Principle 7 - Maintain, develop and work within your professional knowledge and skills

Amrita

Amrita is a student dentist in her fourth year of study. She has a patient who requires a small filling in a molar tooth. She has completed simple and more substantial fillings on a phantom head successfully many times and is keen to put her skills to use on a real patient.

Student dentist Amrita is in the clinic with the patient. She starts drilling the tooth and removing the decay in preparation for the filling. The tooth suddenly crumbles and a large fragment comes away. Amrita is surprised as she feels very confident with her technical skill. However she believes she can still easily complete the treatment.

What do you think Amrita should do next?

Select an option: 

• Explain to the patient that the tooth is more fragile than it first appeared so the filling may take longer and reassure them so they don’t become anxious. Then finish the procedure as the patient’s mouth is still numb and her supervisor is busy with another patient in the room. 
• Explain to the patient the tooth is more fragile than it first appeared and that she will ask the supervisor to check what should be done next, explaining some possible options. 
• Remove the tooth fragment quickly, saying nothing and continue with the more complex filling so as not to distress the patient. They have opted for a white filling so they probably won’t notice.

See what Amrita did next...

Amrita disposed of the tooth fragment quickly without saying anything to the patient and then proceeded to complete the larger filling indicating to the student dental nurse not to mention anything was different. She removed what she thought was the full extent of the decay and filled the tooth, noting what she had observed in the patient record.

The supervisor checked the treatment had been completed. After the treatment, when the supervisor confirmed whether Amrita had completed the patient record they noticed the comments relating to the condition of tooth. The patient had to be recalled and the tooth checked. At the re-inspection it was noted that a crack had appeared in the tooth and there was a deficiency in the filling. This required further intervention in the form of a repair to the filling. Amrita was very relaxed about the impact of her actions, didn’t show insight and failed to recognise her actions didn’t meet the standards required.

This was not the first time Amrita had been overconfident in her capabilities and not sought advice when she needed it. As a result the patient’s tooth had been both put at risk and she had not been honest with the patient. Amrita is continuing to show a pattern during patient treatment of failing to recognise her limitations and failing to seek advice which was having a potentially harming effect on patients. Her student fitness to practise was called into question and she was given conditions on her practice. Amrita was required to stop treating patients and was asked to complete further work on professionalism. She was assessed before she was allowed to treat patients again under increased supervision. She had to declare this on her GDC registration application form.

GDC principles

7.2 You must work within your knowledge, skills, professional competence and abilities.

7.2.1 You must only carry out a task or a type of treatment if you are appropriately trained, competent, confident and indemnified. Training can take many different forms. You must be sure that you have undertaken training which is appropriate for you and equips you with the appropriate knowledge and skills to perform a task safely.

7.2.2 You should only deliver treatment and care if you are confident that you have had the necessary training and are competent to do so. If you are not confident to provide treatment, you must refer the patient to an appropriately trained colleague.

Other guidance

Ask your training provider if there is any other guidance or information they would recommend.

Discussion points

• Have you ever had something unexpected happen during a procedure or treatment when you thought you were at a good standard? How did you respond and on reflection do you think it was the right response? 
• Do you ever feel unsure about how much detail regarding a procedure you need to tell a patient? What should you do if this happens? 
• What other consequences, apart from the physical damage to their tooth, might patients experience if you undertake work which is beyond your ability?

_Disclaimer

_{These fictional case studies are for illustration purposes only and should not be relied on to make clinical decisions. Their aim is to put GDC guidance in context, exploring how some of the principles might work in practice.}

_{The case studies cannot be relied on to be clinically accurate. Nor do the case studies intend to show the "correct" interpretation of GDC guidance, only one (or more) possible interpretation(s).}