TOOTH GERM: Dental Foundation Training

Guest Blog Post with Daisy Ridsdill Smith: DFT Reflections

It's been a while since I've a guest blog feature on A Tooth Germ, but I am so pleased to publish Daisy's insightful reflections of her experience of Dental Foundation Training so far...

Daisy, a DFT based in Suffolk

I am currently 8 months into my foundation year. I moved back to my hometown in Suffolk. Funnily enough I have ended up in the practice where I did my work experience when I was 16 years old. From being a shy shadower in the corner of the room to being the dentist who is responsible for helping people make decisions. It’s a full circle that does help me recognise how far we go as dental professionals through our training at university.

It has been very gratifying to have noticed the improvement in my confidence, clinical skills and communication during these last 8 months. In September I felt shy giving OHE and muddled up the dates on toothpaste prescriptions. Last week I caught myself singing song lyrics from ‘Moana’ to a 6-year-old crying in the chair and successfully getting them through the visit. I genuinely look forward to going to work every week and the dental team I work with are so kind and supportive making it even more enjoyable.

Dentistry comes with challenges, which I feel is exacerbated by the problems faced with NHS dentistry. Where I am working is often described as a dental desert. The books are very full and sometimes it can feel like you are firefighting – which can feel stressful at times. Especially since the transition from dental student to FD is also a learning curve. Initially I would often doubt my decisions and even now 8 months in I need to ask for advice and opinions from my supervisors. Some days can be exhausting (mentally & emotionally). You can take on patient’s problems home with yourself. I often catch myself over-thinking a situation in a day – for which reaching out to fellow DFTs, colleagues, friends and family for life advice has been invaluable. I have found it very helpful to remind myself at the end of the week that 1) you will have helped so many people (even if it doesn’t feel like it!) and 2) everyday we are learning and improving that tiny bit more.

My advice to anyone about to undertake DFT

1. Ask for advice, - both from supervisors and colleagues!

As well as taking feedback onboard. This year is meant for developing you as a clinician so embrace it. I recently gained some tips from another FD working in community for managing nervous children: for example, giving the handheld mirror to the patient for them to hold so they can see what you are doing and have more control.

2) Giving oral hygiene advice is great!

The BSPD recommend 3 minutes of giving OHE every visit for children. If this is a patients only access to the dentist, they may pick something up? Those 3 minutes can easily be slotted while you’re waiting for x-rays to develop or while the surgery is being prepared for the next patient. I like to think of Tesco’s slogan ‘Every Little Helps’ and that they then leave the dentist and share what they have learnt with their friends and it can help educate the community in a domino effect.

3) Be open and honest with your patients.

When mistakes happen, stay calm and communicate appropriately with the patient and the dental team. I once started to remove the wrong amalgam restoration at the end of the busy day. I kept my cool and told the patient there and then. I was on the verge of crying when I got home that day but was proud of myself for managing the situation professionally. I thought about ways to mitigate this risk and now make sure me and my nurse verbally identify which tooth we are working on before we start a procedure.

4) Enjoy the year

We are in such a privileged position as dentists. We really do have the power to directly improve someone’s quality of life. Two of my favourite things are getting a patient out of pain or giving someone their front teeth back.

Thanks so much Daisy for those tips and for sharing your experiences! If you'd like to feature on my blog, drop me a message via the contacts tab!

What's your experiences of DFT? What advice would you give? Please leave them in the comments below.

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16:24

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DCT

SJT Practice Questions with Explanations

SJT time is nearly here for DFT applications... so here is a couple of walk though questions to get you warmed up!

I have previously blogged about my top tips for SJTs and how they are marked... so lets get right into practising some questions.

Question one: ranking question

1. You have a patient booked in for veneer preparation in the afternoon. You have never done this treatment before but you have noticed that your Educational Supervisor (ES), who was due to assist you with this patient, is not in today due to sickness. How do you proceed?

A Reschedule the patient to another time when your ES is in

B Carry on with the treatment, you feel confident as you have discussed with your ES previously

C Seek advice from another associate in the practice

D Call your ES for advice

E See the patient but carry on any other treatments the patient requires

I have seen many variations of the theme of this question in SJTs. It is testing your scope of practice, competence and ability to ask for help to treat patients safely.

When a question like this comes up you should ask yourself 2 questions: is there something in the question that tells me how experienced I am and what harm is at stake for the treatment that is needed? For example, if the treatment is a scale and polish this is fairly low risk in terms of harm and should be a skill that a safe beginner should be able to perform

Applying those 2 questions to the above question: you have never done this procedure before and potentially doing a veneer prep although isn't a big procedure, is an irreversible one that I would expect a safe beginner to need some guidance.

So what is the answer....?

Answer: CEDAB

You need assistance because of the answers to the 2 questions above so C is a good option and therefore first, whereas B therefore is last. You are not given any further information about other treatments the patient might need, but instead of wasting their time if they have an appointment booked, E is a reasonable answer too, although doesn't address the reason why the patient is booked in with you. Rather than just rebooking the patient straightaway (A) there might be another solution, so although your ES is sick, D is slightly better.

What did you get out of 20?

Question two: best of three

2. You arrive earlier than normal to the practice in the morning to find one of the senior nurses scaling one of her friend's teeth. How would you manage this?

A Turn a blind eye, you don’t want to cause trouble

B Ask her to stop and offer to take over the treatment

C Speak to the practice manager

D Report the nurse to the GDC

E Call your indemnity for advice

F Examine the friend to ensure no harm been done

G Call the police

H Rebook the patient with yourself for a full examination and any treatment necessary

Another question where there are many variations in SJTs over the years - again about the theme of scope of practice but also raising concerns. It is important in SJTs to understand how to appropriately raise concerns, as in who to go to for what issue.

In this issue, your nurse is operating outside of her scope of practice and potentially causing harm to a patient. So what is the answer?

Answer: CFH

The most appropriate person to raise concerns to in this SJT is the practice manager, as they will be responsible for the training and management of nurses. You must also consider patients safety, so F and H address this as you immediately check their safety and follow up with a comprehensive examination. Reporting to the GDC is not proportionate, as you don't know if this nurse has done this before, or is aware that scaling is outside of her scope.

What did you get out of 12?

I hope these walk throughs have been useful!

If you'd like more practice for the upcoming SJT, check out this must have book I have co-authored or contact me for one-on-one coaching - for more information see here.

Please note that the above SJTs are not endorsed by COPDEND and are written from my experience of SJTs. When practising with SJTs, the best quality are ones which go through a panel of experts to ratify them and validate answers. All SJTs in the book linked have been through this process.

If you have any questions about SJTs? Please let me know in the comments.

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14:47

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COVID-19

How has COVID-19 affected Postgraduate Dental Training Recruitment?

So amongst everything else, COVID-19 has had a huge impact on how we recruit to postgraduate training posts such as DFT, DCT and specialist training over the past 18 months...

Over the past 7 years, we have gotten used to processes for appointing to postgraduate dental training posts becoming nationalised and more standardised. But for all the processes in dentistry prior to the pandemic, there was always at least one element of the assessment that was face to face. But with the stay at home order last March, this threw a huge spanner in the works about how to approach recruiting to programmes such as Dental Core and Specialist training.

Adaptations were made in difficult circumstances. I was able to contribute to how adaptations were made as I was invited to sit on the Medical and Dental Recruitment Selection Subgroup because of my committee role within the BDA Young Dentists Committee. These meetings gave me an insight into the difficulties of trying to ensure that recruitment processes still went ahead, were as fair as possible, were able to make reasonable adjustments to candidates who needed it and all this within a very tight time frame! Since the first round of recruitments, feedback has enabled the group to make adaptations and changes; all the while having to balance the risk of further lock downs, surges in infections and redeployment of both applicants and assessors.

I don't think that any recruitment process will ever be 100% perfect and there will always be some candidates who might prefer previous styles of recruitment; but looking at the whole picture of what our current situation is, I would like to reassure anyone who has gone through a recruitment round during COVID-19 that the team have made a sterling effort to ensure fairness and transparency in the light of an ever evolving environment.

So how have things changed...?

Dental Foundation Training

The last 'normal' round of DFT recruitment was in 2019 where the process had 3 elements: SJT at a Pearson Vue Centre and then 2 face to face interviews of Professionalism, Leadership and Management, and Communication.

Although COVID-19 numbers were lower in the summertime of 2020, it was still deemed too high risk to continue with this form of assessment as it would be difficult to implement social distancing across the assessment sites, factor in for sickness, isolation and shielding candidates. So the process of DFT recruitment has been SJT assessment only.

Of course there has been further disruption with the prospect of some students not being able to graduate from university and those in Scotland having their training extended. Preferencing posts was therefore pushed back to summer 2021 and instead of preferencing schemes, candidates have been asked to preference individual practices in anticipation of there being 2 start dates for DFT in 2021/22 to allow for those who need extended training prior to graduation.

The plans for 2021/22 recruitment process have recently been confirmed to be a score for recruitment based on:

SJT taken at a Pearson Vue centre (75%)
Online Teams Communication interview (25%)

Dental Core Training

My heart goes out to anyone who was expecting DCT recruitment last year as normal when BANG the pandemic hit, interview dates were cancelled and everyone was in a state of flux while new plans were being worked out.

In the end, similar to DFT recruitment, an assessment purely based on SJT was decided upon, but the most recent recruitment this year was as follows:

SJT taken at a Pearson Vue centre (33.3% of marks)
Online Teams interview, with Clinical station (33.3% of marks) and a Clinical Governance station (33.3% of marks)

Specialist Training

Specialist training recruitment has always been a bit more complicated as although there are fewer numbers of applicants to deal with, every dental speciality has a slightly different process. For example, when I went through Special Care recruitment, we had a practical assessment on phantom heads, then a second day of interviews with 4 stations. All of this as you can see was face to face!

2020's recruitment was decided to be on self-assessment only, asking candidates to fill in elements that usually crop up in portfolio stations such as presentations, posters, publications, experience, number of procedures etc. There was also 'white-space' questions in some applications that was used where there were ties between candidates.

2021 saw a similar process to shortlist candidates, but there were also elements of online interviews which were slightly different depending on specialities - some asking for presentations, pre-submission of evidence to talk through, or some based on clinical scenarios or clinical governance.

Academic Clinical Fellow posts also had their assessments this year online, with online interviews on top of having to benchmark through the national recruitment processes of the relevant training grade as stated above.

To find out more information about current recruitment processes, please refer to the COPDEND website.

What about the future?

As proved over the past 18 months, it seems that we are not particularly good at predicting what's going to happen in the future!

Chatting to some young dentists, there is an opinion that we should return to previous assessment styles as soon as we can. However, there are some advantages to keeping some of the elements of how assessments are done now. It introduces more flexibility for candidates, organisers and interviewers as it cuts out travel to venues and can be easier to accommodate into working days. SJTs also have a good evidence base, especially in medicine, as a fair way to assess candidates; however, it is a method that results in difficulty distinguishing between candidates above a certain level, so an additional method of assessment (such as an online or face to face interview) can help especially if there are a large number of candidates being assessed.

What we can say is that current recruitment methods are being evaluated to feed into decision making for future recruitment, and this includes listening to feedback of people who have been through the process! This is raised through our BDA Young Dentist Committee where we are able to feedback to the relevant bodies, so if you have any specific feedback you want raised, let your local YDC rep know or leave a comment below and I would be happy to raise this for you.

Do you have any thoughts about recruitment during COVID-19? Please leave them in the comments below

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13:52

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Books

Situational Judgement Tests for Dentistry

17:39

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A Week In The Life

A Week in the Life of a DCT: Joint DFT/DCT in Bradford & Leeds with Iftikhar Ahmad

So here is another entry for this year's DCT competition by Iftikhar Ahmad...

Ifti, a joint DFT/DCT in his second year based in Bradford & Leeds

Hello! I’m Ifti. I graduated from the University of Liverpool and I am currently a ‘Joint Dental Foundation Core Trainee’ in my second year. This entails one week in general practice and one week in secondary care.

I work in the Oral and Maxillofacial Surgery department at Bradford Royal Infirmary and the Paediatric department at the Leeds Dental Institute.

This DFT/DCT post has been challenging yet rewarding in so many ways and broadened my knowledge even more so during the COVID-19 pandemic. A typical hospital week? Let me fill you in. Pardon the pun.

Monday

Every alternate Monday I spend the day on the Paediatric Department usually on casuals. I assess children in pain and get to see not-so-common conditions such as Ectodermal Dysplasia. This tends to be a cute day until a snowball effect of cries ripples through the department. Patience is key!

Tuesday

Redeployment day. Going to a COVID-19 ward as a dentist was alien, hearing medical terms which flew straight over my head finally allowed me to understand how patients feel when we chart. However, I get stuck in assisting with ward jobs, bloods and liaising with different departments. It makes me proud to say I am part of the front-line team during this global pandemic.

Wednesday

Here is where my scalp 15 replaces the drill, I spend the day at Bradford St Lukes Hospital on an Oral Surgery local anaesthetic and new patient list. . A classic day involves: fast-track biopsies, wisdom teeth extractions and assessing lesions. From syndromes to polyps, salivary stones to Pemphigus its always interesting to see what’s referred in.

Thursday

A day on the MaxFax ward, caffeine is fundamental. Commonly I am assessing casuals from A&E due to facial trauma, lacerations or swellings. This is the day I do the most steps, not that anyone’s counting. The team involves medics, registrars and consultants with a vast ray of experience.

Friday

Major oral cancer patients, acutes such as abscesses or fractured mandibles and dento-alveolar procedures are common treatments on day in Theatres! From Iliac bone grafts to enucleation of Dentigerous Cysts its mind blowing seeing the results. Dental extractions are also performed allowing those with experience passing down vital tips and tricks.

Saturday and Sunday

The weekend involves spending time with family and gaining rest. I prepare for the upcoming week in general practice and occasionally cover on-call in the hospital if needed. Sky Sports and yes, a little bit of PlayStation helps pass time during national lock down.

I hope you’ve enjoyed what a ‘week in the life’ of a DCT entails. As mentioned before a role within the hospital setting is challenging however, rewarding in many aspects. It has allowed me to broaden my scope of knowledge and understand the referral process. Communication, confidence and surgical exposure are key elements which have improved my practice. I would highly recommend DCT as the experience obtained is invaluable and also enjoyable working under the supervision of Consultants across different specialities.

To ENTER YOUR SUBMISSION: email your submission via the contact page on the blog - DEADLINE February 28th 2021

Do you have any questions about DCT or the competition ? Let me know in the comments below.

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11:38

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Dental Foundation Training

Congratulations, you’re a Foundation Dentist! Guest Post with Navpreet Kaur

It's my pleasure to welcome this guest post from Navpreet Kaur reflecting on what she would've wanted to know at the beginning of her Dental Foundation Training year...

Ahead lies an exciting, tumultuous yet rewarding path which starts off with your foundation year. Having just completed my Foundation year successfully, I am sharing some tips that I wish I knew of.

Know Who to Contact

During your foundation year, you’ll have lots of people around you for support. However, the important thing is that you know who to approach for certain matters.

Your Educational Supervisor is responsible for:

Day to day issues
Overseeing your clinical needs
Completing DOPS, ADEPTs and tutorials (see below)

Your Training Programme Director is responsible for:

Pastoral issues
Issues that you may not want to discuss with your ES

Don’t forget the support staff especially the lovely admin team who help you when you’re locked out of the portfolio!

Know the Coursework Requirements

For my scheme, the Autumn term was the heaviest for coursework. This includes:

E-learning modules – get this done as soon as possible as there is lots to do and the sooner you get it done, the better
Mini-molar endo – by December you have to submit a multi-rooted root canal case that you have completed. December seems a long time away however, you easily get caught up in the hustle and bustle and before you know it, it’s Christmas! Not to forget that most patients need to be dentally stable in order for us to complete a successful root filling, so RCT usually comes at the end of the treatment plan. Start looking early!
Record card review – a review of your records. Remember, your clinical records are a legal document and need to be clear, concise and contemporaneous. I had a general template saved on the computer for specific procedures which acted as a reminder and saved lots of time.
Multi-source feedback – feedback from colleagues at your practice
Start looking for your audit project early – although the deadline isn’t until Spring time, ideally you should aim to complete two cycles of your audit
Keep an eye out for possible case presentation patients

There is more coursework to come after Christmas, but I found the Autumn term the busiest.

Know the Clinical Requirements

This isn’t much different from dental school and there are rough guidelines on how many procedures you should complete. If you notice yourself falling behind, get help! Ask your ES or associates in practice to send some patients your way. Some additional things are:

DOPS (direct observation of procedural skills) – your ES observes you undertaking a simple procedure on a patient such as a simple filling or radiograph

ADEPTs (a dental evaluation of performance) – again, your ES observes you undertaking treatment on your patients

Keep up with the Portfolio

The portfolio is used to monitor your progress and help you identify areas for your improvement. Make sure you log all of your clinical activity, tutorials and reflections meticulously. I kept a tally in my surgery and if you’re nice to your nurse, she’ll do it for you! You have to complete certain sections before the end of the month and after a certain date, they will get locked. For the first few months, I created reminders for myself to complete this but it soon became a habit.

Invest

Loupes are a fantastic addition to a dentist’s armamentarium. I cannot emphasise the difference they make to the quality of your clinical work and posture. It’s a huge expense when you’re straight out of dental school and when the GDC’s annual retention fee has burned a hole through your wallet but they are worth it!

It’s OK to Feel Overwhelmed

If like me, you went straight from school to University and have never had a full-time job, DFT will be exhausting. Don’t be alarmed if for the first few months, you come home and just fall asleep. The first few months of DFT will be physically and mentally exhausting.

You will:

Be working full-time
Possibly have re-located
Learning clinical and non-clinical skills at an incredibly fast rate
Getting used to a new environment and finding your role
Meeting new people
Completing coursework
Keeping up to date with the e-portfolio
Having a personal life

Be kind to yourself and take time out. Speaking of which, take annual leave throughout the year rather than saving it all for the end. This helps prevent burnout. Remember that your fellow FDs on your scheme are going through the same thing, connect with them – sharing a problem is a problem halved!

Don’t be Afraid to Try New Things

At dental school, you may have only used one type of obturation system or just one type of post system. Chances are, your ES will have access to equipment that you’ve not used before. Here’s your chance to use it! Of course, observe first and then give it a go.

Learn to Reflect

You’ve probably done some in dental school but be prepared to do a whole lot more. Initially, I saw it as a tick-box exercise and just wanted to get it over and done with until, my ES introduced me to the Gibbs’ reflective cycle. I urge you to take a step back after a long day and use the Gibbs’ reflective cycle to think about your day. It helps you make sense of the things that happened, what role you played, what you could have done better and what you excelled in – it’ll help you become a better clinician.

When Should I sit the MJDF/MFDS Part 1?

The MJDF part 1 has two sittings: October and April. I would definitely recommend sitting this exam in your FD year as the knowledge you require is very similar to your finals. I chose to sit the exam in April (which got postponed due to the pandemic) because I wanted to completely focus on finding my feet as a FD. Some of my friends sat the exam in October and passed and were glad to have done it earlier on.

Do you have any questions about getting into Dental Foundation Training? Please leave them below

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11:51

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Dental Foundation Training

DFT vs. DVT... What's the Difference? Guest Post with Taranjit Kaur & Maisha Qureshi

Since the season of national recruitment for foundation and vocational training, I'm so pleased to feature this guest post by Taranjit Kaur & Maisha Qureshi explaining the difference between the options after graduation for dentists in Scotland and in the rest of the UK...

Taranjit Kaur & Maisha Qureshi at their graduation

For all UK dental graduates expecting to work within the NHS, it is necessary to complete a training year, which in England, Wales and Northern Ireland is known as Dental Foundation Training (DFT), and in Scotland, Dental Vocational Training (DVT). Taranjit Kaur and Maisha Qureshi graduated together from the University of Dundee in 2019, but where Maisha applied for DFT and has been working in Essex, Taranjit went through the process of DVT in Glasgow, Scotland. They are now at the end of their training years and looking forward to venturing into associate life.

Initial Application Process

For DFT, applications are made through the Oriel portal, and open in August and close in mid-September. You will be invited to book an online Situational Judgement Test (SJT) for November and usually an OSCE style interview with two stations: Communication and Medico-legal ethics. These tests are used to rank applicants, the higher you score, the more likely you will be to secure the post of your preference. The 2020/21 round of DFT applications will rely solely on the SJT, due to government guidance relating to Covid-19.

Applications for DVT usually open in September and close in October and no examinations or OSCEs are required. Dental students in Scotland are reminded of all dates and deadlines by their university however if applying from out with Scotland, an invaluable resource is the NHS Education for Scotland (NES) website. NES are responsible for DVT in Scotland however registration is now done through Oriel. Registering is fairly quick process as only basic details and eligibility for application is checked. CV and references are not required at this stage. This part of the process is a bit more laid back than England, and you can more or less forget about it till May.

Ranking and Securing Final Placements for DFT

Applicants for DFT are able to rank schemes from all over England, Wales, and Northern Ireland, from December up until a week before placement in June. You will be able to access some information about each scheme, such as the location for study days. It is important to only rank places you will be willing to go, but keep in mind that always with DFT there are more applicants than positions available, and not ending up in your first choice doesn’t mean you won’t have a great year.

In June, you will find out which scheme you have been placed in and consequently what rank number you achieved. You will be given the option to decline or accept the scheme, or accept with upgrades, meaning you will automatically be moved to a scheme higher up your preferences if a position becomes available. Once you have confirmed your decision, this cannot be changed.

Within your scheme, you will be given more information about the specific practices. Each scheme organises practice preferencing differently, you may have the opportunity to meet the supervisors or not, and again your rank will determine your final placement. By the end of July, you will be able to contact your Educational Supervisor and organise meeting the team and signing the contract, to start in September.

Open Days and Interviews for DVT

The second stage of the DVT application involves visiting practices and interviewing with potential trainers. Around May, ‘visitation period’ will open for around 2 weeks and allows you to view all the DVT practices and trainers in Scotland. Oriel provides trainer profiles in which you can read what the trainer and the practice has to offer. It is best to upload your CV before visitation opens and have two references ready.

Most practices prefer for candidates to attend an open day after which they will select people for interviews. Open days for different practices can clash as they are often all held in the first week of visitation as interviews are held in the second week. This can result in a busy schedule and a lot of travelling from one practice to another. It is important to be quite swift as often popular practices have a limited number of slots and these can go quite fast especially in bigger cities. The best advice I would give is to have your CV and cover letter ready to email to the practice to secure a time slot and bring a printed copy to give to the practice at the open day.

Interviews consist of meeting with the trainer and often other staff. They usually ask questions relating to your CV and try to gauge if you would be a good fit within their team. It goes both ways; this is an excellent opportunity to ask any questions you may have regarding their practice or team. It allows you to view the surgery you will be working in as well as what equipment is available.

After the interview, the trainer will contact you if you have been shortlisted, which you should consider when preferencing. Trainers and trainees each list their preferences and rank them from 1st (most desired) to 7th (least desired). The practice will not reveal what rank they have placed you on their list and you should not tell them either. NES is very strict in this area and if ranks are revealed, they consider this as cheating. Practices in some rural areas are able to directly offer you the DVT position after an interview in which case the matching stage is bypassed.

Results are then released, and you will be made aware if you have been matched to a DVT practice. If you have not, the clearing process begins, and you can view practices that have also not been matched. Practices are contacted and they may call you for another interview. The Vocational Training year will start in August.

Due to Covid-19 pandemic visitation and open days were not possible and instead all interviews were conducted online. The process will likely return to normal however it is best to check the NES website for updates.

At the end of the day…

For both DFT and DVT, the year progresses quite similarly. You will be working towards becoming more confident and clinically independent while still having the supervision of your trainer, and you will have the opportunity to socialise and network with other trainees and supervisors at your study days. The study days cover a range of topics, and a mix of hands on practical work and teaching, as well as opportunities to present your own work and projects.

For both of us, it all boiled down to where we saw ourselves settling in the future, and we both wanted to move back closer to home. Over the course of the year we learnt more about how to work within an NHS contract, which varies in Scotland from the rest of UK, and we had opportunities to network and make contacts, which can lead to great friends and mentors. Both of us feel it has been a great step between undergraduate dentistry and ‘the real world’ and despite the unforeseen interruptions, we are ending our training year on a high.

Important Information Sources

For more about the DFT process:

https://www.copdend.org/postgraduate-training/dft-recruitment-2019/

For more about the DVT process:

https://www.nes.scot.nhs.uk/education-and-training/by-discipline/dentistry/dentists/dental-vocational-(foundation)-training.aspx

Due to the current Covid-19 pandemic, some aspects of both processes this year will be affected, so please keep yourselves up to date and informed. If you have any questions, please feel free to contact us!

Thanks for this amazing post Taranjit & Maisha! Please leave any questions in the comments below

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11:14

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Coronavirus

COVID-19 diaries with Rachel Botrugno: Life as a FD during lock down

Another COVID-19 diary now with Rachel Botrugno, a foundation dentist based in Bristol

Rachel, a Foundation Dentist based in Bristol

It has been months now since I've picked up a dental drill. My feeling towards this is similar to when I finished on clinic in final year with months to wait before starting clinical dentistry in my foundation year. I didn't foresee this feeling returning during my FD year...

During this time, some things continue as they would have done... like sitting my SJT (completed in a test centre as my internet connection can't be trusted). Good luck to everyone awaiting to hear their fate regarding DCT posts.

I've been going into my practice to assist with telephone triaging our patients. This is difficult to compare to the volumes of experience we were gaining at the start of the year, but I feel this has helped me in some areas of my dentistry. I feel my ability to take a succinct history from a patient has greatly improved, as well as effectively communicating to patients that antibiotics are not indicated for their pulpitis. Another skill is familiarisation of interactions and contraindications of analgesics and antibiotics, particularly ibuprofen. On those busy Monday mornings my time management and communication with the rest of the team also grew.

A fellow FD and I also created a dental prevention video. This was aimed at benefiting adults and children around Bristol associated with a local social enterprise known 'Jumpsuit', some of whom we worked with during our community project. This was great fun to produce and involved videos on how to use a manual vs. electric toothbrush as well as how to use disclosing tablets, all done from the comfort of our own homes.

Fortunately, our TPD has been very proactive in booking speakers and maintaining regular communication with our scheme via our 'Zoom study days', the highlight of these is catching up with the rest of the scheme, often sharing our baking successes.

During lock down, I have spent more time doing yoga. I have been using an app called 'Yoga l Down Dog', which has a free trial period available. I'd recommend for any keen yogis out there but also for anyone who wants to start, I highly recommend it!

Like many, I have been reflecting on how fortunate I am compared to others, in terms of my good health and my continued income. I have tried to consider how I could help other members of the community, now and into the future. I've helped in small ways by providing leftover samples of toothpaste from our FD community project to a local community hub. I have also signed up to 'Reenage' which is a charity that gets volunteers in touch for phone calls with lonely and isolated older people in the community. I have really enjoyed speaking to the patients over the phone in practice and for some it has really come across how they enjoy a chat as well as receiving management for the dental problem.

Good luck to any of the FDs returning to practice over the next few weeks. Stay safe!

Do you want to write a COVID-19 diary? Please get in touch! Whether you're a dental student, foundation dentist, dental core trainee, associate, dental nurse, therapist I WANT TO HEAR FROM YOU!

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16:36

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Coronavirus

COVID-19 diaries with Rameeta Bharma: Lock Down as an FD

Next in the COVID-19 series is Rameeta Bhamra...

Rameeta, a Dental Foundation Dentist

March. What a month. How things changed. I'm Rameeta and I'm currently working as an FD. Going into work at the beginning of March, things were relatively normal. DCT SJT and MJDF Part 1 exam preparation were under way, talks of fundraising for the practice 5km Colour Run, bickering over whether chocolate digestives trump rich tea biscuits was a daily occurrence, oh and there was the odd mention of 'Coronavirus' in conversation.

The number of new cases slowly increased, with hourly updates thanks to my nurse and although the WHO declared the COVID-19 outbreak as a pandemic many thought and to a degree (I think) took comfort in assuming that Coronavirus only affected vulnerable groups; those who have underlying health conditions and the elderly. Surprisingly, many patients also considered it to be scaremongering bu the media. So just like the rest of the UK, it was business as usual for the dental world.

How. Things. Changed. And fast. My diary became emptier as patients started cancelling appointments. Like many FDs, I had finally started to get to grips with working in general practice when guidance from NHS England and the Deanery was released, which meant drills down regarding Aerosol Generating Procedures (AGPs) and within a few days my full diary of patients quickly disappeared as the practice closed it doors until further notice. The MJDF part 1 exam along with SJTs and many other exams were postponed.

So since mid March I've been off work and I volunteered to be redeployed into hospital and assist with NHS 111 triaging as have many FDs and dental teams; but I am yet to hear back. The last 7 weeks however, have entailed numerous and unnecessary trips to the kitchen, triaging patients over the phone, case write ups, keeping on top of my DFT portfolio and A LOT of CPD.

I decided to move back home after spending a month alone in lock down. Big mistake, as those trips to the kitchen have become even more numerous and unnecessary and have also involved a lot of baking (yes, I did make banana bread, twice). As well as this, I've used this time to reflect and think about future goals, spending time with family and also for some much needed R+R (maybe a bit too much); but honestly, I'm ready to go back to work. When? My guess is as good as yours. I'm sure we can appreciate the challenges presented by the dental field and the nature of our jobs in explaining the uncertainty as to how dentistry will move forward after this lock down period and as to why resumption of normal dental services and clinical practice doesn't seem to be anywhere in the near future.

Stay safe!

Do you want to write a COVID-19 diary? Please get in touch! Whether you're a dental student, foundation dentist, dental core trainee, associate, dental nurse, therapist I WANT TO HEAR FROM YOU!

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11:49

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Coronavirus

COVID-19 diaries with Onkar Mudhar: DFT vs. Coronavirus

Here is my next COVID-19 diaries entry with Onkar Mudhar, a DFT based in Essex and fellow Dental Training Consultants crew...

Onkar, a Foundation Dentist based in Essex

I'm Onkar, a foundation dentist based in Brentwood, Essex (yes... that is where they film THAT television show, but lets just skim past that). Having recently graduated from King's College London in July 2019, I was thrilled to be starting my FD year. Being in charge of my own treatment plans, seeing multiple patients a day and actually being able to use 'Doctor' to sound a little more fancy were the small pleasures I had been looking forward to now for half a decade!

Fast forward to September 2019, the 'honeymoon' period was over, I was in full swing of foundation training. The pace picked up fast, from 5 patients a day in my second week, to 12 patients a day in my fifth week, I was finally starting to feel confident and looking forward to the daily grind! Weekly study days at Basildon Hospital added to this, as we spent our Fridays either in lectures or having practical sessions on topics such as composite bonding or crown preparations.

By Christmas, we started hearing of a 'flu like virus' in the media which had begun spreading in Wuhan... initially, we all brushed these concerns off! We're a tiny island, miles away from Wuhan, we don't have much to be concerned about... or so we thought!

March 2020 and we were in the crux of the 'Corona Crisis' - not much guidance had been given to dental professionals and most of us were continuing to work as normal, asking patients if they had travelled to any high risk areas in the last few weeks or had any chest symptoms or a fever, before blissfully carrying on with routine treatment such as fillings and root canals. Furthermore, our weekly study days were still going ahead, along with other events held in and around Essex and London - we were progressing with caution and things started feeling a little uneasy...

By mid-March, we had confirmed cases all over the country including Essex and frank discussions were being had at the practice I work in. For reference, it's a large corporate consisting of 12 surgeries, encompassing orthodontics, implants, facial aesthetics and routine NHS and private dentistry. The patient base is huge and the number of staff employed is exceptional - something had to be done to prevent the potential spread and with little to no government guidance the practice decided to take things into their own hands!

Scrolling through social media at this point emphasised how frustrated dentists in a general practice setting felt... movements on Instagram such as #DownDrills encouraged the halting of all AGPs (aerosol generating procedures) to prevent accidental transmission. As a foundation dentist, my colleagues and I felt somewhat in limbo. Having received little guidance from any official bodies, I was still in practice seeing emergencies mainly for extractions or to write any prescriptions. In addition, we received an email informing us DCT recruitment had been 'postponed' and all our study days for the foreseeable future had been cancelled. Adding to this uncertainty, was the constant hearsay that all foundation dentists were to be redeployed to a hospital setting. Emails were sent back and forth, transferable skills forms indicating what we'd be comfortable doing were filled out, but nothing was ever actioned and I am yet to hear back...

To say I felt deflated would be an understatement... I was thoroughly enjoying my foundation training and by March, was often seeing 20+ patients a day carrying out a variety of treatment and to add to my woes, I still needed to fit crowns on three of my patients (I hope those temporaries are still holding up!).

By the time official lock down came into play, we were informed by our TPD (training programme director) that we weren't to come into practice anymore and instead, help telephone triage from home. For the first 2 weeks of lock down I was helping doing this, but ran into difficulties with electronic prescribing, not to mention the fact patients didn't understand why we couldn't see them in practice...

After the creation of multiple group chats, it was then decided we would need to operate on a skeleton system, which involved a dentist coming into work every day, telephone triaging on site which would effectively combat the issue of prescribing, accessing notes etc. Being a 10 minute drive from my home, I was more than happy to volunteer and have been attending the practice 1-2 x a week alongside a senior dentist, telephone triaging ensuring all patients queries are taken care of.

It's now been more than a month in lock down and I am still waiting to hear back about redeployment. Along with telephone triaging and listening to countless webinars, I have been enjoying the family time and have been carrying out my daily exercise so I don't feel guilty when indulging in a few too many desserts!

A highlight of this time has been the donations my fellow Dental Training Consultants and I have raised... between the team we have donated 10,000 products including oral care packages, soaps, creams and lip balms to hospital frontliners and homeless centres in London and Essex. This has truly been an amazing experience and we hope to continue to donate once their crisis is over.

Just some of the donations Onkar and the team have collected for NHS workers and homeless hotels

To say the last few weeks have been a whirlwind would be an understatement. COVID-19 has been relentless, whether it be the way it has rampaged through families or the effect it is having on our front line staff who work tirelessly through gruelling shifts to ensure we are taken care of... on behalf of all of us, I can only say thank you. And to anyone who has lost a loved one to this dreadful disease, my deepest apologies.

My foundation training year has been filled the the term 'reflect'. Reflect on your molar endo, reflect on that crown prep that didn't go too well, reflect on that extraction...

Reflecting on COVID-19 I think it's clear that humans as a species are constantly in a rush. We always have something to do, somewhere to be or a deadline to meet. This is the first time the majority of us are sat at home, idle, waiting for something to do and initially it felt odd but now, it seems we're getting through it.

Lastly, one thing that we can ALL take from COVID-19 is the theory of human nature. Kindness, compassion, charity and unity are words that spring to mind when I think about the actions I've seen form people all over the country. Whether it be clapping for carers at 8pm every Thursday, dropping food outside an elderly relatives house or simply running that 5k on Instagram and donating to charity of your choice... it's clear to see in times of darkness, kindness shall always prevail.

Do you want to write a COVID-19 diary? Please get in touch! Whether you're a dental student, foundation dentist, dental core trainee, associate, dental nurse, therapist I WANT TO HEAR FROM YOU!

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12:23

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DCT

6 Top Tips for Situational Judgement Tests

Dental Core Training interviews should be coming up shortly! So here is some last minute tips for, in my opinion, the hardest part of the assessment.... the SJT!

What are Situational Judgement Tests?

Situational Judgement Tests (SJTs) were first introduced in medicine as a way of objectively assessing candidates outside of clinical expertise. They are not designed to test a clinician's clinical knowledge, but instead to test:

Professionalism
Teamwork
Communication
Prioritisation skills
Putting patient's best interests first

This style of assessment is becoming increasingly popular in medical recruitment. It is used to assess candidates in dentistry for foundation training, dental core training and some speciality training recruitment. So if you are looking to go further in postgraduate dental training, it should be a style of assessment you should get used to!

For DFT training, they currently make up 50% of your interview score, for DCT they make up 25%.

How Are They Marked?

There are 2 types of questions in SJTs:

Ranking-based: you are presented with 5 different answers and you need to rank them in order of appropriateness. 20 marks are available
Best of 3: you are presented with 8 different answers and you need to pick the 3 most appropriate. 12 marks are available, 4 for each correct answer you choose.

For the ranking-based questions, you get marks for getting the answers as close to the correct order as possible, as explained in the table below.

Scores awarded if the correct answer was in the order ABCDE

As you can see, you would lose the most marks if you get the bottom and the top answers the wrong way round.

Top Tips

Focus on the top and bottom answers - get these the wrong way round and you will lose the most marks. If you get answers in the middle slightly the wrong way, you will only close 2-4 marks out of 20!
Only use the information that is in the question - every word in an SJT in there for a reason, learn to read scenarios to pick out the most useful words or wordings e.g. 'urgent', 'stable'
Do not make assumptions - while the information they give you in a SJT is limited, there is plenty of information that isn't in there! Think laterally and don't make assumptions about what the question is asking
Think about the consequences - think about what the consequences your actions will be on yourself, your team and your patients
Don't second guess yourself - answer the question then move on. Overthinking answers will just confuse you!
Think of how the answers fit together - for best of 3, it usually asks when they are considered together. The 3 answers you pick need to work well together, not repeat or contradict each other

And remember, more practice doesn't necessarily make perfect! You can't revise for this part of the assessment, just remain calm and work out a strategy that you can use in a time-efficient way. And GOOD LUCK!

If you're interested in preparing one-on-one for SJTs, I am offering limited spots for personal coaching. See here for more information.

Do you have any questions about dental core training or the assessment? Let me know in the comments below.

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11:52

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My advice to anyone about to undertake DFT

1. Ask for advice, - both from supervisors and colleagues!

2) Giving oral hygiene advice is great!

3) Be open and honest with your patients.

4) Enjoy the year

Question one: ranking question

Question two: best of three

Dental Foundation Training

Dental Core Training

Specialist Training

What about the future?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday and Sunday

Know Who to Contact

Know the Coursework Requirements

Know the Clinical Requirements

Keep up with the Portfolio

Invest

It’s OK to Feel Overwhelmed

Don’t be Afraid to Try New Things

Learn to Reflect

When Should I sit the MJDF/MFDS Part 1?

Initial Application Process

Ranking and Securing Final Placements for DFT

Open Days and Interviews for DVT

At the end of the day…

Important Information Sources

What are Situational Judgement Tests?

How Are They Marked?

Top Tips

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