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Third Year Clinical Experience

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Hello! 

I am a third year dental student and we have just recently started our clinical experience on real patients. I must say I love it! It's great getting to practice dentistry on real people and interact with different personalities every day. I am just suffering from some anxiety due to the pressure and expectations that is on us now. I performed decently (average) in the pre-clinical semesters and lecture material, but I still happen to forget things during clinic, whether it is certain techniques or diagnostic criteria. I have gotten poor grades (and I mean really poor! I failed a couple) on a few clinics so far and we have just recently started! It's making me very worried about my performance. I know this is mainly just anxiety and should improve with time, but my low grades have been due to deficiencies like misdiagnosing, cutting a preparation beyond the cavitation, forgetting to gather important medical/dental history information, and at one instance I almost hit the pulp, which required us to change up the restorative plan.

I'm just curious, to all the 4th years or graduated dentists out there, am I an anomaly, or is this what I should expect? I am mostly worried because I have heard of people being required to repeat the year due to these sorts of deficiencies in clinic. In fact, I have been told that one of the graduated classes at our college had 3 people required to repeat their year. I really don't want to repeat anything! I'm an OOP student and my parents have invested a lot in me, financially and emotionally, to be here. I don't want to disappoint them or myself by failing a whole year. If there's any reassurance you have for me, or any practical tips to overcome these problems, I would really appreciate it! 

 

 

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I teach third years on occasion. You guys have literally just started interacting with patients in a way that goes beyond hygiene/cleanings. It's completely normal for this to feel foreign, awkward, nerve-wracking, anxiety-inducing, the-walls-are-closing-on-me-please-end-this-now. And in a school environment, it can be really strange since you feel like there are multiple people breathing down your neck. It's for this reason I really try to take a different approach most instructors do with students; I'm there to help you guys learn, to make the situation enjoyable and fun and as casual as possible, not berate or put you down for doing something I wouldn't do or differently than I think you should. It's completely unreasonable for me to expect you to know exactly what to do, how to do it, when to do it, and then execute it to my standards. The truth is, when you walk out of clinic, you shouldn't be pondering "Did I do good? Did I do that well?" you should be thinking, "Did I learn something today? Yes. Okay. Good. Onto the next."

I know it's hard not to get tunnel vision with what you're doing, but try to take a step back and realize that you're there to learn. You are indeed, there to make mistakes. I know that sounds catastrophically wrong, but it's the truth. It is a school, first and foremost, not a dental clinic. The patients receiving care bit is sort of just a necessary consequence. I assure you that, in the end, although it's a long road, it all evens out, and your learning continues heavily into private practice.

I'm 3 years into private practice and only now can I say that I feel pretty confident with 90-95% of the situations I encounter on a daily basis in general practice. I still refer things out, and even with some bread-and-butter things I still run into trouble, because it's the nature of it. But I approach situations like this differently. I used to approach it with the occasional "I'm not sure what the fuck is going on here" mentality and allow fear or anxiety to take hold. Now I approach it with the mindset of "I'm just here to do my best and take good care of my patient and maybe learn somethign along the way" and I allow that to take me wherever it may. It has allowed me to become a better dentist, both clinically and non-clinically.

You're not just a student of dentistry, you're a student of life. Treat it that way and you'll feel less anxious about your situation. Zoom out a little bit. It'll be fine.

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20 hours ago, KentuckyFriedBlaziken said:

I drilled the wrong tooth once on a pt and I m still here so you ll be fine

I've:

  • drilled the wrong tooth
  • called the patient the wrong name for an hour straight (this was literally last week and my patient coordinator was just too nice to tell me during the appointment even though she's usually very blunt with me)
  • broke off a ~2cm piece of maxillary hamulus and caused a massive sinus exposure (removed part of the sinus floor) while extracting an ankylosed 17
  • caused a pulsing bleed (broke the alveolus on the palate and exposed the greater palatine artery) the while extracting a 16 on my second day of practice
  • broken a few files during endos
  • cut tongues a few times with the highspeed (eh, it happens)

And etc.

And I consider myself clinically a pretty decent dentist. These things are gonna happen. You can't stop the waves, but you can learn to surf.

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Concur, procedural mishaps certainly happen in medicine as well despite our best intentions. That being said, dentistry is more a private practice environment, so I'm curious how you approached the situation with patients and how they reacted? Presumably patients won't expect everything will go perfectly smoothly if they're attending a student clinic, but what about those in a regular office?

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1 hour ago, Lactic Folly said:

Concur, procedural mishaps certainly happen in medicine as well despite our best intentions. That being said, dentistry is more a private practice environment, so I'm curious how you approached the situation with patients and how they reacted? Presumably patients won't expect everything will go perfectly smoothly if they're attending a student clinic, but what about those in a regular office?

I manage any immediate complications first, and just tell them. Informed consent is huge but you don’t always have time to go over every potential complication or adverse outcome. I’ve learned how to succinctly and casually go over the most important stuff in a way that informs, clarifies, doesn’t overwhelm and doesn’t terrify the patient. I keep it light. But going over things at least briefly means as a clinical you can’t lose. If it goes smoothly, you’re a hero. If a complication happens but you told them, you look like you’re thorough and competent. 

 

I can genuinely say I have never had a patient become upset at me. Not once. Maybe a little disappointed at the situation, but never upset with the care they received. I’m fortunate in that way but it’s also because I speak and carry myself well, which ultimately affects patients perception of you much more than the work you actually do, at least in dentistry. That can be both a blessing and a curse depending on who you are and your personality. 

 

Im sure it’s similar in many private practice environments in medicine. 

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Thanks for the answer - agree communication and paying attention to patient perspective are paramount. I think medicine is a bit more formalized in routinely getting signed informed consent for procedures, including detailing (1 out of xxxxx) worst-case scenarios. None of my visits to the general dentist, endodontist, or oral surgeon have been quite so explicit and usually focus more on what one might expect after the procedure. I think I'd remember if someone told me they might cut my tongue...?

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On 1/14/2019 at 3:02 PM, Lactic Folly said:

Thanks for the answer - agree communication and paying attention to patient perspective are paramount. I think medicine is a bit more formalized in routinely getting signed informed consent for procedures, including detailing (1 out of xxxxx) worst-case scenarios. None of my visits to the general dentist, endodontist, or oral surgeon have been quite so explicit and usually focus more on what one might expect after the procedure. I think I'd remember if someone told me they might cut my tongue...?

I use written consent forms for anything beyond simple restorative (fillings). Any form of surgery, endodontic and even some prosthodontic/crown & bridge work carries a signature.

I don't go into so much detail that I tell people "I could cut your tongue," because although that's a minute possibility, it's unreasonable to expect one to go over things like that. If that were part of informed consent I guess you could say anything could happen.

For a complication or adverse outcome to be part of your discussion it has to be both a) reasonable in likelihood and/or high in severity and b) specific to the procedure at hand. Harming someone's tongue while doing dentistry is way too non-specific. It could really happen during anything we do, and as a result it's not reasonable to discuss it before touching the patient. Otherwise I'd have to go over the following:

  • you might gag
  • you might not like the taste of shit we put in your mouth, in fact all of it tastes like poo so you're fucked anyways
  • I'm gonna have to pull on your cheeks & lips, if you have dry lips they might crack and bleed and that's no fun
  • I'm going to waterboard you with water hahaha sucks to be you
  • literally none of the things I have to and/or may do to you are pleasant, whoops

and etc ad nauseum

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I agree with cleanup - I have close family members who are dentists - and they all say that while in dental school - everyone is likely experiencing the same negatives and anxiety but no one is willing to admit it to each other given everyone's competitive nature - depends on the class makeup I guess - but chances are everyone around you are feeling just as badly.

 

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