CEREC: A Powerful Tool For Deliberate Practice
In a previous articleThe Deliberate Practice of Healthcare, we discussed how deliberate practice was one of the key ingredients in developing skills. Deliberate practice as described in the book “Talent is Overrated” by Geoff Colvin is: “an activity designed specifically to improve performance, often with a teacher’s help; it can be repeated a lot; feedback on results is continuously available; it is highly demanding mentally; and it isn’t much fun.” Perhaps the most challenging aspect of this definition as it relates to dentistry is obtaining continuous feedback, followed closely by “with a teachers help.” Cerec technology is a highly valuable tool to assist the dedicated dentist who wants to move from indifferent to a student and beyond.
Decide to Improve
The first step to growth and improvement is to decide that you want to get better followed closely by an analysis of your current skill. The former is a highly private deliberation the latter usually requires an independent assessment. Ask yourself why improving your ability is a worthy pursuit? It is possible that it will not be worth the time and effort to get better? I am sure you could become a faster typist with deliberate practice, but it may not be worth the effort. Remember Colvin’s definition of deliberate practice is that it is highly demanding mentally and isn’t much fun. If the reason you want to get better is not clearly defined and articulated, it is unlikely that you will be able to persevere through the challenge. If you do decide to pursue improvement you need someone without emotion to tell you where your skill is lacking. This level of personal vulnerability and critique is not much fun. Find someone who is considered an expert at the various aspects of CEREC; it might be different people for different skills. The best mentor for prep design may not be the best mentor for crown design. Ask around and find the right person to assess your ability. Once you have decided to improve your skillset and determined where you stand in your current expertise it is time to develop a system for deliberate practice. Bellow is a sample system.
Create a System
The best system will operate independently of you. You are busy, and the last thing you need on your plate is the implementation of another system. After the system is created, you should be able to delegate the work of application of the system to one of your employees. The key component of the system is that it should be able to provide you continuous feedback with a teacher’s help. If you practice alone, this means you need a system to disperse your information to your teacher quickly and efficiently. In today’s electronic environment this is easy even if it is a little clunky. I recommend purchasing a tablet with a decent camera. On the tablet, you will need two apps, one designed to create a collage of photographs (I use MOLDIV) and one intended to create a word document (PAGES). Use the word document to communicate any characteristics that are important for your coach to know and for you to be able to identify the patient in the future if you want to go back and dig deeper. It is important not to include any personal or identifiable information in the collage that will be created so as not to violate any HIPPA laws. The word document should contain the tooth number, the name of the assistant, and perhaps an internal identification marker like a patient number. A comment area should be included to help your mentor understand some of the unique and challenging factors associated with the case. The collage system should have enough spots to capture:
1. A diagnostic x-ray pre-preparation
2. A try-in x-ray of the restoration
3. A final seat X-ray
4. An image of your prep (taken from the CEREC acquisition software)
5. An image of your restoration from the occlusal
6. An image of restoration from the intaglio surface
7. A screenshot or two of your word document. (See Sample Below).
Once the physical components of the system are in place train someone in the office to create the collage (after training putting the picture together takes about five minutes.) After they have learned how to put the collage together, you have to decide how you will transport information to your mentor. I use a service called Gloo out of Boulder Colorado, which is great if you are going to include social accountability into the system. Social accountability is a term I use to describe the fact that all of my associates and myself can and do see each others work. If this will just between you and your mentor text messaging the collage will probably be sufficient. Next, hold your assistant accountable to upload every restoration with which you use your CEREC. If your team understands the purpose of the work (you are committed to improving and becoming an excellent dentist), they will do the job happily and even take pride in your commitment to excellence.
Enlist or Hire a Coach
Finding the right coach/mentor is potentially the hardest aspect of getting started. Ask yourself a question: who can help me get better? Ideally, the person would:
1. Be further along in their CEREC training than you
2. Have enough time/capacity to give you timely feedback
3. Be willing to be completely honest in their feedback
4. Care about your growth and development
5. Care about you
Finding someone that meets the five criteria may seem like an impossible ask. I suggest you be willing to pay for this service. Would you expect a personal trainer or nutrition coach, a music instructor or landscape architect ever to provide you with a service for free? You are asking for a commitment to your development as a dentist and education requires tuition. If you are interested in hiring a coach or becoming a coach feel free to reach out to me and I will try to match up parties on either side.
Now you have everything in place, and it is time to begin deliberate practice. You have to fight slipping into autopilot. Take the time to get better. Don’t be embarrassed by the challenges that you will face. Embrace those challenges and conquer them. The benefit to your growth and development and the quality of the restorations that will improve the oral health of your patients is worth the effort. In his book, “Talent is Overrated” Colvin retells the story of Benjamin Franklin who had a strong desire to become a better writer. He would find a piece of exceptional writing and break apart the meaning of each aspect of the work. Franklin would then put it away for a period long enough to forget the specifics of what the master had written. After a sufficient time, he would take out the outline and rewrite the piece in his style. Finally, he would judge his work against the master. It was a laborious effort, but in the end, it paid dividends. As you approach your work know that a masterpiece lives within the tooth. You need to work to bring that masterpiece out. It is not easy. But as John F. Kennedy said: “We do not do these things because they are easy, we do them because they are hard.”