Let me take you through my journey. I know that many of you will be embarking on your careers as you start your foundation dental training, in what has become known as the Dental Foundation Year 1 or DFY1. Many will be excited, some nervous, and others eager to finally earn a buck for their filling and drilling. I was all of the above. I spent a fabulous year in a practice in Woodford with 8 part time dentists and two DFY1s. I still remember my first patient... when I got an upper impression stuck in the patients mouth, and after doing this three times went to my trainer with my tail between my legs, a red face and an empty tray in my hand (the actual impression material itself was still in the patients mouth!). What a bad start I thought. But then there's a positive note here to appreciate too... it must be all uphill from here!
The DFY1 year is a chance to work in a somewhat sheltered environment, where you have on hand a foundation trainer who is available to answer any questions you may have, or help you out of a sticky situation if you find yourself in one. Currently, vocational trainers are required to be at the practice three days a week, and to provide an hour slot a week in which to conduct a tutorial, the format of which can be mutually agreed between DFY1 and trainer. In my experience, the tutorial was informal and relaxed, and ranged from peer review to case based discussions to chair side teaching. At the end of the first tutorial, where we covered the basics we had to know, such as use of FP17DC forms, my fellow DFY1 and I decided on a topic we would like to know more on, and agreed to cover that topic with our trainer the following week. And so we went from there. Week on week, we would have new experiences, unravel new scenarios, discover our strengths and weakness, our loves and hates, and based on these we would put set the theme for forthcoming tutorials. It was a fantastic opportunity to tackle the teething pains we inevitably faced, to discuss our theories and experiences on how things should be done, and to learn tips and tricks from our trainer on various treatment modalities, from crown and bridge work, to in house bleaching. As we progressed along the way, we completed our e-portfolio or logbook of cases that we had seen and completed, and assessments of our ability in key dental treatments. This is a requirement of the deanery based post, and often I struggled to keep on top of it, but I am sincerely glad that I did and that I can now look back on the sheer number of scale and polishes I did! The requirement included recording our reflections on interesting cases or 'wonderments' as we went along. I would write about the inconsolable child I managed to work my charm on, or on the times I found particularly happy or particularly sad. Perhaps it is from these that we grow the most.
The DFY1 year is invaluable. It's the time to make mistakes (not on purpose!) and have someone point them out to you to help you become a better clinician. It's the time to ask any question you might find silly - chances are they aren't that silly! And if you are lucky like me, develop lasting friendships with the people you work with and create a home away from home. My experience was a bit more unique than others; there were two of us DFY1s which had its ups and downs. The positive side is that I had someone in the same boat as me, someone I could ask and share experiences with, and someone who could lift me up with her embarrassing dental stories when I perhaps felt I was not as good as I wanted to be...and vice versa. The downside perhaps is that we compared ourselves to each other, and inevitably no two people work the same way. This meant rather than focus on picking up speed and skill, my colleague stressed herself out by thinking she wasn't as fast as she should be, whilst I relaxed and didn't push myself to pick up speed because I wasn't comparing myself to the other fully fledged racehorse dentists in the practice, and felt I was doing A-OK. Either way, we were both wrong. Both had strengths and weakness that the other didn't have, and forgot that the FD time was about quality, more than quantity.
If you find yourself in this unique situation, make the most of it! Be there for each other, lend a helping hand, discuss cases and questions, and above all, don't compare yourselves to each other. And if you find you are fighting for time with your trainer, communicate with him/her effectively so that you can use the time you do have to maximum efficiency. Don't worry, in the end, you will all develop into well rounded competent clinicians and fly the nest. The year itself ends with a presentation of your management of a complex case to a room full of trainers and trainees in your scheme. This is a great ending to the year as you can really appreciate your hard work come together, learn from others, and if you are lucky, win an Olympic style medal!
When my time as a DFY1 was coming to an end, I realised two things: Firstly, I loved what I was doing and secondly, I wanted to be better. There was one area in particular I knew I wanted to improve, and this was oral surgery. It was for this reason I applied for a post as a senior house officer in oral and maxillofacial surgery (or maxfax), a deanery based training post known as DFY2- Dental Foundation Year 2. I spent the first six months at a district general hospital in North East London, honing my surgical skills and tackling difficult wisdom teeth extractions, impacted canines and bumps and lumps. As a maxfax DFY2, my duties included being on call once a week covering a 24 hour shift period, or one weekend in seven covering a 48 hour weekend on call.
Working in a district general hospital meant I spent my time after 5pm till the following morning on my own, answering the bleep, managing referrals from other hospitals, and attending to patients coming in to Accident and Emergency with all sorts of problems: from a lost filling to a broken jaw to a swollen eye or a non-stop bleeder from the head and neck region. Perhaps the most foreign thing I first had to learn to do was assessing and suturing facial lacerations. I remember thinking this was a massive step, going from suturing the mouth which, let's face it, no one will really see or know if I did well or not, to suturing gaping wounds across someone's face, which is readily visible and can easily scar. However, this soon became the most enjoyable aspect of being on call, as I learnt to put wound edges together carefully and create a neat, clean closed wound. Being on call also meant attending to our inpatients; these are the patients who we keep in hospital who are due to or have been to theatre for surgery, either for facial swellings from dental infections, or secondary to surgery such as excision of an SCC or correction of a facial deformity.
My second six months in maxilla facial was spent at the Royal London hospital, a major teaching hospital in east London. The surgery I saw here was often more complex than that at a district general hospital, and the team was much larger. There was a great opportunity here to conduct audits and be supported in doing so, and the social environment here was great. I was also lucky to have the opportunity to spend time in the restorative department as part of my rotation, learning new skills from the restorative consultant and ensuring I kept a hand in dentistry. The downside of being in a large team is that I didn't get as much hands on here as I wanted to, as there were so many trainees at my level and above, eager to do what I wanted to do. Be prepared to be more of an observer in theatre than a doer in a major teaching hospital.
Within maxillofacial, there are various sub-specialities including orthognathic surgery and facial deformity, trauma and oncology. The weekly job description would vary depending on what firm or sub-speciality I was working in. The great part of my first six months is that I did a bit of everything, and moved from firm to firm every two months. For me, I enjoyed the orthognathic surgery the most. This is where dentistry meets maxillofacial. It is here where I was witness to joint clinics between consultant orthodontists who manage dentoalveolar disproportions, and maxillofacial surgeons, who surgically help to correct gross malocclusions due to skeletal discrepancies. I thoroughly enjoyed my time in this firm and developed an interest in orthodontics from my time here. The surgery results make a drastic and instant difference to patient's features and really do make you fall in love with the work they do.
Moving on... as a trauma SHO, the job would often involve pre-clerking or assessing patients who had been victims of trauma, be it from alleged assaults or road traffic accidents, and preparing them for theatre as soon as possible to reduce any fractures they may have sustained. This is a particularly interesting firm, as the work is fast paced, the surgery is thrilling, and the stories are captivating. My experience as an oncology SHO in a district general hospital differs to that in a major hospital, as often the major free flap surgery takes place in a major hospital with a much bigger team.
If you are an oncology SHO, chances are the surgeries with which you are involved in theatre will run late, and you generally deal with medically compromised patients. The job is difficult and stressful, the hours are long, but the rewards are many. You cultivate great working relationships with the people around you, and your job literally entails saving people's lives. Cancer touches the lives of many and is never pre-empted. It was from my experience and admiration of the work done in this field that I have come to support Saving Faces- the Facial Surgery Research Foundation. This is the only charity in the United Kingdom solely dedicated to the worldwide reduction of facial injuries and diseases. I would encourage you all to take an interest in this research foundation which really does make a difference to many.
My time as a maxilla facial SHO has come to an end, and although I enjoyed it and learnt a great deal, I know now that a career in maxillofacial surgery is not for me. I have developed an interest in dental specialities, and as such have accepted a job in a hospital learning more about what I want to do. Regardless of outcome, the skills I have developed in my foundation years are invaluable, and easily transferrable to any dental career path I choose to undertake.
My parting words of wisdom are to be true to yourselves, follow the paths you are interested in, and not one you feel you should be interested in. I know that no matter what you choose to do, after spending quality time as a DFY1 and DFY2foundation dentist, you will certainly become better dentists overall. Look beyond the fears, trust in all your hard work and savour finally getting to do what you've worked so hard for. This is the beginning of the rest of your lives...Good luck!