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Introduction

The average career of a dentist may be 40 years1 and pro-activity is needed to ensure that the professional does not stagnate. This can be challenging especially as the demands of dental service provision often necessitate a steadfast routine which, whilst efficient, may lead to 'rust out' or 'burn out' (Table 1). In this article, we provide top tips for keeping dentistry stimulating.

Table 1 Symptoms and causes of 'rust out' and 'burn out'
Full size table

1. Reflect and refine your working practice

a. Identify good and bad habits

A habit can be defined as a 'fixed way of thinking, willing, or feeling acquired through previous repetition of a mental experience'4 and is central to developing routine, a core component of working life. Self-reflection with adjustments to habits or routine are essential to the reinforcement of good and reduction of bad practices. Crucially, this can help check negative thoughts such as, 'what's the point; I am going have a bad day; nobody understands the difficulties we face' and reduce the risk of falling into spirals of self-doubt.

b. Pause and take time

Consider:

  1. 1.

    Am I happy in what I do?

  2. 2.

    What do I like about my job/profession?

  3. 3.

    What don't I like about my job?

  4. 4.

    How can I build upon what I like?

  5. 5.

    How can I change what I don't like?

c. Plan

A professional development plan (PDP) is great for specifying short, medium, and long-term goals, not least because it requires the individual to consider what they want to achieve. Once you know what you want to achieve, turning these aspirations into a Specific/Measurable/Achievable/Relevant/Time-bound (SMART) objective can help formulate a pathway for how you will attain them.5

2. Keep challenging yourself - avoid 'rust out'

a. Vary your routine

It can be really easy to fall into a working pattern where the complexity of the clinical work becomes less challenging and requiring reduced proactive thought for the planning and execution. Subsequently, clinicians run the risk of becoming 'stale' and, without change, may exacerbate the feeling of being 'imprisoned' within the four walls of their surgeries.

b. Identify a 'problem of the week'

Find an area for improvement within your practice environment and work collaboratively with the team to solve this. This can lead to a sense of satisfaction, enhance team cohesion, as well as improving the overall operating environment for staff and patients (see section 4 - leading change).

c. Advance your clinical skills

Clinical practice is a process and not a discrete or 'achieved' event. Dentistry (like medicine) is in a constant state of progression. Failure to consistently strive for clinical advancement leads to stagnation, which risks leaving the individual ever further from the 'gold standard'. Top tips for clinical advancement:

  1. 1.

    Be humble and constantly willing to enhance your skills

  2. 2.

    Combine innovation, evidence-based dentistry, and audit of practice-based outcomes to drive forward improvements to clinical delivery

  3. 3.

    Seek mentorship from a more experienced colleague within your area of interest

  4. 4.

    When identifying cases suitable for safe clinical advancement, look for those which offer one or two aspects for development. Build gradually. Try not to overload on the most difficult cases

  5. 5.

    Maintain a logbook of clinical cases with critical reflection on outcomes, assessing both positive aspects (for incorporation into practice) as well as areas for development.

d. Develop your skills with postgraduate study

When choosing a course or programme, consider:

  1. 1.

    Prioritising your learning needs, and how these fit with your aspirations for current and future clinical practice

  2. 2.

    What type of educational format will most appropriately meet your learning needs and personal circumstances:

    1. i.

      Fully remote online learning

    2. ii.

      Blended online/face-to-face learning

    3. iii.

      Full-time residential programme.

  3. 3.

    Arrangements for funding - whether this needs to be personally funded, or whether an employer can part- or fully-fund the training

  4. 4.

    Time commitment for travel, attendance and studying.

e. Develop your special interest

The primary care (Tier-1) environment provides an array of opportunities (and challenges) for provision of quality dental care to a broad patient demographic. However, many GDPs (if not all?) will naturally develop a special interest in one or more specific areas of practice. Clinical advancement within an area of 'special interest' may be informal, or part of a formalised pathway leading to accreditation as a:

  1. 1.

    Dentist with Enhanced Skills (DES) [previously known as a Dentist with Special Interest (DwSI)]. This is an NHS appointment which enables practitioners to take referrals of Tier-2 complexity.6 Currently, DES opportunities are mostly confined to NHS dentists offering Tier-2 oral surgery and orthodontic services.

  2. 2.

    General Dental Council (GDC)-accredited Specialist. The GDC maintains lists of dentists who have demonstrated satisfactory completion of training in one of 13 recognised dental specialities.7 Specialist dental care involves the management of cases of up to Tier-3 complexity. The commonest pathways to specialist accreditation are shown in Table 2.

    Table 2 The commonest routes to GDC Specialist accreditation
    Full size table

If you wish to become a DES or Specialist, ensure that you familiarise yourself with the regulations for accreditation in these roles (noting that regulations change over time).

3. Develop with your peers

Engagement with a group of peers who are professionally engaged provides contacts and context to discuss professional challenges and problem solve. Forums include:

a. Morning case discussions

Timetable ten minutes before the start of your clinical day to identify the case(s) that you are either looking forward to, or concerned about, and present them to your colleagues. This not only provides an immediate and easy forum for success/problem-sharing but also facilitates the opportunity to mentally prepare for the day ahead.

b. Dental study clubs

There are a multitude of dental study groups across the UK, organised by a range of providers, including GDPs or Specialists, with or without affiliation to public or private organisations. Meetings provide the opportunity to:

  1. 1.

    Network and make friends with a group of fellow dental professionals

  2. 2.

    Share experiences of challenges encountered (and overcome) in practice, including group case discussions

  3. 3.

    Undertake +/- lead in the delivery of a continuing professional development (CPD) serial.

c. Professional associations

There are many UK-based professional dental associations, which seek to develop, promote, and educate within their area of interest. Benefits of membership include the opportunity to:

  1. 1.

    Enhance situational awareness and insight into pathways for career development. For example, the College of General Dentistry has a range of structured career pathways for the whole dental team including the Certified Membership scheme8

  2. 2.

    Attend regional and national meetings, discuss specific subjects and controversies, whilst gaining CPD

  3. 3.

    Present a poster (either a clinical case report or research project), which can help hone scientific writing and presentational skills

  4. 4.

    Apply to become a member of a board or committee, which provides the opportunity gain insight into, and contribute to, higher-level leadership

  5. 5.

    Participate in or facilitate 'Young Practitioner' groups, to engage and support development of junior dentists.

4. Stay with the vanguard

a. Keep up to date with advances in healthcare

Change is continuous and, within healthcare, techniques and materials quickly become obsolete as innovations emerge; for instance, the current transformation to digital impression taking. Maintaining awareness of emerging technologies is key to ensuring that you (and your practice) are optimally positioned to adopt change when the timing or environment is correct.

b. Lead change

Top tips for leading a change project include:

  1. 1.

    Not all change has to be revolutionary. Set change targets that are realistic, with outcomes that are easily accessible

  2. 2.

    Get experience with small projects before tackling bigger ones

  3. 3.

    Choose a project that will bring tangible benefits for the clinical team, and ultimately patient care.

  4. 4.

    Ask your team what they find challenging/ inefficient and offer them the opportunity to come up with the solution. Empowerment is likely to result in greater engagement, and superior outputs

  5. 5.

    Focus on the outcome rather than (real or perceived) obstacles to change. Believe that within the pursuit of the ultimate goal, as problems are encountered, these issues can be overcome

  6. 6.

    Stick with it! Establishing a new way of working takes times, and the draw of reverting back to the comfort of pre-existing practices is strong. Leading change requires you to energise those around you, patience, and fortitude. Use audit to assess the effectiveness of the change project.

5. Be an educator

a. Learn whilst you teach

Teaching often encourages self-reflection, where you really probe how much you know or don't know about your subject. Whilst this undoubtedly has benefits for your own professional development, the sharing of knowledge and acquired experience can also be incredibly rewarding.

b. Develop your educational skills

Ideas for incremental development as an educator include:

  1. 1.

    Developing and delivering:

    1. i.

      In-practice one-to-one training serial

    2. ii.

      In-practice training serial to multiple learners

    3. iii.

      Presentation at a regional study day

    4. iv.

      Presentation or webinar to a national audience

  2. 2.

    Applying to work as an:

    1. i.

      Educational supervisor

    2. ii.

      Undergraduate tutor at a dental school

    3. iii.

      Postgraduate tutor

    4. iv.

      Formalised training and development as a medical educator. For example, a postgraduate certificate in Medical (or Dental) Education, with the option to extend this to Diploma or Masters-level

    5. v.

      Join and engage with the Faculty of Dental Trainers (Royal College of Surgeons of Edinburgh), or similar organisation.

6. Seek to balance life and work - avoiding 'burn-out'

a. Consider what your priorities are in life

Seek to organise your schedule to flex time towards those things that matter most.

b. Consider a change of scene

Personal and family circumstances vary, but if possible, relocating to a new role or geographical location presents an exciting opportunity to reorientate your outlook and explore new opportunities.

c. Volunteer your time and skills

Offering your time and skills for the benefit of others, without the expectation of renumeration, often provides a holistic reward to the volunteer whilst also benefitting wider society.

Top tips are intended as a series of experiential tips, rather than a compendium of the evidence.