The View From VT
Katie MacDonald talks about her journey from VOCATIONAL TRAINING to associate and provides some timely reflections for current VTs, new associates and practice owners
In addition to marking the end of 12 calendar months, New Year is often considered a time for reflection. It provides an opportunity to look back on the previous year’s successes, failures, dramas and disasters. And, most importantly, trying to forget about that one treatment that didn’t go quite according to plan…
For me, 2016’s achievements have included; completing Vocational Training, passing Part 1 of the Membership of the Faculty of Dental Surgery (MFDS), and securing my first associate job. Several hours spent re-evaluating my life choices, endless note-writing and a few episodes of near-exhaustion were also involved.
Despite this progression, experiencing mixed emotions in the first few months following VT led me to question whether young dentists will ever be prepared for the challenges of professional life beyond training, and the advice I wish I could have given myself.
Working in a supportive and encouraging environment changed my view on dentistry
There are three words I would use to describe the three main phases of my career so far: challenging – the word I use to describe dental school; supportive – my experience of VT: and shock – the reality of being a first year associate. Having found the academia of dental school demanding, my initial goal for VT was just to survive the programme. However, the experience of working in a supportive and encouraging environment changed my view on dentistry, and the short life span I had previously associated with it.
Like many of my fellow graduates, I chose to avoid speciality/hospital routes and remain in general practice as a dental associate.
AKA an accelerated course in practical dentistry designed to make you a safe practitioner (with the added bonus of working in a supervised and protected environment). Or put more formally: “A post-qualification training period, which UK graduates are required to complete, in order to work in NHS practice.”
This is the reassuring message the BDA offers prospective patients doing some background research into their recently graduated dentist. And an alias many VTs will come to appreciate during the more intense “work experience” related patient interrogations:
“You look about 14”, “Where did you work before this?” and “How long have you been qualified?” are common cynicisms you become expert in answering.
As intended, my VT year provided the opportunity to develop a wide range of clinical skills in the time needed, without pressure. A full and well-organised book also ensured a varied range of NHS treatments and patients. The demand for Prior Approval cases and private treatments was fewer, but in keeping with VT requirements.
In addition to accruing essential continuing personal development (CPD) hours, study days offered a welcoming break to the working week and proved invaluable in sharing clinical experiences and picking up useful tips along the way.
Trainee experiences within the group varied greatly – some positive and some negative – but despite a lack of complete standardisation, everyone passed “satisfactory completion” without problem.
The result? Ten eager young dentists ready for the challenges of general dental practice. Apparently.
Twelve years of combined education to earn the status of fully-qualified general dental practitioner. More than a decade spent learning (six years of that dedicated to teeth). And I still felt unprepared. The VT safety blanket had been removed, its absence replaced by a colossal sense of responsibility and fear of the unknown.
Despite such a positive and progressive VT experience, adapting to associate life still proved challenging and felt overwhelming at times.
Like many of my fellow graduates, finishing VT meant finding a job in a different practice. This involved moving to an unfamiliar environment and working with a different team, equipment, materials and software. Habits that were second nature in VT have to be re-learned; from finding the recline button on the dental chair, to familiarising yourself with multiple drawers in a foreign surgery.
You realise you didn’t quite know how to work the “different” rotary system only when you’re half way down a canal, and the impression material you’ve been handed looks different because you discover you’ve never used it before.
The ultrasonic on the side unit isn’t fixed to the chair and has its own pedal you keep forgetting about, and now you’re battling with an X-ray machine that refuses to stay in place.
Failing at basic dentistry – and this is only day one!
After an exhausting few weeks, you begin to settle into a routine, but now paperwork and forms that you never paid any attention to in VT suddenly become relevant, as does the prospect of organising your own book. “Money” turns into a dirty word and private treatments become more significant.
Finally, at the end of month two, the long-awaited schedule arrives. Line 40 is the first thing you look at. “It’s all been worth it” you think, until you deduct the tax!
A lack of full-time associate jobs meant working two part-time positions, which has resulted in two very different experiences.
One of the practices is based in a university campus. My day is never dull and involves treating mainly students and staff.
It mimics general practice, with the exception of more emergency appointments and an increase in sports-related traumas.
Despite the risk of going straight from VT into a single-surgery practice, the support of the dental team has more than made up for my lack of experience. Having to make decisions independently has also benefited my treatment planning and clinical decision making skills – something I feel may have taken longer to develop had I not been in that situation.
My other job is exactly what you would expect from a predominantly NHS practice; a mix of patients from diverse socio-economic backgrounds, requiring multiple treatments. Denplan has been a concept I’ve had to get used to, as is discussing implant placement as a treatment option in-house.
Despite it being a four-surgery practice, a lack of communication and support has felt isolating at times and made the initial transition into general practice slightly more challenging.
Two very different practices and one steep learning curve later, I feel like I’m starting to get a grasp of being a dentist. Reflecting on this experience has made me realise how much I undervalued the VT programme at the time and the importance of utilising it to its fullest extent.
In hindsight, there are certain things I would have done differently, so I’ve come up with a list of changes I think would have helped me:
Tips for VTs
1. Try, try and try again:
- Don’t be hesitant to attempt treatments you’ve never done before
- You’re going to have to do it sometime so take advantage of the support while you have it
- Patients understand that you’re still learning in VT and make allowances for this.
2. Use free time wisely:
- Write up tutorials or reflective logs
- Observe treatments that you lack experience in
- Go over financial reviews and familiarise yourself with the schedule.
3. Observe other associates working:
- When was the last time you watched another dentist working? Probably during your work experience for getting into dental school. It’s amazing what you can learn.
4. Familiarise yourself with the SDR:
- Know the most common codes – you won’t always have a nurse who will chart this for you
- Prior approval charting: extensive/full case examination, clinical photographs, radiographs, study models, duplicate study models (diagnostic – not included in prior approval limit).
5. Have an idea of your monthly income (before and after tax) and the size of your patient list:
- Compare this to the start of your training – you’ll soon realise the progress you’ve made
- Use this as a gauge to determine what you would earn as an associate. Is it enough to live off?
- This question is commonly asked in associate job interviews.
6. Communicate with reception to help organise your book:
- Give reception an estimate of your treatment times (e.g. RCT 45 mins, fills 40 mins, denture work 30 mins)
- Start this now and it’ll be far easier in your first associate job.
7. Be aware of the paperwork/forms/admin that goes on behind the scenes:
- Prior approval/GP17
- Referrals: where to? Method: email/letter etc.
8. Be able to make your own clinical decisions:
- Be prepared to support, discuss and defend decisions you’ve made regarding treatment planning
- Remember you won’t always have the reassurance or advice of your trainer.
9. Money matters:
- Provide the patient with all treatment options (NHS and private) and a printed estimate (it’s part of the consent process!)
- Get into the habit of discussing the cost of treatment. Demo/models and a printed treatment plan are helpful aids.
10. Practice safely:
- Know your limitations
- Ask for help, advice and a second opinion when required
- Act within your clinical capabilities
- Remember the option to refer.
About the author
Katie MacDonald qualified BDS from the University of Glasgow in 2015. She is currently working towards the second part of her MFDS and is an associate at Airthrey Park Dental Practice at the University of Stirling.