Clinical Training Questions

Dentistry is learned with the hands as much as with the head. A school's lecture list tells you little about whether graduates will be competent in practice; the clinical programme does. Yet clinical details are often the least visible part of a school's website. This guide sets out what to look for and what to ask, without suggesting that any one model is better than another.

Why clinical facts deserve their own questions

Accreditors and regulators examine clinical education. CODA, for example, publishes separate accreditation standards for predoctoral dental education, advanced programs and allied programs, and its process includes an on-site review with interviews of administrators, instructors, staff and students to verify the school's self-study. The Dental Board of Australia lists approving accreditation standards and accredited courses of study among its functions. That is the formal frame. As a prospective student you also need to know what happens to you, week by week.

The stages of clinical education

Programs differ, but most separate the following stages. Use them as a vocabulary when you ask.

• Preclinical and simulation. Work on models, phantom heads or simulators before treating patients.
• Supervised patient care in a teaching clinic. Students treat patients under supervision, often in a university clinic.
• Outreach or external placements. Time in community clinics, hospitals or other sites.
• Clinical assessment. Examinations and competence checks, in the school or by an external body.

Ask the school to describe each stage in its own words and to say in which year it begins.

Questions about patient care

1. When do students first treat patients, and how many hours per year are spent in clinic?
2. Does the school record minimum numbers of procedures or cases? Are they counted, and who signs them off?
3. Where do the patients come from? A school's patient mix affects what you will see and what languages are used.
4. Who is the clinical supervisor, and how many students does one supervisor oversee?
5. What happens when a case is difficult or a patient does not attend, and can required work be completed elsewhere?

Questions about simulation

Simulation can be an important part of preparation, but a simulation facility does not substitute for patient care in every system. Ask:

• How much of the curriculum is simulated, and which skills are assessed on models before patient work?
• Is simulation accredited or credited toward the required clinical hours, and by whom?
• Does the school say what its own simulation facility includes, rather than naming equipment generically?

Questions about placements and travel

Placements may be at distant sites or in another country, and students may be responsible for arranging them. See Studying Dentistry Abroad. Ask who finds the placement, who pays for travel and accommodation, and what happens if a placement is cancelled.

Questions about language

The language of patients and of clinical records may differ from the language of lectures. See Teaching and Clinical Languages.

Questions about instruments and costs

Clinical work requires instruments, materials and insurance, which are often outside tuition. See Tuition and Instrument Costs.

Connecting clinical training to licensure

The link between clinical training and licensing differs by country, and you must check it for yours.

• In the United States, the American Dental Association states that applicants in most jurisdictions are subject to a clinical assessment and that each state dental board sets its clinical assessment requirements. Its student licensure page lists several pathways that states may accept, including post-graduate residency years, an objective structured clinical examination, a portfolio examination or a hands-on clinical assessment run by a testing agency, and notes that New York requires an approved post-graduate year residency program. Your school's clinical curriculum should be examined with that in mind.
• In Canada, the National Dental Examining Board offers pathways for graduates of non-accredited programs that include examinations and accredited qualifying programs.
• In New Zealand, the Dental Council describes an examination for dentists without a prescribed qualification, and for specialists an examination that includes a clinical component.
• In Australia, the Dental Board states that students do not need to apply for student registration themselves because the education provider does so on their behalf, and there are no fees for it.

None of these facts should be read as a promise that any school's clinical programme satisfies any regulator.

Allied careers are different

Dental hygiene, dental therapy, dental assisting and dental technology programs also have clinical or laboratory training, but they prepare for other careers. A dental hygiene clinic is not a substitute for dentist training. See Dental Qualifications Around the World.

A short list for a school visit or call

• Can I see the clinic and the simulation laboratory?
• What are the pass and progression criteria for clinical years, and what happens if I do not reach them?
• Can I speak to current students about their first patient contact and their workload?
• Which external bodies assess clinical competence, and how often?
• What clinical documents will I receive at graduation, and who can verify them?

Use schools and programs for orientation, then rely on the school's written answers.

Reading the answers

When a school answers, look for specifics. A specific answer names years, hours, sites and responsible persons. A vague answer uses phrases such as "extensive clinical exposure" or "state-of-the-art facilities". Vagueness is not proof of a problem, but it is a reason to ask a second, more precise question, such as "In which semester does a student first treat a patient, and how many sessions per week?".

Compare answers from the school with what current students and recent graduates say, remembering that each is one perspective. Treat claims of procedure numbers as school statements that should be matched to the regulator's or accreditor's published requirements, where such requirements exist. And keep in mind that a larger number of patients does not by itself indicate better supervision; the ratio of supervisors to students and the quality of feedback matter as well.

Common questions

Is more clinical time always better? Not necessarily. Quality of supervision, case variety and feedback matter as much as hours. Ask how competence is judged, not only how long students spend in clinic.

Can I do part of my clinical training in another country? Some programs allow electives abroad and some do not. Ask whether elective time counts toward required hours, and whether the regulator in your intended country accepts it.

What if I have no previous patient-contact experience? Schools expect to teach it; ask how they prepare first-time clinicians and what support is available.