On Competencies

I am nervous whenever I’m in the School of Dentistry in Moos Tower. Even on days like today when I have no patients scheduled, I am constantly aware of a sensation of compression: my heart beating in the back of my throat.

I noticed this today as I was pouring the stone to produce an altered cast. Nothing broke, nothing leaked, nothing was lost. We’ll get this fellow his removable partial dentures (upper and lower) in a few weeks, and things will be fine. So, it’s peculiar that I’m still so full of adrenaline — I wonder if my subconscious senses danger, even though nothing truly bad has happened at school for quite a while.

Last week, I did an operative competency on a patient. In a competency, your skill at performing a specific clinical procedure is evaluated by two doctors. This involves lots of paperwork and for me, lots of worrying. If you make certain mistakes, you fail your competency. This is inconvenient because you must then find another patient who needs the procedure you just failed. Failure can also make you question your clinical skills. (One of the ultimate insults in dentistry is to say someone has “hands of stone”.) However failure isn’t really a big deal — it’s not like failing an exam. You just… don’t really have any negative consequences. Just find another patient and retake the competency. I think if you fail a few times something bad happens, but frankly I don’t even want to know.

“You have 40 minutes left, and if you aren’t done by then, you’ll fail.” My instructor, who was trying to be helpful during my competency, scared the heck out of me. My patient had arrived late, so I got started late. Time was never something I had in abundance. At that point, I was staring down an MOD amalgam prep with no matrix band, and I told myself “that’s a ton of time!” And it is. In private practice, it should take you 5-10 minutes tops to do what I had to do.

It took me 35 minutes.

There are few things that can go wrong when you condense amalgam (silver fillings) into a tooth, which is what I was doing. You can fail to touch the neighboring teeth (“proximal contacts”), which is an automatic fail. That part went fine, but when I was removing the wedges we use to produce these proximal contacts, I realized how nervous I actually was. I picked up the cotton pliers to pull the wedges, and the shaking of my hand telegraphed to the end of the pliers. I tried not to clatter them against the patient’s teeth.

Now came the fun part: removing the matrix band. These bands are essentially rudimentary moulds that give you the rough shape of the tooth’s axial contours. The interesting thing is, you remove a matrix band when the amalgam is still setting up, so your filling is relatively fragile. If you do it wrong, you have to start the condensation over again. I did not have time to do that. At this point, my shaking got bad, and I had to brace my hand against my patient’s teeth. Thankfully, she didn’t notice. Band removed. Contacts verified. Occlusion refined. I passed. It all went fine. Slow, but fine.

I hope I can shake these nerves before I take my fourth board exam in the spring: patient-based boards. Dentistry at the school is stressful enough without having to calm your hands down.

Brief Notes Nearby