Onkar Mudhar gives an account into the first month of his dental core training post at the Eastman Dental Hospital.
Dental core training (DCT) is an additional training year. You carry it out after dental foundation training. It is usually within a secondary care setting, in a hospital environment where you undergo more complex training.
DCT posts are national, ranging from oral surgery to public health. Similar to foundation training, a candidate is allocated a post based on score and performance in the national recruitment examinations.
Throughout my final years of university, I observed the amount of experience the core trainees received. It seemed that they flourished clinically, but also learned important skills to transfer back into practice. For example, their practical skills, multidisciplinary care, time management and working in a larger team.
As I progressed through my foundation training, I knew that I wanted to apply for core training. I was determined to embark on a job in oral and maxillofacial surgery.
My rationale was to develop my confidence, surgical skills and general medical knowledge.
Furthermore, I believe a hospital training post allows you to interact with a plethora of patients. Patients often present with rather complex medical histories. All of these skills, I felt, would be invaluable for the rest of my career.
Securing a post
I secured my top choice post of oral surgery (OS) and maxillofacial surgery (OMFS) at the Eastman Dental Hospital and University College London.
Not only was I excited when I received the news, but also slightly apprehensive. Clinically, I needed to develop my oral surgery skills. This is why I enrolled myself for this year. Equally enough, I wanted to show my senior colleagues that I was still technically able and keen to get involved in various procedures.
My post is interesting because it’s split into three main rotations. These include:
- Oral surgery at the Eastman Dental Hospital (six months) with exposure to allied disciplines of oral medicine and facial pain
- Craniofacial abnormalities at Great Ormond Street (two months)
- Maxillofacial surgery at University College Hospital (UCH) (four months).
My first month has been spent primarily at the Eastman Dental Hospital, being involved in active treatment, treatment planning, shadowing on the consultant clinics and assisting on general anaesthesia cases.
This first month has been incredibly eye-opening. I have been able to learn concepts and apply them immediately with the support of my senior colleagues. Additionally, I feel my confidence with oral surgery increasing on a daily basis. This is due to the continual patient exposure and varying complexity of cases throughout the week.
The first post
An average week for me consists of many early starts and a large amount of coffee. As well as, running around various floors of the new Eastman building on Huntley Street preparing the patients.
Due to my DCT role, They expect me to arrive early, before the allocated clinic start time. This is to prepare any relevant paperwork and consent forms.
I look carefully through the patients’ records before their appointment. Depending on the clinic scheduled for us, there is relevant documentation and media. This includes referrals from their general dentist or enclosed X-rays or photographs that are usually of clinical relevance.
One of the highlights of my first month has been the sedation clinic. Although I was fortunate enough to carry out treatment under sedation at university. It was an extremely rare occurrence.
Having an IV sedation clinic where I am supervised every week has allowed me to develop various skills. These include cannulation, managing anxious patients and my technical ability for tooth removal.
The most noticeable difference between foundation and core training is the amount of responsibility and ownership placed on you. Being in a hospital setting is great as it provides you with a guarded learning environment. However being the junior colleague also involves some key responsibilities.
Every Wednesday, my registrar and consultant supervise my allocation to the general anaesthetic day list at University College Hospital (UCLH). On these days, I consent the first one or two patients for their procedure by 7:45am.
Furthermore, the DCT acquires all of the equipment for any complex procedures (such as an expose and bond). They also prepare the list and collate all the relevant imaging and records.
Personally, I greatly miss this about the hospital environment whilst completing foundation training. The early starts, late finishes and the multidisciplinary approach with a multitude of colleagues such as foundation doctors, senior house officers, anaesthetists and nurses is what I believe truly adds to well-rounded patient care.
Thus far, I have had an incredibly productive and hectic first few weeks. I have had many ‘firsts’ including my first few biopsies, my first surgical extraction of a wisdom tooth, and my first patient under general anaesthetic, all of which have been both incredible learning experiences and general milestone moments.
Naturally, amongst all the positives, there have been moments that have felt incredibly overwhelming. Learning how to use a new computer system was incredibly frustrating. Coupled with the amount of administrative responsibility expected of me, it felt slightly daunting during my first few weeks.
Additionally, it is easy to stop challenging yourself once you settle and become comfortable in a familiar work setting. Diving into the deep end with a hospital post allows you to continually develop new skills. Your seniors push you to attempt treatment under their supervision. You can’t do this in a practice setting.
It is important to try keep morale high during the first few weeks of your core training. The positives often outweigh the challenges. I have had a brilliant first month, and although some days I leave feeling shattered, I feel as if the year is only beginning and I have so much to learn and look forward to.
I hope you have found this interesting and useful. At month six I will be checking in – when I will be finishing off my rotation in paediatric OMFS at Great Ormond Street.
This article first appeared in Dentistry magazine. You can read the latest issue here.