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Features / April 19, 2016

Training and competency in dental hygiene

by Guy Hiscott

Joe Ingham looks at expanding your horizons as a dental hygienist in training and competency

Irish-toothFrom the comfort of the front passenger seat, anyone who doesn’t have a driving licence might reasonably observe that driving is a fairly straightforward process. The wheel is turned in the required direction of travel and the feet operate pedals in order to make the car speed up or slow down. Indeed, most experienced drivers probably make the whole process look routine.

However, if you find yourself stuck behind a learner driver it is immediately apparent that driving, like a lot of other skills, is a process that requires training and practice in order to become proficient. There is also a great variation in the degree of proficiency on display.

In his book Outliers, the author Malcolm Gladwell describes the 10,000-hour rule. This, he says, is the minimum number of hours of practice required to achieve the level of mastery associated with being an expert.

Mozart, whom many consider to be a child protégé, famously started writing music at age six. However, the earliest concerto, now regarded as a masterpiece, was not composed until he was 21 – by that time he had already been composing concertos for 10 years, spending approximately 1,000 hours annually during those intervening years.

If challenged, everyone involved in patient should demonstrate appropriate training

No practitioner should be tempted to perform a procedure on a patient that falls outside their competency. It would be ethically wrong and potentially legally disastrous to do so. In the event of a claim for negligence, the practitioner would be seen in a very poor light if it was shown that they had not undertaken approved training for the procedure in question.

Driving force

While it may be tempting to focus one’s training needs on acquiring new skills, it is important to remember that the core skills of a dental hygienist’s working life need updating. To this end, it is recommended that a dental hygienist should spend time updating their knowledge on decontamination procedures, radiography and medical emergencies, as well as keeping up-to-date with legal and ethical issues and complaints procedures.

It is also important that, if challenged, everyone involved in patient care can demonstrate that they have received appropriate training and, moreover, can actively participate in continuing professional development in the relevant areas.

Like many things, though, there is often no definitive guidance to refer to in order to clarify what constitutes ‘appropriate training’. There may be huge variations in the detail and quality of the material available by educational providers and establishments. If in doubt, it is best to consult dentolegal advisers.

Practice makes perfect

Clearly not everyone falls into the world-renowned expert category, irrespective of how much time they devote to training. However, studies have shown that for the vast majority of people, the maxim ‘practice makes perfect’ holds true.

As a new skill is learned, individuals tend to go through a discrete learning process, which involves the following:
1.    Unconscious incompetence: you can’t do something and you are oblivious to the fact as you have probably never tried it or even thought about it
2.    Conscious incompetence: you cannot perform the task but now at least you are aware of the fact
3.    Conscious competence: you are capable of performing the task albeit by a degree of thinking and concentration
4.    Unconscious competence: you can perform the task well without thinking. It has become second nature and you work on autopilot.

The introduction of independent practice to hygienists is likely to focus the spotlight on training and competency even more

The green light

A lot of student hygienists were former dental nurses. It is not uncommon for them to remark in phantom head practice that performing a dental procedure is a lot more demanding than they had previously realised, when viewed from the surgery assistant’s chair. Dentistry is, of course, a subject that is constantly changing with the advent of new techniques and materials.

Regulations also change: the introduction of independent practice to hygienists is likely to focus the spotlight on training and competency even more. In order to be competent and safe, it can be seen that a period of education and training – and possibly assessment – is necessary.

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Joe Ingham spent 28 years in general practice. He concurrently acted as the dental practice adviser for Berkshire for eight years and joined Dental Protection on a part-time basis in 2008. He now spends four days per week as a dentolegal adviser in the London office and one day per week as a tutor at the Eastman School of Hygiene and Therapy, London.