During my undergraduate degree I spent a lot of time studying. The thing was, most of that time was spent studying poker.

Along with the game itself I dove into psychology, learning, emotional control and meditation. A lesson that stuck with me long after hanging up the poker hat was about the four stages of competence. The concept in poker was to move skills to unconscious competence a state where even the most emotionally frustrating situation (losing a ‘bad beat’, not dissimilar to an unreasonably difficult patient) would not affect the core skill. It was unconsciously working.

“You don’t know what you don’t know” is one of my favourite sayings. And this is unconscious incompetence, a time where we don’t know that we can’t do something. This is actually a dangerous time where we can get into trouble and not even know it. The aligner case that has more to it than meets the eye or the guy who wants to have his teeth built up from attrition yet not understanding his square jaw and sleep apnoea impact this. Be wary.

Conscious incompetence. You realise that you don’t know it all. A humbling yet important realisation that perhaps this case has more to it or should be referred off. Perhaps you didn’t graduate ready for ortho, implants and full mouth rehabilitation. While a safer zone for you and your patients, you might find yourself a bit unmotivated, I felt this at 18months post graduation. When you find yourself here, you need to shift your perception. Allow this to intensify your learning and progression in the areas you now realise you’re deficient. It’s a goal. And you’ve done many years of study, you don’t struggle with hitting clear goals.

Consciously competent. You’re competent at what you do but it takes focused ongoing effort. Crown preps once you’ve done your first 50. You can do them fairly easily and sufficiently well. But not with your eyes closed. You’re on your way there.

Unconsciously competent. Turn the car on, handbrake off, put it in gear. Driving was once a stressful endeavour but now it can pass without you even registering any of the decisions it took to get there. Perhaps, all you consciously noticed the whole way was the (DHS) podcast you were listening to! Some aspects of your dentistry may get there (so I hear!) but perhaps not all.

If you follow some of the great clinicians out there (Dr Omar Ikram, Dr Lincoln Harris) you’ll have heard of the Dunning Kruger effect. In fact, in a recent podcast with Dr Andrew Thorpe this came up multiple times.

The dunning Kruger effect is extremely relevant to all new graduates and I’ll be honest, I’ve gone up and down on that graph more than once. Many things in life need to be learnt the hard way. Just make sure you keep this in mind and don’t take your patients down a difficult path unnecessarily.

The dunning Kruger effect is real and inevitable. But how high you go in unconscious incompetence and how low the realisation that follows is is up to you. Check yourself, your patients will thank you.

David is a recent graduate dentist working in private practice in regional NSW, Australia. Read more at www.dentalheadstart.com/meet-david/

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