Teaching and learning
Thanks to Plymouth University Peninsula Schools of Medicine and Dentistry (PUPSMD), more than 10,000 people in Devon and Cornwall who may not have had access to NHS dental treatment now do. Key to this success are the four dental education facilities run by PUPSMD in the region – two in Plymouth and one each in Truro and Exeter. Dental students treat NHS patients under supervision from qualified dental clinical supervisors, starting six months into their studies with simple exams and dental hygiene and developing their skills over the life of the five-year course to advanced and complex treatments. Here, a dental student and a dental clinical supervisor describe a typical day at a dental education facility.
Martin Wall is a dental clinical supervisor and honorary lecturer at PUPSMD. He qualified from University College Hospital London in 1972 and worked in general practice after qualifying. He ran his own practice in the West Country for 25 years, specialising in holistic dentistry and the care of dentally anxious and phobic patients. The practice featured as a regional winner and national finalist in various award schemes. His professional roles have included two terms as president at the Royal Society of Medicine Section of Hypnosis and Psychosomatic Medicine. He is currently vice president of The European Society of Hypnosis (ESH), and chair the ESH Committee on Educational Programs in Europe…
The challenges ahead
A clinical supervisor’s day begins in the staff room where we share the concerns and challenges of the day ahead. These may be issues with particular students or, more generally, our dual tasks of incorporating patient care with student education.
We are each allocated a bay of six treatment cubicles. We discuss the day ahead with each student dentist, looking at intended outcomes, possible complications and other issues that may arise. When we are happy with the outcome of that discussion, we ask each student to bring their patient from the waiting room.
We visit each cubicle at regular intervals throughout each treatment and when students request advice or help. Our job is to support not just the students but the patients, too.
At the end of each treatment session – and when the patient has left – we take time for reflection with the students, evaluating all that went well and perhaps some things that could be improved upon.
The cycle of treatment and evaluation continues throughout the day, each a unique interaction between patient, student and supervisor.
On the journey home, there is time to think about the dental school experience, about the enthusiasm of these young people at the start of their careers, the complementary perspective of the dental narrative from academic colleagues, and the feeling of reciprocity – that I have learned as much as I have taught.
Ann Duro is a fourth-year dental student at PUPSMD, this year she is gaining her clinical training at at Derriford, Plymouth…
We arrive at the clinic at 8.45am, get changed into our tunics and head up to our clinic bays. Before 9.00am, we set up the bay, clean all the surfaces and the chair, and get all the lab work needed for the day and check it.
We work in pairs: one student is the dentist in the morning and the other in the afternoon. When you’re not the dentist, you act as dental nurse for your partner. We work as a team and your partner is there to support you and help out with the patient (chatting to them while you carry out work or set something up). They also ensure that you have everything you need for the treatment to be carried out, and they get the clinical supervisor when they are needed.
The morning dentist logs on to the computer to see who is booked in. They get the patient information ready and check what treatment is to be carried out in the first session. Once the bay is ready, all the instruments and equipment required for the first appointment are collected and set out ready for use.
At 9.00am, we discuss the treatment of our first patient with the clinical supervisor, including patient history, medical issues, past treatment and justification for treatment. At 9.15am, we call the first patient from the waiting room to the bay. We discuss with them any changes in medical issues, any dental problems and the treatment that will be carried out.
A single appointment is one hour and 15 minutes long and we have a double appointment of three hours for treatments such as RCT, crowns or really complex work.
We call over the clinical supervisor to let them know if there are any changes to the patient’s history and to go through what needs to be done that day. As soon as we get the go-ahead from our clinical supervisor, the treatment can begin.
We carry out a range of treatments at the Derriford Dental Education Facility, from a simple filling, recall exam or placing fissure sealants, to stages for dentures and crowns by taking impressions, to carrying out endodontic treatment or extractions. At points throughout each treatment, the clinical supervisors check our work and provide help and advice where it is needed. Once each treatment is complete, the clinical supervisor does a final check of our work and, if everything is satisfactory, we escort our patient to reception where we book their next appointment.
When we return to the bay, the dental student who was the dentist writes up the patient’s notes, detailing what has been done at the appointment and writing out any lab tickets that are required. The dentist also fills in the ADB forms to register what work has been done. This goes on a database and counts towards our targets for graduating. The clinical supervisor checks all completed paperwork and discusses the next patient. Our partner cleans the bay, packs up used instruments for decontamination and sets up for the next patient.
Our morning sessions end around noon and we are back at 1.00pm where we swap roles with our partner and discuss the first patient with our clinical supervisor, as we had done in the morning.
We usually finish around 4.00pm, with the dentist partner writing up the notes and completing the paperwork, and the dental nurse partner clearing up and packing up for the day. The bay is cleaned down, all the surfaces are cleaned, bins are disposed of, suction units are flushed through and the chairs and computers shut down for the night. We debrief at 4.30pm where we discuss issues that may have arisen through the day and information notices are read out. At 4.45pm, it’s time to catch the bus home for a well-earned dinner.
No day is the same, with different treatments to do and patients with various needs – it is fair to say that there is no standard day!