The Journal of EVIDENCE-BASED DENTAL PRACTICE

REVIEW ANALYSIS & EVALUATION // ETIOLOGY/OTHER

“PREPAREDNESS FOR PRACTICE” FOR

DENTAL GRADUATES IS A MULTIFACETED
CONCEPT THAT EXTENDS BEYOND
ACADEMIC AND CLINICAL SKILLS
To develop a conceptual framework explaining the construct of “preparedness for practice” among dental graduates and to
identify the factors influencing the construct through a synthesis of the literature.

REVIEWER
ALEXANDER C.L. HOLDEN

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Conceptual framework explaining “preparedness for practice” of dental gradu- SORT SCORE
ates: a systematic review. Mohan M, Ravindran TKS. J Dent Educ
A B C N/A
2018;82(11):1194-1202. SORT, Strength of Recommendation Taxonomy.

LEVEL OF EVIDENCE
1 2 3
SUMMARY See article 101433 for complete details regarding SORT and
LEVEL OF EVIDENCE grading system.

Selection Criteria
The authors both independently searched four databases (PubMed, Science
Direct, Web of Science, and EBSCO Host) using various MeSH terms. Their search SOURCE OF FUNDING
strategy was limited to the dental context and specifically to dental students and None declared.
dentists and included published articles up to November 1, 2017. The authors
also identified relevant studies from reference searching within the studies found
through their search strategy. TYPE OF STUDY
Systematic review.
Key Study Factor
The key study factor examined was whether studies contained an assessment of
preparedness for practice in a general dental practice context. Studies that were KEYWORDS
not specific to dental graduates or that did not examine or consider preparedness Dental education, Dentistry, Dental
for practice were not included. graduates, Educational preparation,
Preparedness for practice, Work
Main Outcome Measure readiness
The main outcome measure of this review was to develop a greater under-
standing of the construct of preparedness for practice. The authors identified this
concept as being greater than just clinical competency, involving issues that
impact on how health professionals integrate into the workforce, including in
challenging and nonideal environments. The authors also sought to develop a
theory that explained the notion of preparedness for practice, incorporating the
various factors that contribute toward this. J Evid Base Dent Pract 2020: [101421]
1532-3382/$36.00
Main Results
ª 2020 Elsevier Inc.
Sixteen articles were included in the review, with 7 articles being identified
All rights reserved.
through reading of articles identified from the search. The quality of the selected doi: https://doi.org/10.1016/
articles was assessed using an established approach described by Dixon-Woods j.jebdp.2020.101421

March 2020 1
 The Journal of EVIDENCE-BASED DENTAL PRACTICE
et al.1 The conceptualization of preparedness for practice
was expressed in 11 themes, condensed into 6 by the
authors through synthesis: academic and technical
competence; communication and interpersonal skills;
protective mechanisms and adaptive skills; professional
attitude and ethical judgment; clinical entrepreneurship
and financial solvency skills; and social and community
orientation. The authors also identified 3 themes of factors
that influence this characteristic of preparedness: training-
related factors; gender and experience of the graduate
and/or student; and opportunity of internship along with the
nature of post-training work experience.
Conclusion
The authors concluded that their review draws insights into
how the concept of preparedness for practice is being
understood by students, graduates, and those involved with
dental education. They also stated that their review exposes
deficiencies in the primary research into preparedness that
should be addressed in future studies.
COMMENTARY AND ANALYSIS
There is increasing interest and recognition of the impor-
tance of the concept of preparedness for practice in the
context of dentistry and dental practice. This review rec-
ognizes that this concept is multifaceted and extends
beyond simple notions of technical skill and competency. It
includes components such as resilience, communication
skills, ideas of professionalism, and environmental consid-
erations. The authors preface their review by acknowledging
the hostile nature of some contemporary dental work envi-
ronments that new graduate dentists might face, refer-
encing countries such as India and Brazil where graduate
employment is not guaranteed and dentists may face
financial hardship.
The authors include 16 studies within their review and use
an established approach to assess the quality of these
works. The search terms that the authors employ are
specific to the context of dentists and dental students.
Other providers of dental services, such as dental hy-
gienists and dental therapists, were not explicitly included
in the search terms. The authors do not give any reason
for this exclusion, and this may have led to the review not
including literature that might have been relevant to the
research objectives.
One of the challenges when considering the concept of
preparedness is identifying whose perspective of pre-
paredness should be investigated. In their review, the au-
thors note that most of the research included perspectives
from students, graduates, and academics. The authors note
2 Volume 20, Number 1
that this is a possible limitation of the research but do not
suggest that the perspectives of the wider dental profes-
sion, or perhaps more importantly, the public, should be
sought concerning what the concept of preparedness
should entail. A focus on student and graduate perspectives
in researching preparedness has delivered research out-
comes that overwhelmingly focus on the needs of dental
graduates rather than on whether these graduates are able
to meet the needs of the public. This can be observed
through the stark contrast between the themes of profes-
sional attitude and ethical judgment and between clinical
entrepreneurship and financial solvency skills. The first of
these themes is concerned with the placement of patients’
interests first, whereas the second places the interests of
practitioners first. Although it could be argued that skills in
both these areas are equally important to graduate success,
especially in a challenging environment of practice such as
that which exists in India or Brazil (as described by the au-
thors), how these might equally contribute to providing safe,
effective, and patient-focused care is not so clear. Dentistry
exists in a commercialized marketplace, but this is no excuse
for dentists not to place professional obligations first.2 The
authors do not question how the themes within the review
might be interpreted and construed in the context of the
needs of the public. Future research that considers the
public’s perspective regarding what contributes to
preparedness for practice would add great value to this
subject area.
Much of the literature that was included in this review is
of a quantitative design. The authors note in their
conclusion that there are deficiencies in the design of
much of the primary research but offer no suggestions
regarding what future paths of inquiry might entail. There
would appear to have been little in the way of qualitative
enquiry in this area, but such research could contribute
further and greater insights to understanding the idea of
preparedness for practice. The authors give two objec-
tives for this review: first, they set out to deliver a greater
level of understanding on how preparedness for practice
was conceived within the (then) current literature base
and, second, through grounded theory, they aim to
develop their own theory of the factors that influence
preparedness. The authors synthesize new insights into
the phenomenon of preparedness and produce three
themes around the key influences on preparedness. They
locate these influences within the theory of situated
learning, which details how a learner moves from passive
observation into full participation in the sociocultural as-
pects of professional life. The authors discuss how failure
for students and graduates to be immersed in profes-
sional life in this way may lead to “reality shock.”

This review details the intricacies of preparedness for prac-
tice and also sets the scene for future engagement in this
subject arena to be conducted using more novel and
diverse approaches than through quantitative analysis using
surveys alone. More recent work has detailed how the
notion of “supercomplexity” needs to be considered within
dental curricula, developing an environment where personal
and professional development occurs alongside academic
and technical skill.3 It is undoubtedly important to ensure
that dental students graduate as clinicians who are well
versed in the social language and cultural aspects of
professional dental practice. The essential character of this
educational experience must involve and embody the
values of patients and the public. This aspect of
preparedness for practice is likely to be enhanced and
delivered through the involvement of the public as
partners in the provision of dental education.
The Journal of EVIDENCE-BASED DENTAL PRACTICE
REFERENCES
1. Dixon-Woods M, Cavers D, Agarwal S, et al. Conducting a critical
interpretive synthesis of the literature on access to health care by
vulnerable groups. BMC Med Res Methodol 2006;6:35.
2. Holden ACL. Consumer-driven and commercialised practice in
dentistry: an ethical and professional problem? J Med Healthc
Philos 2018;21(4):583-9.
3. Leadbeatter D, Peck C. Are dental students ready for super-
complex dental practice? Eur J Dent Educ 2018;22:e116-21.
REVIEWER
ALEXANDER C.L. HOLDEN, BDS, MDPH, LLM
Senior Lecturer in Dental Ethics, Law and Professionalism,
the University of Sydney School of Dentistry, Faculty of
Medicine and Health, Westmead, NSW, Australia;
alexander.holden@sydney.edu.au
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