that these individuals are putting themselves at a disadvantage in an ever more competitive job market. Not only do they exclude themselves from NHS careers dentistry due to the lack of a performer number (a PCT necessity to work on an associate contract) but employers will most likely favour candidates who have completed DF1. As well as the procedural benefits of job eligibility that DF1 completion brings, DF1 is extremely good at providing the 'real world' experience that dental school lacks. Until all UK dental schools embrace outreach programmes with open arms, the difference in clinical skills between graduates of different schools will be apparent. DF1 goes a long way to negate these differences and places all holders of a DF1 completion certificate at a similar level.

I felt fairly confident upon leaving dental school that my standard of restorative work was high. However, what I had failed to appreciate was that perhaps my management skills were not up to a correlating level. At dental school, my patients were fully aware they were being treated by a young, inexperienced dental student. They had a comparatively high dental IQ and they were more than tolerant of the slow pace that treatment at the dental school involved. Once in practice, my new patients did not distinguish between  a dentist of 30years experience and me on my first day. Their expectations were high and despite my attempts to manage these, I found myself falling short on several occasions. These shortfalls were not related to the standard of my work, my amalgams were well carved, my composites ledge-less. No, any complaints that I received (one on my second day!) were related to communication. I remember one patient who required a tiny buccal filling, complaining after I had placed said filling at the examination appointment... I'm sure it is a scenario that many dentists face, I won't have been the first and I doubt that I will be the last. DF1 is useful in this situation because, having a trainer there to discuss and reflect with is so helpful and to draw from their experience rewarding. It is also a help that when issues arise, as a DF1 you are less likely to have a waiting room of patients looking at their watches!

Another aspect of 'real world' dentistry that is often overlooked at dental school is teamwork. I remember at my dental school there being a very unrealistic teamwork situation. Suddenly in practice, you find yourself as the leader of a team, with the clinical responsibility to provide prescriptions and instructions to help and assist other members fulfil their roles. I never had any issues with my nursing staff during my DF1 year. They were all so professional and well-trained that patient appointments ran smoothly and unexpected events were dealt with well. The role I had never given much thought to, that of managing non-clinical members of the team was the real test of my leadership skills. Quite often, administrative staff were brought in to fill a vacancy having never worked in a dental practice (or healthcare in general) before. Although they were given the correct induction on issues such as roles, confidentiality and consent, they still had no experience of clinical dentistry. This led to issues where breaches in confidentiality, unprofessional behaviour and lack of knowledge surrounding the profession arose. In themselves, these situations were not un-manageable, but in the situation where I was the only member of staff and immediate action was required, I really struggled. The first issue was one of age. Despite my status as a dentist, as a 23 year old, the ladies in administration were not keen to listen to my opinions, especially as they had children superior to me in years. The other issue is one of seniority. Again, despite my status as a dentist, those staff who had been at the practice for longer than me were not at all keen to listen. When speaking to my peers, they had experienced similar issues, but felt that they would be there for such a fleeting moment that in the grand scheme of things, no action was the best policy. This attitude really bothers me, the GDC specifically states in standards for dental professionals that those who are registered are responsible for those who are not. We as dentists are vicariously liable for breaches in standards from our support staff. My advice to any DF1 who finds themselves in this situation is to have courage in their convictions and speak to their trainer as soon as possible. A good training in dentistry practice will have instructed their staff so that this situation does not arise, but this cannot be relied upon. It may also be easier to conform to a patient's wishes for inappropriate treatment than to say no. A word of caution on this, any treatment we provide needs to be in a patient's best interests. Even if a patient demands a treatment, this may still not be in their best interests and it is our duty as dental professionals to know when to have that awkward conversation and stand our ground in saying no. My personal favourite moment of this nature was when one of the managers at my practice had provided her own treatment plan for a friend who was attending the practice as a patient. I am sure I do not have to convey the extent of my displeasure at this situation. It is absolutely imperative to ensure that as a young dentist, you do not allow yourself to be influenced to provide treatment that you would otherwise not provide. This is the same whether the influencer is a dentist, patient or otherwise.

To conclude, DF1 is a fantastic year, it is the chance to dive into the world of clinical dentistry with your own judgement influencing your practice. If issues do arise, it is important to talk to your trainer, fellow DF1s on your scheme and scheme advisor to resolve the problem as soon as possible. The whole purpose of DF1 is to provide an effective intermediary between dentistry school and associate dentist, this allows a safe environment for you to make mistakes in approach, that are not detrimental to patients and allow you to grow professionally. My final advice is to not be afraid of making mistakes. It is natural and human to make mistakes, it is wise to try and use these to better ones practise.

Mr Alexander CL Holden 
BDS HPD DipNLP D.Hyp GQHP
Dental Surgeon