Despite being given the foundation that a good dental hygiene education provides, I was competent but far from confident when I first began my career as a practicing hygienist. I certainly did not feel like an expert and often found myself suffering from feeling like I was in over my head. I realized that, for all I had learned, there was still a lot I did not know. What I did not realize at the time, however, was that the feelings I was experiencing were completely normal and all part of my education process.
Life after graduation
When I think about my first job in practice, I was bright-eyed, eager, and wanted to put my education to use in a practice setting, but for me, the rubber didn’t quite feel ready to meet the road. I recall feeling overwhelmed that I was on my own. I was in a small, one-hygienist practice and was treated like a professional who knew what I was doing. As much as I appreciated that and felt I knew enough to get by, I would get that feeling in the pit of my stomach when a curveball would get tossed my way, and in those early days, the curveballs never seemed to be in short supply. Time, however, was always in short supply; I ran behind often, and that filled me with more discomfort and self-doubt.
Although I was thrilled about finally finishing the rigors and stresses that we all know are a rite of passage of graduating with a degree in hygiene, it became a “be careful what you wish for” scenario for me. If a patient was less than receptive to my delivery or recommendations, I lacked the confidence to properly address the situation and/or manage the feelings that went along with it. I longed for the reinforcement that used to come from an instructor who would “have my back” and know exactly what to say to the patient.
If I was struggling trying to access an area, or there was that seemingly impossible-to-remove deposit, there was no one standing by to draw on for ideas, tips, or tricks. I had zero confidence in my periodontal charting, and as much as I used to dread my instructor checking my work, I longed for the validation that came from someone verifying that I was on the right track. At that point, I even missed someone helping me identify when I was not on the right track, so they could help set me straight.
It wasn’t just in my periodontal charting that I lacked confidence. I wasn’t sure that my scaling skills were up to par either, and despite all my training and experience in my school clinic, I still had difficulty visualizing anomalies from abnormalities in my head-and-neck exams. I also did not have a lot of confidence regarding identification of possible areas of decay, the differences in restorative materials, and the like. Radiographs were suspenseful in that I was never quite sure if I was going to get the desired image, and I was not experienced enough to troubleshoot placement challenges. I have described it like unwrapping a present in that I never knew if the exposure was going to be a precious gem or an ugly sweater. Unfortunately, sometimes there were uncomfortable patients, retakes, and self-deprecation along the way.
I loved the idea of what it would feel like to be a solid and experienced hygienist. I pictured myself in perfectly pressed scrubs, tapping my foot to background music, having wonderful moments of connectedness with my patients who were receptive to all I had to offer in the way of oral health care. I saw myself fighting periodontal disease with the precision and skill of a ninja and being a superhero in the area of prevention. What I was not expecting was that the road was not always going to be a smooth one. In fact, sometimes it was filled with potholes and bad directions.
The beginning of a lifelong journey
If any of this resonated even a little with you as a new graduate, know that you are right where you are supposed to be. I did not fully comprehend at the time that what I was experiencing was normal and actually an expected part of the learning process. Didactic learning and clinical experience in school are obviously imperative, but the reality is they are only the beginning of what should be a lifelong journey of learning and growth.
A good dental hygiene education is designed to take us to a point of basic competency. Competency is not an ultimate career goal; it is a beginning step toward mastery. What brings us to mastery is experience and continued learning. Your first years out in practice are an important extension of schooling. In the words of Albert Einstein, “Learning is experience. Everything else is just information.” What I learned with time is that every clinical experience (the good, the bad, and the ugly) presented opportunities where I learned and grew as a professional.
In the 1980s, Stuart and Hubert Dreyfus, professors of industrial engineering and philosophy respectively, developed a five-stage model of skill acquisition. The model describes how individuals progress through various levels. The model showed that skill learning was experientially and situationally based, and that there are five distinct stages from novice to expert.1
This model has been studied and adapted to different health-care disciplines. When I combed through the literature related to this model used for nurses, it drew to mind many parallels with dental hygiene. Dr. Patricia Benner developed stages of clinical competence for nurses based on the Dreyfus model. Her five stages from novice to expert highlight how a nurse moves through a hierarchy with each level of increased knowledge and experience. It begins as a first-year clinical student with no previous experience, so he/she must work with very inflexible parameters and rules. Experience moves an individual along the path to the higher levels, where not only do skill and speed increase, but also the ability to better organize, recognize patterns, see situations more comprehensively, and modify plans in response to unpredicted events. The final stage of expert no longer needs to rely on rules to guide their actions. She describes it as a level of intuition based on deep knowledge and experience, and the ability to discern the relevant problems from irrelevant.2-4
With that being said, as a newer graduate, you do not just have to sweat it out while you wait to gain more time and experience. You can pursue that experience with purpose, focus, a better understanding of the process, and self-awareness regarding your development.
Some rungs on the ladder to clinical expertise
Self-awareness and self-reflection: The Commission on Dental Accreditation has outlined in their standards for accredited schools that dental hygiene graduates must be competent in the application of self-assessment skills to prepare them for lifelong learning.5 Reflection on what occurred in a clinical setting allows us to take textbook knowledge and incorporate it at a higher, practical level as we go forward.6
In clinical practice, we need to know information along with the “why” behind it and see a much larger picture with many more variables. This comes with time, experience, and reflection. Asking yourself thought-provoking questions to continually build upon your experience is a critical part of the learning process. Think about your patient experiences each day. Where do you feel you are successful, and how can you create more of those experiences? Similarly, consider the challenges that you faced. How did you handle them? What did you learn? What do you need to do to improve in an area, and what will you do differently the next time you are faced with a similar situation?
The road can be bumpy sometimes, but remember that even on the toughest days that are a blow to your ego, you are learning. In fact, what I found is that each challenge gave me an opportunity to learn something new or to consider a different approach to solving a problem. Each bump in the road helped me to identify the areas where I needed more work, more practice, or more education. The more patients I saw, the more I was able to discern what I was looking at with a much keener eye. The more experience I got, the better I was at finding strategies to stay organized, on track, and on time. The more periodontal disease that I identified and treated, the more I was able to customize care based on what I had learned and observed from previous patient experiences.
Mentorship, community, and resources: Align yourself with practices and individuals who are excited to mentor you. Consider joining your professional association, local study clubs, subscribing to dental journals and magazines (like this one!), and online communities where there is an abundance of wonderful and experienced people who are willing to share what they know with you.
Maintain a strong network of peers and keep in touch with former professors and clinical faculty members. I always love hearing from former students and receiving messages, sometimes years after they graduate, looking for further guidance or advice. I, for one, am always happy they reached out to me.
Also, with regard to resources, as much as it is important to self-assess as described above, it is equally important to keep an open mind and a willingness to learn. External feedback can be a wonderful resource. Try not to take constructive feedback as anything other than an opportunity to learn something or see something from a different perspective. None of us know it all, and there can be more than one valid approach to something.
Ask questions and use the critical-thinking skills along with the scientific, evidence-based research skills you learned in school as you consider the answers. The only bad question is the one you have but fail to ask.
Set continuing education goals. Customize your plan based on areas of interest and those areas where you feel you may not be as strong, knowledgeable, or experienced.
Show yourself kindness and compassion and be patient: I have taught as a clinical instructor for many years, and I have seen this trajectory I described play out with my former students with whom I have kept in touch. In fact, one of my current coworkers is a former student, and the office we share is her first position since graduation and licensure. The proximity of our workspaces allows me to see and hear her confidence and skill level increase daily over this 18-month period.
We have conversations about periodontal diagnosis, treatment-planning, clinical techniques, and patient communication skills. Each of these discussions is like a ruler that measures palpable progress. Her time management, confidence, and critical-thinking skills have grown, and the nature of the conversations is shifting from one of a student asking her former instructor for advice, to colleagues who are collaborating and sharing ideas. In fact, I asked her for her opinion on this article before submission for publication. She will be the first to tell you she is still learning, but she told me she feels “more competent,” and I can see that feeling of competence shine through in the way she approaches her day and its challenges.
Expertise in any area takes time, commitment, determination, and drive. Remember that you know so much more than you think you do, and where you are right now on the learning curve is where you are supposed to be. The other thing to realize is that no matter how much time and experience you have, you will be faced with challenges from time to time. They are one of the things that keep you learning and growing.
Each experience we have provides us with the building blocks we need to get to levels of increasing competency, all the way up to expertise. Experience coupled with a continual quest to learn, and the self-awareness to know that there is always something to learn, not only take us to the point of expertise, but for me, have provided a continual spark that has kept me as engaged and energized in my career as I was in the very beginning. With each year that passes, and as you gradually move your way up the rungs to clinical expertise, you will be able to look back and see how far you have come, and it is a most amazing view!
1. Dreyfus SE. The five-stage model of adult skill acquisition. Bull Sci Tech Soc. 2004;24(3):177-181. doi:10.1177/0270467604264992
2. Benner P, Wrubel J. Skilled clinical knowledge: the value of perceptual awareness, part 1. J Nurs Adm. 1982;12(5):11-4.
3. Benner P, Wrubel J. Skilled clinical knowledge: the value of perceptual awareness, part 2. J Nurs Adm. 1982;12(6):28-33.
4. Benner P. Using the Dreyfus model of skill acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice and education. Bull Sci Tech Soc. 2004;24(3):188-199. doi:0.1177/0270467604265061
5. CODA accreditation standards for dental hygiene education programs. American Dental Association. https://www.ada.org/~/media/CODA/Files/dental_hygiene_standards.pdf?la=en. Accessed September 2018.
6. Branch WT, Paranjape A. Feedback and reflection: Teaching methods for clinical settings. Acad Med. 2002;77(12):1185-1188. https://journals.lww.com/academicmedicine/Fulltext/2002/12000/Feedback_and_Reflection__Teaching_Methods_for.5.aspx#O4-5-3. 2002;77(12):1185–1188. Accessed September 2018.
Julie Whiteley, BS, RDH, is certified in human resources. She holds degrees in business administration and dental hygiene and has worked extensively in both fields. She is on the faculty of Massachusetts College of Pharmacy and Health Sciences University in Boston. Julie bridges her knowledge and experience from business, clinical hygiene, and teaching to deliver information and programs that enhance dental practices. Contact her at [email protected].