Natalie Bradley gives her insight into a hospital training environment.
Although 95% of dentistry is carried out in primary care, there’s always an option to work in hospital dentistry.
Following my dental foundation training (DFT), I decided to go back into a hospital training environment for dental core training (DCT).
Working at different hospitals will give you different experiences but just to give those of you who may wish to do DCT an idea of what it’s like, here is how a typical week looks like for me.
Kicking off the week I spend my time on restorative consultant clinics. Depending on which consultant I’m working under, I see a huge variety of cases from tooth wear to amelogenesis imperfecta to denture cases to sleep apnoea.
Seeing all these referrals from dentists has taught me what cases are actually appropriate to send to secondary care and what I should be expected to treat out in practice.
Tuesdays are spent treating patients on my own restorative list. Seeing patients in hospital is a different experience compared to in practice; you move locations a lot and have different nurses working with you, generally things take much longer, but you can do some pretty cool treatments under the supervision of consultants.
I’ve been treating some really interesting cases such as hypodontia patients, implant-supported overdenture cases and constructing mandibular advancement devices.
Wednesday and Thursday
These days I’m kept very busy on the acute dental care (ADC) department. We see all sorts at Guy’s and sometimes it’s a real challenge to manage these patients. Although the majority of patients are walk-ins, we also see ward patients of Guy’s and St Thomas’, which can involve managing seriously ill people such as oncology patients.
We do of course see many a fat-face and have the pleasure of excising plenty of abscesses (a skill I was never taught as an undergraduate). What did surprise me was how many GDPs ‘refer’ into ADC rather than follow the set appropriate channels. Explaining to a patient that I can’t provide an emergency root canal under sedation on the same day is rather challenging when a GDP has implied that this is possible.
My Friday mornings alternate between oral surgery consultant clinic and day case theatre.
The cases I see on these consultant clinics can vary hugely again from wisdom teeth to temporomandibular joint dysfunction (TMJD) to cystic lesions. These sessions have really improved my letter writing skills as well as helping me understand what choice of anaesthesia is appropriate.
For day theatre cases, I’ve learnt how to work in a team between the dentists, anaesthetists and recovery nurses. Treating patients under general anaesthetic is really stimulating and satisfying; most of the cases I see are simple or surgical extractions but I also provide other treatments such as exposing and bonding impacted teeth.
Sometimes on a Friday afternoon we have teaching sessions to keep our skills up to date, especially in areas that we weren’t that confident in as an undergraduate such as radiology and management of dental trauma.
After a full week in hospital, somehow I still manage the energy to work Saturdays as a GDP in practice – something many of my peers also do.
I think it’s really important to keep my skills up in practice, as I don’t currently see myself staying full time in hospital. I work to shorter appointment times than in the week to keep my speed and I can keep myself familiar with the units of dental activity (UDA) system.
It also keeps the variety to my week so I don’t begrudge getting up early on a weekend – especially since the morning commute is much quieter than normal.
Being back in hospital certainly keeps me busy. On top of clinical duties, I can get involved in audit and research projects as well as teaching undergraduate students on clinics. Working in different environments each day is something that I find really stimulating and learning from some of the most respected clinicians in the country is a privilege – I’d definitely recommend it to other young dentists.