Lucy Cracknell and Zoe Buontempo

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As final year dental students at King's College London in 2020/21, we were bracing ourselves for a busy year ahead of examinations, practical assessment and Dental Foundation Training (DFT) applications, completing all of this whilst in the midst of a global pandemic. However, upon arrival at our outreach placement at the University of Portsmouth Dental Academy (UPDA), the tutor responsible for Dental Student clinical audit (KJ) introduced the professional need for audit and offered all students support if they wished to complete a 'student led audit'. Despite our full schedules we were keen to take up the challenge and thus make the most of this opportunity.

Reasons for completing an audit

1. Practical

The Care Quality Commission details that an audit is a 'tool to improve the quality and efficiency of patient care.'1 Audits on infection prevention and control, accessibility and radiographs are described as essential.1

2. Learning opportunity

The audit process is notorious for being long and tricky. As this was our first time, we felt that familiarising ourselves with the process would no doubt make life easier the next time we came to tackle a project. Completing essential and also desirable audits are necessary throughout all dental professionals' careers, so getting to grips with the audit process now has put us in good stead for the future. Participating in clinical audit also helped us to really appreciate what it means to be a dental professional and demonstrate some of the skills required to be a dentist.

The audit should be done to identify areas requiring change, with the aim of improving patient care which is at the heart of what we do as dentists

3. Improving patient care

'Do not do an audit for audit's sake' - wise words from our mentor; the audit should be done to identify areas requiring change, with the aim of improving patient care which is at the heart of what we do as dentists.

4. Portfolio building

Whilst we may be busy as students, it won't compare to life in the real world, so we thought this opportunity was too good to turn down when we have tutor support and a bit more time on our hands.

Completing an audit has many stages, so we have created a step-by step student guide from our first audit journey to help future dental professional students.

Choose your topic

This is the first challenge and can seem daunting as audit ideas are very wide ranging from infection control to paediatric safeguarding to antibiotic prescriptions. We were directed to the audit archives at UPDA, where we could see previous student-led audits for inspiration. We brainstormed which topics we were interested in and after discussing these with our tutor, we decided on a radiography-based audit, focussing on Dental Panoramic Tomograph (DPT) justification and reporting.

Background research

To be able to carry out an audit, it is important to know any guidance or standards regarding your topic area. We researched the justification for DPTs and their reporting so we could compare this to the audit results produced, which would then enable us to make recommendations for change. Coming up with clear aims and objectives also gave focus to our audit.

Collecting data

With help from staff at UPDA, we were able to access patient records of those who had previously had a DPT taken. A timeframe of April 2018 to December 2020 inclusive was used for our retrospective data collection. The data collected needed to be accurate, available, complete, fit for purpose, relevant, reliable, timely and valid.2

Pilot audit

A pilot audit is the process of completing an audit but with a small sample to highlight any necessary changes to the methods before beginning the audit. We used five randomly selected DPTs using a random number generator. The patient notes were then accessed on CS R4 Clinical + management software system, the record keeping system used at UPDA, to examine the justification and reporting of the DPTs and identify any flaws in our procedures.

This is the first challenge and can seem daunting as audit ideas are very wide ranging from infection control to paediatric safeguarding to antibiotic prescriptions

Main audit

Following the pilot, we completed the audit which was made easier by sharing the workload between the two of us. A total of 62 patients were randomly selected using a random number generator and, having refined our methods as a result of our pilot audit, we easily completed our data collection over one of the weeks we spent in Portsmouth on outreach. We made good use of any spare time in our appointment diaries and by staying on after clinics. Owing to the pandemic there were obviously no distractions, so we used some of our evenings in halls of residence to evaluate our results and write our report.


After the results have been collected, the findings of the audit should be written up as a report, often following a template, detailing the background, aims and objectives, methods, results, discussion, recommendations and action planning and finally the conclusion. An abstract can be used to briefly describe the project; it is also important to acknowledge others who help guide and facilitate the audit process, as well as including a reference list on sources used. The results will identify areas for change and improvement or will confirm good practice. However, the recommendations are the critical outcome of a 'one cycle audit process' as this is how the patient care is going to be improved. An action plan can be used to detail how to put these recommendations into practice.

In our audit, few of the included DPTs were reported in detail, particularly lacking a comment on the extra-oral anatomy, we suggested a new reporting template on the clinical electronic record system to prompt clinicians to comment on the extra-oral anatomy as well as the teeth, using published reporting advice.3


Although this may seem tedious, re-auditing is essential in order to make sure your recommendations and subsequent changes are actually working, thus completing the 'one cycle audit'. Otherwise, it would be just doing an audit for audit's sake which hopefully you've gathered from this is not the point.


Hopefully this step-by-step guide has made the audit process clearer as it is not as daunting as it may seem. Speaking to the audit co-ordinator provided us with a wealth of information and advice; they are a good point of contact and source of knowledge. Consider reaching out to older students who have audit experience or even turn to the internet for help as there is a huge volume of audit material out there. "Student led audit" has been embedded into the placement at UPDA for over 10 years and we certainly felt that we have benefitted from this approach and feel empowered to tackle audits in our foundation training year.