I graduated from Barts and The London in 2023, and I am currently coming to the end of my year of Foundation Dentist (FD) training. I can only describe the experience as a rollercoaster ride. The ups and downs have taught me invaluable lessons that I hope to share with those about to embark on a similar journey.
Induction period and study days
This varies from scheme to scheme, but in my area the induction period was roughly two weeks. We had sessions introducing us to what the year would be like, and icebreakers with the rest of the dentists on the scheme. It was useful to know the deadlines for different milestones, such as the Interim Review of Competence Progression. The induction was good because it does settle you in but it does not feel like too much hard work.
Study days typically start within the first few weeks of starting FD. Depending on your scheme, they may continue every week until the end of the training year. On the North West London scheme, they finished around March so we were expected to be in practice five days a week.
Adapting to your patient demographics
I have been working in Wembley Park, a high-needs area in the London Borough of Brent, which consistently ranks as one of the highest areas for dental decay in the country. The patient demographic you encounter during your foundation year will vary, and it is crucial to adapt your skills to meet the specific needs of your patients.
In my practice, I frequently treat a lot of partially dentate patients, as well as patients with multiple carious lesions. This has given me extensive experience with extractions and fillings. If you are practicing in different areas, you may have a lot of fully edentulous patients, so will focus far more on creating dentures than I have done. Regardless of your location, make the most of your patient base, as there is much to learn.
Embracing the steep learning curve
Do not be afraid of being in a high-needs area even though it can be slightly overwhelming at first, especially if your experience at university was not very clinical. Early on, you may feel uncertain and lack confidence, but like a muscle, your competence will grow with consistent training. By the end of FD, you will be a more confident and sustainable clinician.
The renowned “Dunning-Kruger” effect where initial confidence gives way to the realisation of how much you still need to learn – can be stressful. However, as you learn from your mistakes and gain knowledge you will feel much more competent and confident.
Dealing with time pressure
Take your time to do things correctly. With enough repetition and exposure, you will start to become faster and more efficient. In the first couple of months of FD, I was seeing about five to eight patients a day. Now, as I near the end of the year, I see between 10 to 15 patients daily, depending on the complexity of their needs.
In a high needs area like mine, where patients may not attend regularly, I usually try and stabilise as much as I can in one appointment, which may require more time. The good thing about FD training is that you can work with your receptionist and Educational Supervisor (ES) to book patients in for an appropriate length of time based on your confidence level. It is important not to rush your work with the aim of seeing as many patients as possible. This approach is not sustainable and will burn you out very quickly. Focus on thorough, quality care, rather than quantity.
Flexibility is key in appointment lengths
When it came to booking appointments, I typically allowed 30 minutes for examinations – a decision some might find controversial. However, with new patients who have not seen a dentist in years, are in pain, or have multiple carious lesions, extra time is essential for a thorough examination, treatment planning, and building rapport. For fillings, I booked between 30 minutes to an hour, depending on factors such as the number of carious teeth, the proximity of the caries to the pulp, and how deep the lesions were.
At university, we typically had three-hour appointment times, which is what I was used to. I had to book two hours for my first root canal treatment appointment due to a lack of confidence, and not knowing the practice and team very well. Over time, I started booking 45 minutes to an hour for molar root canal appointments, but realised I was rushing, so I have recently been booking these in for an hour or an hour and a half. This way I feel far more comfortable and confident. I would say I have eased in now, and that time is not so much of an issue. However, I have only got to this point by learning from my mistakes, and plenty of trial and error. Rushing would not have allowed me to provide the best treatment for my patients, or to learn effectively.
Leaving dental school friends behind
Not to be too sentimental, but this was tough.
Some of you may be on a scheme where there are friends from your university, but others, like me, may not be as lucky. Being from Barts, 90% of the dentists on my scheme were from Kings College London but everyone was very welcoming. Being able to share stories about similar experiences throughout the year was very reassuring, so I realised that everyone was in the same boat. The study days quickly became an outlet for all of us to meet and share our wins and losses, in addition to studying.
Support and building a professional network
This year has been largely self-driven. I have two ESs, one part-time, and one full-time but I quickly realised I could not rely on them solely for support, as they have their own challenges. Instead, I turned to other dentists, which highlighted the importance of having a professional network.
I am fortunate to have a dental nurse who is understanding and flexible, allowing me to run late if necessary. Our positive working relationship has enabled me to try several new techniques this year. However, I have learned that it is important to establish professional boundaries from the start. While being friends with your nurse can make work more enjoyable, it is crucial to maintain mutual respect to avoid miscommunication and ensure the best outcomes for your patients.
Final pieces of advice
- Communication is key: Work on your communication skills before and during the year. Good communication can open doors, prevent misunderstandings, and foster better relationships with colleagues and patients
- Invest in good loupes: This will offer sharper vision, improved dexterity, and greater precision, enabling you to deliver exceptional care
- Take pictures: You will never regret the photos you take, but you might regret the ones you do not. Photos help you identify areas for improvement and allow you to track your progress throughout the year
- Prioritise work-life balance: Do not forget to take care of your mental and physical wellbeing. Take breaks and go on holiday to recharge—you will need it!
By following these tips and embracing the challenges and opportunities of your FD year, you will grow both professionally and personally. Remember, every experience is a chance to learn and improve.