Top Ten Tips for New DCTs
Robbie McLeish - University of Edinburgh JTG rep
1.) Be Prepared
Preparation is key in all walks of life, and nowhere is this truer than as a new DCT working in a hospital setting. This rule applies across all aspects of work; from ward rounds, to theatre list and clinics. However, for this first tip, getting some insight into your new place of work will pay dividends for starting on your first day. If you have the opportunity to spend half a day shadowing a current DCT or staff grade, amazing. Given this is not always practical, even getting in touch with someone who has done the job before can give you lots of useful information before starting. This advice isn’t exclusive for DCTs new to OMFS, and can be a useful for anyone with previous OMFS experience starting at a new unit. There can be massive variation in practice and protocols across different units, especially when crossing the border, so getting a heads up on how a unit runs is invaluable.
Further to this, swatting up on your base knowledge of Maxillofacial trauma and oncology, head and neck anatomy, oral medicine etc, will be a massive help to make sure you hit the ground running. Books such as Dentist On The Ward, On-call in Oral and Maxillofacial Surgery and the Oxford Handbook of Oral and Maxillofacial Surgery are cheap to purchase, at an appropriate level and easily accessible.
2.) Decide What You Want To Get Out of The Post
Everyone will enter DCT with a different plan and set of premeditated learning objectives, and it will come as no surprise to any middle grade, registrar or consultant that most DCTs aren’t looking for a career in OMFS. Just because your dreams don’t lie in almost bankrupting yourself through two degrees, doesn’t mean your time can’t be valuable. There is a lot of important ties between OMFS and dental specialties, such as: Restorative, Orthodontics, Oral Surgery, Oral Pathology and Oral & Maxillofacial Radiology. Make it clear to your clinical supervisor early on what your goals are and they can help you get the most out of your time. Inevitably, there will be elements of service provision you need to uphold, including on-call cover, clinics and theatre; but try and use your time around this to benefit your career trajectory as much as possible. Also, don’t forget you have a study budget that will go to waste if not used, so plan carefully what courses, symposia, conference etc will benefit you, so be sure to use every penny.
3.) Seek Experience In Sensible Places
As a slight extension from Tip 2, be pragmatic in where you look to gain your experience. This may seem obvious, but you would be surprised the amount of trainees who recognise their learning needs but don’t think logically about how to achieve them. A prime example could be wanting to gain experience in cannulation for IV sedation, but restricting you experience to emergency patients coming through door who need admitted and the half day sedation list you help out on every 4 weeks. Hospital theatres are full of lists of short cases where every patient gets a cannula placed in the anaesthetic room. Maxillofacial dentoalveolar general anaesthetic lists are a great example of this, and would easily allow 6 opportunities - under the supervision of an IV expert - in one day. Hospitals are an excellent resource for training in a wide range of clinical skills, either on real patients or in simulations, and are an opportunity not to be missed.
4.) Jobs List
Again, another simple one but you’d be amazed the amount of people that don’t do this. Covering the emergency bleep whilst looking after the in-patients on the ward is a daunting task, and can easily result in a busy list of jobs to be done. Given these can be all over the hospital, from the ward, to the out-patient department or A&E; keeping a legible and up-to date list of jobs on your person is crucial. This could be on a small notepad, or maybe on the back of your handover. A simple numerical or bullet point list, with small boxes next to the tasks that can be shaded once completed, keeps all your work in one place and helps visualise everything needing done. This can be helpful when trying to prioritise your jobs based on location, urgency etc. The aforementioned boxes can also be partially shaded if the job is in progress, like a set of bloods you took and need to review once they’re back. Jobs can also be grouped by patient, or by the type of task; find whatever works best for you. Ultimately, this will ensure you don’t forget something important on one of those busy shifts where you feel like the list is never ending.
5.) Effective Handovers
This is one that does take time, and practice of your SBAR is crucial; but an effective handover really can make or break a patient’s care outcome. It is one of the most important tools in healthcare and effectively being able to communicate with another clinician or healthcare professional about a patient’s care is a skill that will serve you in whatever role you end up choosing. It is also a skill that is easy to gain experience in. Updating the nursing staff about in-patients following the ward round, running a patient by a senior on clinic, handing over an out of hours referral to the overnight DCT. Practicing structuring your handovers and picking out the salient information means you won’t miss anything when it comes to dealing with an actual emergency.
6.) Contemporaneous Ward Round Notes
This is a minor one, but always comes back as a bugbear across the MDT. Often as the on-call DCT, your role will include attending the ward round and scribing the medical notes for in-patients. Depending on where you work, this may be in a paper set of notes that remain on the ward, or in electronic notes that can be accessed across the hospital. Regardless of the modality, the notes stand as the primary source of information on everything related to the patient, including the ongoing plan. If they aren’t kept up to date in a timely fashion, important information can be missed by other members of the MDT. This isn’t always of significant consequence; however, it can and has resulted in disastrous outcomes, like an emergency theatre patient being fed because no one except the surgical team knew they were to remain fasted.
This comes back to an earlier point on effective handover, which should always be an important cornerstone of the ward round, particularly if the surgical team is not based on the ward. Electronic notes can at times be delayed as they do not need to be completed whilst on the ward round, often being saved on to Word documents prior to being uploaded. This may be due to other emergent commitments pulling attention away from writing the notes. A good rule, even when busy, is to ensure that at the very least, all the plans for the patients are documented and available to view by the end of the ward round.
7.) Involvement In QIP & Teaching
Your time in OMFS may only be six months, as such getting involved in quality improvement projects early on means you will be able to see the projects all the way through. Speaking to permanent members of staff about what ideas they may have, or previous projects the could benefit from a further cycle, will get you looking in the right direction. Having clinical audits, improvement projects and research under your belt will be of huge benefit if you plan on applying for specialty training.
Most units will also run departmental teaching that is great to get involved in. If not, have a chat with the consultants and start your own departmental teaching. Even better, include the foundation doctors and ward staff if possible. Being involved in establishing a teaching programme within a unit will look excellent when applying for further training.
8.) The Right Equipment
As mentioned, being prepared is crucial, and this extends to bringing the right equipment. Thankfully, in OMFS there isn’t any requirements for expensive equipment. Many DCTs may already have a pair of loupes, and these can be useful in theatres or when doing local anaesthetic lists in the outpatient department, but are by no means a requirement at this stage. The one singular piece of equipment that you will find invaluable is a high-quality pen torch. As the on-call DCT, you will spend plenty of time looking in patients’ mouths in poorly lit A&E side rooms, and having a good light source to pick up the subtle asymmetry in the oropharynx of the five-day post-op wisdom tooth removal patient is vital.
Although most phones have a decent built-in light, bringing it out when assessing a patient looks somewhat unprofessional and can be problematic with regards to cross-contamination. A good quality pen torch can be purchased for as little as £10, is easily disinfected, and will make you every consultant’s best friend on the ward round.
9.) If You Aren’t Sure, Ask
It goes without saying, but no one is expecting you to arrive as a Maxillofacial Surgery expert and expectations won’t be high. What is expected is that you are enthusiastic to learn, keen to get involved, and are a safe practitioner who can communicate effectively. To this end, if there is anything you aren’t certain of, or just need some reassurance, please ask. Most senior members of staff are hugely approachable and more than happy to help, and even on the off chance they’re not, the safety of the patient comes first; so if you need to ask, ask.
This also applies to asking questions to further your learning. As mentioned, building a solid foundation is crucial, but don’t hesitate to ask any clarifying questions or seek further knowledge on anything you see on clinic, in the theatres, or on the ward.
10.) Enjoy Your Time!
Overall, the vast majority of DCTs thoroughly enjoy their time working in OMFS and find it an invaluable learning experience. Skills like assessing a facial swelling, knowing how to approach an unwell patient, venipuncture and IV cannulation, and working as part of a large MDT have applications far beyond a surgical ward and will hold you in good stead for whatever pathway you choose to follow. Good luck and have fun!
