Introduction

Most newly-qualified UK dental graduates will take the path to general practice. If they wish to practise within the general dental services they must undertake a 12 month period of vocational training (VT) as a vocational dental practitioner (VDP) in an 'appropriate' dental practice or community clinic under the immediate supervision of a vocational trainer. The Dental Defence Agency has a parallel arrangement for new graduates wishing to enter the armed forces. Administratively, VT is divided into 15 regional deaneries. A regional advisor co-ordinates and monitors each of the schemes in that region. Each scheme, which usually consists of 12 training practices, is organised and similarly monitored by a VT advisor. The schemes can effectively be viewed as the functional units of VT. The regional advisor is usually one of the senior VT advisors in that region.

The aim of the application procedure is to achieve the best match between trainer and VDP.2 For both parties to gain maximum benefit from the year, this relationship has to work and it has to work well. With this in mind, all deaneries provide their trainers with advice and guidance on VDP selection. All publish lists of the training practices in the schemes of that region. In an attempt to minimise the trauma of the process, some regional deaneries hold 'job shops' so that prospective VDPs are able to meet the trainers in an informal setting. The Handbook for Trainers2 also provides clear and comprehensive selection advice for trainers.

All trainers conduct VDP interviews, but Morgan3 has presented evidence for the weakness of the interview as a selection method. It gives the illusion of validity, but has a poor predictive record. In earlier work, Morgan4 analysed decisions made in interviews for head teachers. Five criteria dominated decisions: personality; experience; answers to questions; qualifications; and appearance/presence. If personality and appearance are combined (they are, after all, aspects of personality variously defined), this category accounted for 39% of all criteria used. It could therefore be argued that selection under these circumstances is more a test of social acceptance than future job performance.

The situation in which many trainers find themselves is not an easy one. In the more popular areas, trainers will receive around 100 applications per placement. CV templates are available that VDPs are encouraged to follow, but this can result in applicants presenting very similar CVs that perhaps hinder rather than help the decision making process. If trainers assume that a basic level of competence is provided by the dental degree, then personality/interests or 'something different' in the CV can become attracting features. Furthermore, training practices are usually quite small; fitting in, being part of the team, the community of practice, may well be considered more important than a demonstration of competence.

It is essential to identify how VDPs view success in their search for a placement. Each potential VDP will assign different criteria in their assessment of success, but the pressure they are under to secure a position can be immense. Bartlett et al.5 pick up on this point:

'Although it has been demonstrated that the geographical location of a practice is considered vital in job selection, the financial and social pressures to gain employment are likely to persuade all but the most determined, to accept the first post that is offered.' (p284).

Brasher and Chen6 simultaneously analysed nine separate selection criteria. Many of the presumably relevant criteria for success were not significantly related to each another, and where there were significant correlations the magnitudes were small. They concluded that job search success is a complex and multi-dimensional construct. Focusing on a narrow range of variables will only capture part of the picture. They suggest that, rather than emphasising a set of criteria at a certain point in time, more attention should be paid to the process of search success.

Surprisingly, very little has been reported about the actual selection experience. Chadwick and Newton7 summarised the experiences of one cohort of Dundee graduates. The application process was considered inefficient, but this can be explained, in part, by the fact that the mean distance travelled by prospective VDPs in order to secure a VT position was 465 miles. What does come through clearly is the stressful nature of the process and a rushed application procedure that pressures the applicants into making ill-considered decisions. Clow and Mehra8 confirmed these comments and noted the extreme dissatisfaction that existed with the selection process from both trainer and trainee (VDP) perspectives. They also reported 'occasional gender discrimination.'

We do have the short but fascinating personal account of D'Cruz.9 This dates from the pre-compulsory days of VT but much of what he noted at that time is relevant today. He articulates the tension and stress of finding a VT position:

'It will soon become apparent that it is not necessarily the 'good' practices that are oversubscribed, but merely the ones that are close to, or in London... Do not be discouraged to find that as many as twelve people have already been interviewed [by a practice].'

Interestingly, we also have a short account by Lester,10 D'Cruz's trainer. Significantly, Lester stresses how important it is to spend time choosing a VDP:

'In my opinion it is necessary to see a candidate at least twice for a minimum of a couple of hours on each occasion to ensure that the year's relationship will be a fruitful one.'

Lester accepts that to do this with all short-listed candidates is a significant commitment in time, but he makes the point that it is really no more time than a VDP is expected to commit to the process.

Methodology

In previously reported work,1 the authors have presented a descriptive analysis of the VT year. This involved following 35 VDPs and their respective trainers through the VT year. This report explores how the VT selection process was experienced by these subjects. What was the selection process like for them?

All the VDPs were graduates of the King's College London Dental Institute and they all undertook VT in the South East of England. Using a semi-structured questionnaire format, each VDP and trainer was interviewed once the selection process had been completed. The interview considered all aspects of the selection process placed within a chronological framework.

The VDPs recruited were those who had shown an interest in participating in the study. They were in essence a self-selecting group. The trainers were effectively chosen by the VDPs. The trainers had been qualified for a mean of just over 21 years. They had taught on average five VDPs, the range of training varying from the VDP being the trainer's first, to trainers who had been involved in training for more than ten years.

Brasher and Chen6 remind us that attention must be paid to the process of selection. It is not really possible to separate the experience of the VDP from that of the trainer – each is dependant on the other. Therefore the idea was to develop the notion of the typical or most likely selection experience, based on those of the participants. What are trainer and VDP most likely to experience at this time?

Based on a constant comparative analysis11 of the interview transcripts, it was possible to develop a model of a typical trainer/VDP selection experience and this was brought to life by identifying the training partnership that best fitted this template. It is the selection experience of this partnership that is presented in the account that follows. Obviously the match between this partnership and the template was not perfect. Where appropriate, the manner in which this partnership differed from other VDP/trainer experiences is discussed.

Results – the typical selection experience

Choosing the practice

Miss P had placed the location of the training practice at the top of her list of decision criteria. It had to be close to her parental home. She applied to over 50 practices in waves of increasing distance from her South East London home. She included a photograph on her CV, as she had been advised to do so by a VT advisor who had come to talk to the final year about life in vocational training. Fifteen training practices asked her to attend for interview; she attended eight, five of these being in her preferred location to undertake VT. These interviews were translated into two offers of a VT place, both close to her home.

The mean number of VT applications for Miss P's entire qualifying year was 31, somewhat less than Miss P's 50, but very few of the VDPs had her degree of success. A VDP was more likely to receive seven invitations for interview, attend four and receive two offers of a VT position.

How did Miss P choose her practice?

'It was close. I had a good vibe. The staff were pleasant and it felt like a nice practice to work in. Mr S [her trainer] had some nice ideas. He didn't seem... in other interviews they asked how quick are you? I was a bit wary; I felt some of them [trainers] saw training as a way of getting money out of you. I didn't get that feeling with Mr S.'

There had been an initial short interview and Miss P was then invited back to visit the practice for a longer session and meet the staff. This second session lasted in excess of two hours.

Like Miss P, the overwhelming majority of the VDPs favoured a practice close to the place they considered home, be that their permanent or term-time address. This invariably meant the Greater London area, but only just over half were successful in finding a VT practice in such a location.

As with Miss P, her peers were keen to find a VT practice with a friendly and pleasant environment. Knowing or speaking to the outgoing VDP was considered important; most prospective VDPs tried to do this and everyone including Miss P suggested that they would advise others to do likewise. The feedback so received was critical and a major influence on whether a prospective VDP would accept or reject an offer. Miss P did in fact speak to the outgoing VDP and received a most negative report on the practice and the trainer, but the manner and nature of the criticism suggested to her that he, and not the trainer, was at fault.

The format of the interviews varied considerably; some trainers held formal interviews with common questions for each interviewee. Others were very informal, with some prospective VDPs, Miss P included, reporting that informality was actually unsettling.

But the applicants were difficult to please. They wanted a pleasant environment. They wanted formality, but not too much. They were wary of questions regarding knowledge of dentistry. Trainers who presented the interviewee with case scenarios to discuss were not popular.

One VDP echoed the comments of Bartlett et al.:5

'I had lots of interviews lined up, but I got fed up with the whole thing and took the first offer. Later I thought that I should have gone to more, but I wanted to concentrate on finals.'

Miss P confirmed that the whole process was a very stressful one. She also pointed out that the situation was made worse by the fact that the majority of her peer group, herself included, wanted to stay in London and the South East.

Of some concern was the conduct in some of the interviews. One VDP reported that a trainer interviewed applicants in the practice waiting room, with the patients present for at least some of the time. There were also isolated reports that caused concern regarding the ethics of the whole procedure. Post-interview, one trainer left messages on an applicant's phone, asking her not to attend any more interviews because 'we really want you.' When she phoned the trainer later that day to accept the position, she was informed that the post had been given to someone else. Miss P had heard of such instances but was of the opinion that at least some of the accounts were exaggerated.

VDPs were not without fault. Miss P was aware of peers who had accepted a VT position, but who were still actively attending interviews for a more favoured place. What was of particular concern was the fact that some VDPs had suggested to Miss P that they considered this practice entirely appropriate.

The perception of disadvantage in the selection process was significant. Whilst Miss P had no complaints about her treatment, others were less happy with their experience. Time and time again female students commented that they hadn't had any problem themselves, but:

'The boys just seem to walk into the jobs.'

Another VDP, perhaps putting the previous comment – and that of Clow and Mehra8 – in context, commented:

'It's just not fair. There doesn't seem to be any obvious racism or sexism. But look who gets the jobs. Mind you, we do outnumber the boys two to one!'

In common with many of her peers, Miss P had attended some regional 'job shops.' These were very useful in helping the VDP meet trainers and get a feel for VT. Miss P commented:

'Yes they are really very helpful. Meeting the trainers [in that setting] makes the whole process a little bit easier. But it's still a very scary time!'

Miss P reported that it had been disconcerting to meet her friends and colleagues at each of the interviews she attended. In fact she found herself, as others did, in direct competition with her best friend and flatmate.

Choosing the VDP

At the time of this training year, Mr S had been qualified for seventeen years and Miss P was his fifth VDP. This placed him exactly at the mean of clinical and training experience of the trainers in the study. The range of trainer experience varied from those who were in their first year of training, to two who had been in VT since the pilot schemes of the late eighties, one now in his eleventh year of training. Mr S had received well in excess of eighty applications for his VT place and he commented that most of the CVs were very similar and each school seemed to have a particular style.

And Mr S's selection criteria?:

'We go on location to a degree. It is a massive change for them. So if someone is staying... if they are local, it is one less issue to consider. We interview about ten, and then we invite about five of these to sit in with us – for about two to three hours. The whole practice makes the decision... at the end of the day it is teamwork, they have to fit in.'

Mr S's two-hour interview was not the norm with his all peers, but it was with the more experienced trainers. They saw this as time well spent; a worthwhile investment if it meant that the training year was going to be a success. One very experienced trainer commented wryly, but seriously, that he spent more waking hours with his VDP than with his wife. The relationship had to work.

The majority of the trainers concurred with Mr S with regard to the importance of location. One asked:

'Are they local, will there be a major relocation? Are they used to the area?'

They wanted the VDPs to be close at hand and although many VDPs were prepared to relocate, trainers saw this as another major change in their lives and starting VT was more than enough. So all else being equal, the local applicant would get the position.

But the overwhelming issue was that VDPs had to fit in; they had to get on with the staff. Like Mr S, trainers are looking for someone to join a team – to join the practice family. Personality was therefore a critical criterion as Morgan et al.4 suggested it could be. Mr S:

'It's personality. How they mix. I'm not worried about how good they are. They all have to learn – that's what I'm here for.'

Another trainer commented:

'They have to fit in. It's personality. I have to have a happy working environment.'

In common with Mr S, many of the other trainers thought the CVs they received were all very similar. Too many of the applicants had copied web-based recommended formats, including the wording. Therefore something different in the CV would invariably result in an offer of an interview. As one trainer noted:

'It's not surprising really [that all the CVs are the same]. They've all done the same thing, but you can tell which school they come from. I look behind the CVs. What are their interests? What do they do?'

One trainer, a VT advisor, had suggested that students should be advised to have something different – something that stood out in their CVs, or they would be ignored. He used the example of once interviewing a candidate because he kept ferrets! One of the authors helps with many CVs and had suggested to one student that she make more of the fact that she taught the piano and asked if there was anything else she could put in. She replied, 'I'm a Charlton Athletic season ticket holder.' It was very reassuring to hear her trainer specifically mention these points as one reason for calling her for interview.

Interestingly, one of the most experienced and popular trainers chose a candidate whose references suggested that she was good with patients, but 'nothing special' in terms of her academic record. Another experienced trainer echoed Mr S's lack of concern regarding their clinical skill, but went a step further. He reported that he specifically avoided 'high flyers.'

Miss P had not targeted the practices she applied for. Trainers considered this an important tactic to gain an interview; this showed that the VDP had done some homework. The 'Dear Sir/Madam' approach in an application letter was common and unlikely to succeed. A well-written and directed letter would almost certainly result in an interview, but so many letters were poorly constructed. One trainer from Rye in South East England had received an application from a student saying that he had always wanted to work in Wales! The majority of the trainers noted how little effort a small but significant proportion of applicants had put into the process.

In common with Mr S, most trainers did not like applicants phoning them. Yet a few trainers expected it. One trainer prioritised those who did so.

The outcome

Having secured her place in VT, Miss P reported that she was very happy with her choice of training practice. Mr S seemed ideal and she looked forward to working with him. The practice staff were friendly and professional and the location was favourable. Mr S was similarly happy with his choice of VDP and anticipated a successful year. Whilst not every training partnership was as successful as this one, most trainers and VDPs considered their choices to be good ones. It is fitting that the final comments are from Miss P and Mr S.

Miss P:

'Oh, he is very good. He stands out. He enjoys it. He's not the best model as a business man. He's not very good at selling, but that's not what it's all about. I would certainly recommend him – absolutely.'

And Mr S speaking post-VT, reflecting on the year as a whole:

'I knew I'd made the right choice. The year went very well. She was good from the word go.'

Discussion

Not surprisingly, a friendly and welcoming atmosphere is what VDPs are looking for in a VT practice. They want to feel safe and supported in this new teaching environment, but the search for a place is a difficult one. Most of the new graduates wanted to stay in the South East of England where the competition for places is fierce and the timing of the process could not be worse. When most of the applicants were attending interviews, they were aware that their final examinations were a matter of weeks, sometimes days away. It is not surprising, therefore, to find that, confirming the findings of Chadwick and Newton7 and Clow and Mehra,8 many applicants feel under immense pressure at this time.

It is little consolation for the applicants to realise that the system is not really any better for the trainers. It was not unusual for trainers in this study to have over 100 applicants and in an already busy practice, it can be very difficult to devote the necessary time to the selection process.

Although dramatic, it is important to put the instances of inappropriate behaviour in context. They were not common. But bad news travels fast and such instances were invariably widely reported and as Miss P suggested, perhaps exaggerated.

Selecting the 'right' VDP was obviously a critical factor in determining the success of the VT year. Trainers who spent considerable time getting to know the short-listed applicants did so because they were more likely to have a predictably successful year. In essence, these trainers were able to select an appropriate VDP, one who could be part of the team. Morgan3 presented evidence to demonstrate how weak the interview is as a selection method. But with these invariably very experienced trainers, the selection process was so much more than an interview. They did not simply rely on an interview and perhaps a degree of luck for a successful outcome. Their selection practice echoed the comments of Lester10 regarding his selection of VDPs.

There is another issue. Not unreasonably, deaneries and advisors provide a format to help the trainer choose the 'best' candidate. But what is best? The notion of the competent professional possessed by the trainers in this study was very interesting. It was significant to see that one of the most experienced chose a candidate whose references suggested that she was good with patients, but 'nothing special' in terms of her academic record, and that another trainer specifically avoided 'high flyers.' These trainers seemed to be consciously avoiding the 'best' and looking for something else – a 'well rounded' candidate perhaps. We suggest that these trainers were choosing VDPs who fitted into their own individual team or community of practice – and this took priority over the skill of the VDP. So as Morgan4 suggested, the interviews were being used, at least in part, as a test of social acceptance rather than potential performance as a dentist. This would seem to be entirely appropriate; the training partnership needs to be a successful one. The trainers also know that the award of the BDS degree assures a certain level of clinical competence.

Conclusion

The application process is not perfect. The timing of the process is a major problem but the recruiting cycle of VT has to have defined start dates that are linked to when the UK undergraduates qualify. Whilst it is widely recognised that the whole process is difficult for prospective VDPs, what is often ignored is the fact that this is also a difficult time for the trainers. The process of selection must take place alongside their everyday general practice and training activities. Those responsible for selection in VT are making efforts to make the process as atraumatic as possible for all concerned, yet many VDPs will still identify with D'Cruz's comments9 – comments that date from the pre-compulsory days of VT.

What does come through in these findings is the fact that the more effort participants put into the process of selection, the more successful they are in finding what they want. And that holds true not only for the prospective VDP finding a training practice, but also for the trainer finding a VDP who becomes a successful member of that particular practice team.