Blog Post: March 2021

CPD Junkie Blog

How high you go in unconscious incompetence and how low the realisation that follows is up to you. Check yourself, your patients will thank you."

Dr. David Keir

The Unconsciously Competent Dentist

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, first described by Noel Burch during the 1970’s. The concept is to move skills to the unconscious competence state, where even the most emotionally frustrating situation (losing a ‘bad beat’, analogous to treating an unreasonably difficult patient) would not affect the core skill. It is unconsciously working.

Unconscious Incompetence 

“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 18 months 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.

How high you go in unconscious incompetence and how low the realisation that follows is up to you. Check yourself, your patients will thank you.

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