Practice makes progress: a cross-sectional regulator-aligned performance appraisal among general dentists in an integrated academic health system
This cross-sectional study of general dentists in the UAE reveals that while self-perceived proficiency and clinical practice frequency are positively correlated, a significant gap exists in procedure-heavy domains, suggesting that system-level interventions should prioritize protecting clinical exposure in under-practiced areas rather than solely focusing on additional training.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Keeping a dentist's skills sharp is not just about personal pride; it is a matter of public safety. Just as a pilot must regularly fly to stay current, a dentist must keep performing procedures to maintain the ability to treat patients effectively. In the world of healthcare, there is a constant tension between what a professional believes they can do and how often they actually get the chance to do it. If a dentist feels confident in a specific skill but rarely practices it, that confidence can become a false sense of security. Conversely, if they practice a skill often but lack the training to do it well, the risk of error rises. The most effective way to manage this is to look at both sides of the equation simultaneously: the dentist's self-assessment of their ability and the real-world frequency with which they use that ability. This dual view helps health systems understand where their staff are thriving and where they might be losing their edge due to a lack of opportunity rather than a lack of talent.
In a recent study conducted within Dubai Health, an integrated academic health system in the United Arab Emirates, researchers set out to examine this exact relationship among general dentists. They wanted to see if the dentists' confidence in their skills matched how often they actually performed those skills in their daily work. The team surveyed forty-four dentists who work across the system's clinics. These dentists were asked to rate themselves on fifty-four different tasks, ranging from basic check-ups to complex surgeries. For each task, they answered two questions: first, how proficient they felt they were, and second, how often they performed that task in their routine practice. The survey was designed to align with the official rules set by the local health authority, ensuring that the questions reflected the actual legal scope of work for a general dentist in that region.
The results revealed a clear and consistent pattern. Overall, the dentists felt quite confident in their abilities, with an average proficiency rating that translated to about eighty-six percent of the maximum possible score. Their reported frequency of practice was also high, sitting at roughly seventy-nine percent. This suggests that, as a group, these dentists are generally competent and active in their field. However, when the researchers looked closer at specific types of dental work, a significant gap emerged. The dentists felt most confident in foundational areas like preventing tooth decay, handling dental emergencies, and managing general oral health. In these areas, their confidence and their actual practice were closely matched.
The story changed, however, when the researchers examined more complex, procedure-heavy tasks. In areas such as surgical management, restorative work, and specialized prosthetics, the dentists' confidence remained relatively high, but their actual frequency of performing these tasks dropped noticeably. For example, in surgical management, the dentists felt they were about sixty-five percent proficient, yet they reported practicing these skills only about fifty-two percent of the time. Similar gaps appeared in restorative management and pediatric dentistry. The data showed that the more complex the procedure, the wider the gap between feeling capable and actually doing the work. This was not a sign that the dentists were unaware of their limitations; rather, it suggested that their confidence was based on training, while their practice was limited by the structure of their daily work.
The study also explored why this gap existed. Through open-ended questions, the dentists explained that the issue was not a lack of knowledge or skill, but a lack of opportunity. They cited limited appointment times, the unavailability of specific materials in general clinics, and the difficulty of scheduling follow-up visits as major barriers. Many noted that complex cases often required more time than the standard forty-minute slot allowed, or that they lacked access to specialized equipment like dental labs or microscopes. Consequently, even though they felt capable of performing these procedures, the workflow of the clinic made it difficult to do so regularly. The researchers found that this pattern was consistent regardless of the dentist's years of experience or their highest degree, indicating that the issue was systemic rather than individual.
The findings suggest that the solution lies not in more classroom training, but in changing how the work is organized. The dentists themselves requested specific types of support: protected time to perform complex procedures, guaranteed access to necessary materials, and opportunities to work alongside specialists under supervision. The study concludes that for an academic health system to truly support lifelong learning, it must ensure that the environment allows dentists to practice the skills they already possess. By aligning the daily workflow with the professional scope of practice, the system can turn high confidence into high-frequency practice, ensuring that the "practice" part of the saying "practice makes progress" is actually happening.
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