Reflections on dental school so far: thoughts before heading in to final year
Life is full of milestones, and as I approach another one upcoming, my heart tugs towards the time that has trickled by slowly but surely, like eroding its memories into a sandstone monument that does not realise or want to believe that time has passed.
While the world outside my window has remained largely the same save for a few new fruit trees, the person on this side has not. The past years have seen me through a few formative phases of my life and how they have flown. For sure, the last couple of ones have been riddled with uncertainty (thanks covid), but in its own way, it’s been a perfect little niche for fermenting thoughts. I suppose gratuitously, this has led to an opportunity to reflect on the past seasons of growing - as a person and as a young tooth saver. With great memories and great friends, my body feels finally rested after exams and my heart remains full thinking of the company I have and future hopes that grow ever more tangible. So much to reflect on and so much to look forward to.
So I won’t say too much here, but instead let you see the journey for yourselves. Because in the realm of dental school, we have experienced more changes than many of us had ever thought to imagine. From seeing our first patients to online learning, dental school never ceases to surprise.
Biggest steps this year: responsibility grows as your oyster grows
As little dental students swimming in the ocean of practicum, our oyster suddenly got a lot bigger this year. That meant so did our responsibility, in a good way; the way that grows one into an increasingly sharper ethicist and a clinician with ‘acumen’ (as one of our lecturers likes to put it). When the stakes are higher, there is an impetus to step up to match that.
The change? We started treating patients in the clinics for the first time. Yes, our very own patients! Ours to provide care for the duration of our degree, or until treatment is complete. It was both nerve-wracking and exciting, being a responsibility a long time coming. It didn’t disappoint our young hopefulness - many of my colleagues have started and maintained great relationships with their patients. In many ways, we owe them immeasurably as they very patiently and kindly tolerated our tottering steps (for example, trying to figure out how the radiograph holder handle wanted to slot into the ring, or double checking we counted the teeth right, or even the whole business of having 3 hr appointments!).
The wait was finally over, though I must confess that as excited as I sound recalling these memories, we did try to rein ourselves in and stay calm. Dental school had trained us well to keep eagerness tampered by patience and growing maturity over the years. Like children, we wanted to squeal over the proverbial feeling of at last smelling perfect golden cookies freshly sent out of the oven. And yet to continue the analogy, dental school was the baker that relentlessly turned us from a young misfit of ingredients into a ‘good cookie dough’. For starters, it was surprising how diverse the cohort’s pre-dental background was; we had scientists, artists, accountants, radiographs and previous oral health therapists in our year. And so, our beginning years of life sciences and dental foundations brought us all up to speed to treat our patients safely. The first two years saw us spend so much time with each other, discussing and learning all this theory - medicine, dentistry, ethics, communication, etc. - all very safe and sound. However, as we discussed these from the warmness of our lecture theatres and tutorial rooms, we still seemed far removed from the 'real world'. It is one thing to talk about theories and hypotheticals, another to be confronted with those very situations. Nothing really compares to how everything comes alive during a patient appointment. All those hours of learning become a frantic test of our ability to extract history, synthesise information, prepare treatment plans etc etc. - perhaps finally good use of our books, tears, sweat and our time in simulation clinics bending necks over Mr. Mannequin. To take a leaf out of Parkinson's Law, which says that tasks expand to fill the time allocated, it seems fair to assume a similarity to responsibility and skill, in the way that skills grow in as much opportunity they are given to grow. This was what clinic represented for us, but if you will indulge me then let me backpedal a bit to show you how the adventure really unfolded.
I'll start by admitting that if we were to be completely accurate, it wasn't the first time we'd put any instruments into a live patient's mouth. Our practice patients as early dental students were, in fact, each other! We were mutual guinea pigs for how to hold the mouth mirror, how to position ourselves, how to probe with the right pressure - we even tested our shiny new loupes on each other. It's a moderate exercise in trust; as they say, "It's why you have to be friends first." But that is where the difference ends. Although we had experience practicing on each other, most young and fit dental students have relatively pristine dentition. This does not really reflect the conditions under which we would be working because sadly, the majority of public dentistry where our clinical placements take place, is not done in perfect mouths. Oftentimes, patients in the hospital system have been on the waiting list for a long time, have circumstances preventing them from being able to see a private dentist faster, may need multiple teeth treated, and/or treatment in multiple disciplines. There will be many who have other co-morbidities; the clinicians will readily tell you that patients come in with medical histories in the form of reams to be attached to the patient file. Overall, these mean more complex treatment and in terms of multi-disciplinarity, I myself have already written a few correspondence letters to a number of specialist physicians to ensure clearance for procedures. This is the reality of dentistry and a harsh glimpse into where the need lies.
This year, what we have seen has led to a bit of a jerky wake-up call and difficult growth. As I reflect, long gone are the days of stumbling over ourselves trying to figure out how to hold the suction in each other's mouths and try not trigger any gagging. Even learning indirect vision feels a lifetime ago - I remember the early days practicing drawing teeth and crown morphology on paper in front of a mirror and thinking my dad might shockingly even have a secret talent for it (maybe I’ll sneak a peek in later); funnily enough, I used to never believe when dentists say they couldn't work without a mouth mirror anymore, and I now find myself joining these ranks. With all these happenings among the years, I find myself not having enough hours in the day to learn all that I want to.
Then I remember that this is just the beginning of a lifetime in dentistry and there is so much to learn. I hope that my aspirations and my compassions might overlap and I will stay true to where and how I want to serve in this field. I wish this for all of us, and the future is plentiful and I am sure again, our hopes will not be disappointed.
Improvise, adapt, overcome: lessons in resourcefulness
While there are plenty of bright sides to dental school, the truth is dental school can also be a tough ride. Learning becomes a journey in "creative productivity" and if that weren't difficult enough, add in a pandemic to the mix.
Part of coping through dental school is learning to find humour and grace in the situations that arise. Heaven knows how hard our lecturers tried to make things relatable and fun when we went online; their efforts to keep our learning going did not go unnoticed. It strikes me that lockdown has profoundly changed the pattern of the workscape, and dentistry has not escaped this either. The gift of technology has seen its reigning era and ever-growing grasp permeating into all aspects of our lives - including simulation clinic: home edition. For some context, this is possible because the majority of our simulation equipment is kept with us and ferried between either Westmead and Sydney Dental Hospital depending on the session, since both have sim clinics attached to them. Understandably, this can become quite the lamentation since the equipment is not always light. You could imagine our surprise when after the lockdown showed no signs of lifting soon, some clinic disciplines moved online - the ones that could be. However, there is always a silver lining and this time, the nice side being this time we only had to ferry our things from our bag to the nearest desk at home. Super convenient. And the camera proximity meant we all had a 'close-up' demonstration of our educator's model, an added plus.
Although this simulation stint was last year, I believe some valuable lessons have carried well into this year. Resilience, flexibility, resourcefulness - with more stories to share here. While university clinics are often well stocked, dentistry is a consumable-heavy field and sometimes even with the plethora of choice, the right 'thing' just is not there. I've seen wedges being used as wedgets when nothing else in the university clinics will keep the rubber dam in the gingival embrasure. We have also seen and experienced the race against setting amalgam, tutors sharing the secret of smushing the capsule contents with a finger and then employing instruments to condense. Unfortunately, preparing materials is more complicated since with the new covid regulations, the consumables that used to live in individual bays were taken away for safety from aerosols. They are now all located at a communal area in the front of each clinic, from which we all load up from at the beginning of a session because no leaving of bays once we have gowned up. Instead, a 'runner' or dental nurse has to fetch any extra materials during the procedure, neither of which are always available. I must say this was one way to make us quickly learn what all the materials were for each procedure so that we could set up as much as possible before the appointment started and we were prisoners of our own bays. All in good humour and in the name of infection control.
But if there is anything new to take away from these new and wild circumstances, it would be to enjoy the journey as creatively as possible, as much as possible, and keep perspective in mind. Uni is a special time of our beginning careers and I am so grateful that I have amazing friends to go through with, who help me to see the light in our learning every day. I used to think our lectures in resilience were a rather nebulous topic, but there can be so many invisible mountains every day that finding joy may be a chore. This does not mean we should force ourselves to be happy when things are truly bad, but I think there is grace to be given to ourselves and each other. While setbacks may happen by natural disaster or human mistake, we can only overcome obstacles by forging ahead since the present will not rewrite itself. What we can do though is turn discouragements into learning experiences and I suppose ‘emotional resourcefulness’ means practicing exactly that; the most resilient clinicians are the ones who are able to think differently about circumstances and consider all facets. The things we encounter will only get harder from here on so as I reflect on all these, I think one of my resolutions going into a jam-packed year of 2022 will be: “Keep your hands busy, your eyes forward and your heart light.”
Dental students try to understand machine learning
It sounds like a section heading that if it were an article, it would probably be 'clickbait', but I promise it's true. We have to work on a research project throughout dental school and my group's project put simply, was to explore how artificial intelligence has a place in automated detection on panoramic radiographs. It's actually a super interesting field that really pushes the frontier of the STEM landscape and exemplifies that even the newest technologies are finding its applications in dentistry.
However, it was a huuuuuge struggle to even begin to understand this mammoth topic. Those who have dabbled would know that machine learning is an amalgamation of multiple disciplines including mathematics, computer theory, neuroscience and many more. I personally thank all the crash courses and layman resources available online and a very clever compsci friend. One of our group members once tastefully pointed out, "It's like we started reading a textbook from chapter 19." Truly, I have never felt so lost reading something before. And much less to create diagrams for a research paper.
As I recall this, my amygdala reminds me that the "diagram-creating phase" belongs to a folder in my brain that probably wants to label the experience: "fight or flight". I say this in some degree of honesty that it made me want to run. Here's what happened. In order to create the diagrams to go into our appendix, I'd created a OneNote clippings notebook and several super comprehensive Notion pages to compile all this information about the architectures of three convolutional neural networks (CNNs) used in our study. Those pages became endlessly scrolling documents but thankfully I had the premonitory sense to create a contents header and labelled clearly as I went so thankfully they were at least still navigable. However, the less savvy part of me decided to use good ol' PowerPoint to create the diagrams, instead of a diagram-creating software (though my rationalisation was that I didn't have time to learn a whole new system whereas I already knew PowerPoint well and had learnt some tricks from previously making diagrams). Fortunately, we got there in the end, but I think a small part of me shrivelled over how many notes I took compared to how little space our diagrams ended up taking (one and a half pages in our paper). As a friend once put it - it's like when you research for ages and put the hours in, but have little to show for it. Truly.
Now, you might be asking - why are dental students doing this kind of computery stuff? Shouldn't they be doing something better suited to their skill set? You're right, that was perhaps the more tech-y side of things. In fact, our other task was to annotate a few hundred radiographs in order to create the data that our machine learning algorithm could understand. This was the part that was actually really fun (dare I say), and really made us faster at interpreting radiographs. Although it was quite a tedious and time-consuming task, that is the less-glorious-reality of research where grunt work has to go in to generate the results. I'll also admit we all were pushing close to the deadline and I even ended up doing a good chunk of the annotations between a wedding ceremony and reception of a church friend that day. A bunch of us were at a friend's house to bide the intervening time, and I remember sitting on the sofa in the living room with 'The Lord of the Rings' playing on the TV, others watching the movie while I annotated radiographs on end. It was a sight to behold and I think it's a chuckle-worthy story now that the stress isn't an imminent threat anymore. If you're the type of person who likes to work with some background noise (minus Gandalf vs Saruman's tower battle which wasn't all that mild), it wasn't too bad.
All in all, I think this research experience so far has taught me a lot about patience and realistic planning. Research is one of those unpredictable things that can be really hard to make plans around. It has been an interesting learning curve because I am one of those people who likes to schedule things back to back until all of a sudden, my calendar is full. But research meetings, for example, can easily run past expectations - two hour meetings become a four hour zoom call, particularly if your group is the type that prefers to work in big chunks. I think from now on, I will consider ways to plan meetings more effectively and also my schedule more loosely - in the sense that there is more wiggle room. Lockdown has been a good way to let go of my quasi-neurotic scheduling tendencies and learn to take each day as it comes. Let’s hope I will remember these lessons into the new year.
No boundaries to friendship: swapping picnics for dramas, drills for paintbrushes
As the old adage postulates, "Work hard, play hard." All in all, it's not wrong - the mindset of 'having something to look forward to' really does help persevere through the week though.
It is no secret that dental school is long hours, not including the behind-the-scenes work and study on the side. In a normal, non-Covid week, the schedule can easily reach 40 contact hours a week. That a lot of time to be spending together in clinics. However, the wonderfully convenient side to this is that by virtue of being around each other alllllll the time, friendships become easily made. If not careful, the workload can get overwhelming and certainly, little things like a bad day can make the weight seem even heavier. It is so important to have a great support network and friends to go through together. And it is really easy to be fish banding together in our koi pool of uncertainty. Your friends, my friends, our friends, clinic group to friends. There is much to be said about solidarity and I recall a conversation with a friend over dinner while discussing quarter-life crises. Perhaps it was brought on by just having finished first aid training and looming over us was a gloomy sense of mortality and the unpredictability of life. We spoke about our dreams and how dentistry can be one of the loneliest professions, not necessarily just by environment but that it can be difficult to understand the rigour of the training, the tears and sweat poured into endless hours perfecting our craft, catching up on backlogged work and knowing there is always more to learn. However, I am sure these thoughts are not just exclusive to ours and many other professions must inevitably feel similarly.
Nevertheless, it’s important to ‘chin up and shoulders back’ every now and then, and celebrate on the sweetness amidst the bitterness. As each profession has its woes, it also has its joys and in the same way, each season of life is special and its unique joys should be enjoyed to the fullest. Living in the now, university should be experienced not just wholly in studying, but student life and friendships. This is because I stand by the philosophy that experiences are not just single-purpose stints, since there are always ripple effects. It is with confidence that I say one of my greatest collateral joys in dentistry is my friends, who remind me that there is more that I came to university for than just studying and more that I will take away than just a degree.
And so it is perhaps a function of going around the sun more times, but nostalgia has been a returning theme over the past month. If I were to keep a gratitude journal, I suspect something I would re-write would be that I am thankful there will be so many fond memories to look back on. Some memorable pre-lockdown hangouts include catching up on the beautifully grassed law lawns on main campus after anatomy labs, a wedding (yes, one of us got married during dental school!), surprise birthday picnics in different gardens of Sydney, dent ball and halfway ball, visiting night markets and using our breaks to savour different egg toasties that elevated lunch to a new level of yum. These moments were pockets of bliss that helped foster friendships outside of lecture theatre or tute room activities.
As the pandemic came around, we found other ways to hang out and I was surprised. A big thing that happened was group of my close dent pals started watching episodes of dramas together every week. It took us a few goes to find the optimal viewing modus operandi, but we eventually got the hang and oh it was so fun. We would set aside a few hours, hit ‘play’ together and enjoy the virtual squeals we shared every time there was a dramatic moment. I loved that this was a way we stayed continuously in touch with each other throughout lockdown and that it became a regular weekly activity to look forward to. Another stint that makes me chuckle every time I look back on it was a ‘Bob Ross’ paint night we tried our utmost hardest for - it took us one hour to get through seven minutes of the video, although I must admit part of the challenge was constantly rewinding to ensure we had found the right colours and mixed our concoctions to satisfaction. Of course, there was some improvisation and substitution, including by myself who had forgotten to buy canvas of all things. Alas, we “improvise, adapt and overcome”, so I made do with calligraphy paper that had likely been in my basement since childhood. By the end, we were thoroughly exhausted, but our artworks turned out surprisingly well! However, I believe we tacitly agreed that if another paint night were to happen, it would be in person. All in all, it was a new experience that I had not thought possible before the pandemic.
Being someone who sometimes struggles to keep in touch with others digitally, I was challenged more than ever this past year as the technological platform became the predominant means to keep in touch. I am also a bit of a homebody so my resolution for this year is to step outside of my comfort zone more. I want to make the most of next year as we spend our final dozen months together in this chapter, especially before we all go out to different places. Some will be going home to international or interstate, some will go rural, some will work in the public system in other cities and some will stay here in the city. But still, we will graduate and in ways we are already colleagues in a relatively small field. For that, I am thankful we all happened to be here together at the right time and right place. Life is a multifaceted marathon and one of the greatest jewels it can give us are relationships that give immeasurable joy beyond the fleeting objects of this world.
Concluding thoughts
Just the other day, I was on main campus for the first time all year for a friend’s graduation. As I made my way up to the quadrangle, it was incredibly nostalgic to walk through quaint backstreets I had admired countless time, crossing the wooden boardwalks, passing the lawns and curved benches, reminiscing over this being a place that I associate with many fond memories. While the past couple years of dentistry have not been on main campus, I have come to somewhat find familiarity in the smell of Clinell wipes, the plastic wrinkling of clear shower caps on overhead lights, and our bright orange chairs and bays.
There are only so many more days that I will walk these disinfectant smelling corridors on the norm, and that is okay for sentimental me. I love to look back on memories, but this year I suspect I will not have much time or energy to linger in indulgence. Instead, I am learning to be okay with looking forward more bravely, leaving my comfortable places and not fearing changes that will inevitably tide in.
On a similar vein, I am sure we will face more challenges, which I am committed to not shying away from but instead welcoming and considering them as a better teacher than safe praise can be. We are only just learning new things but newer research in the future may well shake the foundations of what we believe to be true now. Moreover, we will likely be pushed and stretched further beyond anything previously encountered, and a part of me feels ready for that challenge. The other part of me knows it will be tough and that it is important to stay close to friends and loved ones. I know I am incredibly lucky to have abundant blessings in the form of good friends and colleagues. As we enter this final year together, it is my prayer that the memories will remain and create a lasting bond.
Life is peppered with milestones, but let us not forget the journey in between.