anyone feel incompetent in clinic?

[mike05tusdm]

Hi All, I've only been in clinic for a few months(I'm a 3rd year), so I'm just wondering if feelings of "I don't know what I'm doing" are common at this stage of the game. Right now, I need so much help from faculty just to be able to do something as simple as an operative procedure. So far I've done mostly exams and cleanings, a handful of operative, and 2 crown preps. I haven't done any endo or any complicated prostho yet-I suspect I'll feel even less confident having to do those in the near future. Right now I can't imagine myself being capable of treating patients on my own without faculty guidance in a year and a half.

Just my $0.02 Mike

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[UBTom]

Hi Mike,

I can sympathize... I was in your shoes last year when I was a new 3rd-year, fumbling around and taking 3 hours to do one sealant.

It will get easier though. The thing is, once you have done a procedure for the first time, you usually realize "that wasn't so hard!" The next time you do the same procedure you would approach it with newfound confidence.

Since you have already cut two crown preps, it must be pretty familiar to you by now. Cutting preps for an FPD is the same, except you just have to pay more attention to maintaining a common path of insertion.

Doing CU/CLs and RPDs are not very difficult either, for the first two visits anyway (primary and secondary impressions, the 2ndary with border molding). After taking jaw records/establishing VDO, it's pretty much all lab work (setting teeth, flasking, etc.).

Endo is easy after you've done the first one. If you can, get a simple case to start off with such as a single-canal anterior. After the first one you will be confident enough to move onto the more complicated ones, like #5 or #12 (with 2 canals). After that, give a molar a try.

I was afraid of doing anything at the beginning of last year. Now that I'm halfway through my 4th year I've found myself doing things A LOT quicker. Sealants in 5 minutes. A Class-II Amalgam in 40 minutes (with the rubber dam and all the bells and whistles). Crown prep, provisional, pack cord and PVS impression all in one 3-hour clinical period. Perio surgery crown-lengthening in 1 hour. #5/#12 endo in 2 visits.

Keep on truckin'. You'll get there!

 

[ShawnOne]

I have a question for anybody who is knowledable about PBL.

At USC, Dr. Shuler, who is in charge of the PBL cirriculum, told us interviewees that PBL addresses the problem of 3rd years jumping into clinic. (Starting clinic in 3rd year)

According to him, through USC's PBL implementation, the clinical aspect of dentistry is tied in with the theoretical and is taught from day 1. (like a combined approach) So nobody at USC should feel like the OP once in their 3rd year. (which he said is a common occurance in traditional DDS)

Anybody out there have any experience with this and would like to comment??

 

[aphistis]

Our PBL doesn't really include any significant clinical focus I've noticecd. Sure, the information is more clinically presented (by nature of the case study format), but the studying isn't any different from ordinary lecture material. I'd be interested in hearing how USC thinks they include clinical stuff into their PBL.

 

[UBTom]

Hi Shawn,

PBL is good for teaching you diagnostic skills I think. i.e. if your patient presents with an unusual condition, PBL is good for teaching you how to make a list of possible disorders ("differential diagnosis") based on the presenting symptoms and how to go about determining what that condition is and formulating treatment.

The problem Mike is having is just the usual first-time jitters and unfamiliarity in doing procedures in clinic, such as cutting an amalgam prep or making a partial denture. That's not something PBL will help you much with.

There is only one way to gain clinical experience in doing procedures... And that's to do 'em!

 

[DcS]

When do most schools start in the clinics on average?


At UNC, we started prophys in the summer of the 1st year. In 2nd year fall, we start with our own family of patients and do amalgam/composite restorations and sealants, and some scaling/RP. This spring (of 2nd year) we will be able to do fixed pros as well. I'm assuming this is early compared to most school, which is nice.

So what is the norm?

 

[aphistis]

I think we hit the clinics starting after spring break 2nd year.

 

[UBTom]

Most schools start comprehensive care sometime in the 2nd year it seems.. Here at mine, we start doing prophies Fall of 2nd year. When Spring 2nd year rolls around that's when we get assigned patients for comprehensive care, including operative, fixed, removable, endo and perio. We do peds and OMFS stuff on rotation.

My sister tells me at NYUCD they start comprehensive care clinics also Spring of 2nd year.

 

[ShawnOne]

From my understanding USC starts clinical exposure during their first semester.

I know the 1st semester students I observed in early October were already doing radiographs in the clinic to go along with the x-ray related PBL case.

 

[groundhog]

A couple of comments to the original question that applies to any intense high consequence training program in general.

1: Pain trains

2: If at first you are not feeling anxious and a bit in over your head, you are likley a danger.

 

[PashaJ]

At BU we do the radio rotation in first year too, but I wouldn't count that as the beginning of clinic really. I believe we start in the 3rd year. We start later, in comparison, due to the APEX rotation we do after 1st year and after we take our part 1 in December (second years take it this Monday I think).

 

[ToothDoctor]

Here at SIU we are in the clinic right now (second nine weeks of first semester of first year). We are performing oral exams, perio screenings, coronal polishings and sealants on each other. We are split into groups of 3 (1 "patient", 1 "assistant" and 1 "dentist"). Each student has a chart and when we are done performing any procedure listed above we have to complete notes in the chart following SOAP and have the chart signed off by a faculty member. Next semester we take group field trips to schools where we polish and place sealants on children who otherwise wouldn't receive care. I think clinic exposure this early is great!

 

[ItsGavinC]

I was under the impression that "being in clinic" referred to operative dentistry, not merely placing sealants and the like.

Although prophies, etc. are certainly important, for the sake of comparing one program to another, I think operative dentistry on a patient pool signifies the beginning of "clinical experience".

Just my two bits.

 

[UBTom]

I agree. I think "comprehensive care clinic" is the better term. That's when you are finally in the clinic treating real patients doing comprehensive work just like a real general dentist-- Not just prophies and sealants, but operative, endo, fixed, removable, perio, exos, peds etc. You do the initial exam, draw up the treatment plan, and take care of it from start to finish including referrals if something is out of your scope (such as teeth that need postgrad endo work).

Most schools start the dental student in comprehensive care clinic usually sometime in the 2nd year... I'm sure there are a couple of schools where the student jumps right into comprehensive clinic near the end of the first year too; good for getting as much clinical exposure as possible but probably a bit nerve-wracking.

 

[ItsGavinC]

I fully agree with all you said. It's all about having a patient pool, and your noncompliant classmates don't count!

 

[DcS]

To clarify for UNC, we enter Comp Care in the fall of 2nd year with our own patient pool. Although in the summer of 1st year I volunteered at a free local clinic and performed my 1st amalgam, it was quite a nerve-racking experience!

 

[Rob2005]

Mike,

I totally empathize with you, my man. I am also a 3rd yr with just a few procedures under my belt, and I also find myself thinking, "How the hell am I going to fly through this without holding anybody's hand after a mere yr and a half?" The other day when I was cutting my second crown prep, a little voice inside my head kept on shouting at me to call the instructor over to check every little step, as I had been doing in some of my other procedures. I disregarded this inclination, however, and plowed through most of it solo. As funny as it may sound, doing this gave me a great feeling of empowerment and independence. I think sometimes we don't give ourselves enough credit for how much we really do know and can accomplish. Funny, I keep on telling myself this, but I am still scared sh*#tless to do my first root canal tomorrow, even though it's a straightforward single canal.
I wish there was a magic bullet that would cure all this instantly, but I think that in less than a yr's time, we will be the "big" seniors, and that will be a confidence boost in itself.

I think the one of the hardest things to deal with in clinic is that I am learning how inexact of a science dentistry is, as each instructor has their own opinion of what is best for the patient. A nice thing about this, however, is the creativity and freedom that the profession allows. Anyway, it would be nice to hear from any other 3rd yr students who are struggling through the same predicament.

Rob

 

[DrRob]

I am in my second year of practice and I still feel "inadequate in areas" - of course I do not sweat the same things I did in junior year but I do agree with the fact dentistry is not an exact science and that what seems to fustrate people.