Confidence vs Competence in Dentistry

by Bruce V. Freeman, DDS, DOrtho, MSc; Gary Glassman, DDS, FRCD(C)


Confidence and competence are two words that are neither synonymous nor interchangeable. Confidence must be earned, as when it is simply imagined it can lead to a false sense of security in one’s abilities, which results in, you guessed it, incompetence. Why do we as dentists struggle so much with our confidence and question our competence? Of course, there are outliers at both ends of the curve – we have those who are supremely talented yet lack confidence and then we have the special few whose confidence is completely unfounded. Let’s revisit the Dunning-Kruger Effect, which is a cognitive bias whereby people with limited knowledge or competence overestimate their own abilities in that domain. There is a great podcast entitled, “The Dunning-Kruger Hijack (and Other Criminally Stupid Acts),” which is a cringeworthy account of many examples of the phenomenon. When Dunning-Kruger collides with the Impostor Phenomenon (whereby we continue to doubt our abilities even when we have them), you start to have an idea why so many dentists struggle to know if they are doing their patients a service or a disservice.

Why Do We Struggle?

The author, Dr. Freeman, touched upon a possible cause in his blog entitled, “Facing Your Fears.” He cited an article by Kathryn Fox in which she writes about the challenges new graduates face, from competition to the looming threat of a patient complaint. These issues also affect seasoned clinicians who start to question themselves in the face of rapid advancements in technology, increasing patient demands and competition from a new generation of practitioners. Now add in Cognitive Dissonance, which is defined (thanks Wikipedia) as a “psychological stress” that occurs when people are faced with two inconsistent ideas that they do everything to try and make consistent. “I must be a good dentist; I have been practicing for 20 years,” says the veteran clinician faced with disbelief that their work is failing or their patients displeased. Once we understand how our minds work and the tricks they continue to play upon us, we can step back, look at the bigger picture and shine a light on our abilities (and the much tougher part, our inabilities). Albert Einstein, ever the pragmatist, once wrote: “It is a painful thing to look at your own trouble and know that you yourself and no one else has made it”.

How Do We Help Ourselves?

Education, education, education. We mean reading journals and taking courses, not scrolling Instagram! We must continue to nudge ourselves out of our comfort zones, recognize what we do well, and not so well, from clinical care to patient communication, to cultivating a practice culture, and seek out the training and mentorship to move forward. The fear, as Kathryn Fox wrote, of being caught out or seen as “less than” can result in an inertia, even freeze, where practitioners feel lost or cannot realize there is a light at the end of the proverbial tunnel. The author, Dr. Glassman, over the many years he has given his course on clinical endodontics, has seen first-hand that many people, once they know what “good” looks like, leave his courses, and never do another root canal! There are many, however, that see the effort necessary to learn and master their craft and embark on the journey to competence. That is what we all need to recognize: competence comes before confidence. Malcom Gladwell riffed upon the work of psychologist K Anders Ericcson, saying it takes 10, 000 hours to master a skill, a number, Ericsson laments, Gladwell arbitrarily assigned. That said, it is true that it is countless hours of deliberate and focused practice that results in mastering a skill. You can play tennis every day of the week but unless you dedicate time to specifically work on your serve, lob and net game, you will not be winning Wimbledon any time soon. We all need to have confidence in our ability to learn and grow but also in our ability to recognize we cannot be great at everything and which procedures to focus upon and which to refer to a colleague. Patients can sense your fear and apprehension and know when you are faking it or worse, when your confidence is not supported by competence.

Providing Patients With The Best Experience

Patients want their dentist to be personable and trustworthy. They want a dentist who will be empathetic, offer choices, have impeccable skills and can address their problems with long-lasting solutions. From courses to mentors to study clubs, there are so many ways to seek the help you need to do great work. One thing that is an absolute must in building confidence is to refrain from comparing yourself to others on social media; that is a dangerous trap that can wreak psychological havoc. Instead, surround yourself with positive and supportive people who can teach and mentor you. This is a sure way to get you on the path to competence and a well-earned confidence that will result in the best possible experiences for your patients.

About the Authors

Bruce Freeman is an honours graduate of the University Of Toronto. He completed the Advanced Education in General Dentistry program at the Eastman Dental Center in Rochester and returned to U of T to complete his Diploma in Orthodontics and his Master of Science degree in the field of temporomandibular disorders and orofacial pain. He is Co-Director of the Facial Pain Unit and Hospital Dental Residency Program at Mount Sinai Hospital.

Gary Glassman, graduated from the University of Toronto, Faculty of Dentistry in 1984 and was awarded the James B. Willmott Scholarship, the Mosby Scholarship and the George Hare Endodontic Scholarship for proficiency in Endodontics. A graduate of the Endodontology Program at Temple University in 1987, he received the Louis I. Grossman Study Club Award for academic and clinical proficiency in Endodontics. Dr. Glassman lectures globally on endodontics and is on staff at the University of Toronto, Faculty of Dentistry in the graduate department of endodontics. Gary is a fellow of the Royal College of Dentists of Canada, Fellow of the American College of Dentists, endodontic editor for Oral Health, endodontic editor for Inside Dentistry, Faculty Chair for DC Institute and Chief Dental Officer for dentalcorp Canada. He maintains a private practice, Endodontic Specialists in Toronto.

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