A Mixed-Methods, Longitudinal Study Into Dental Graduates’ Transition To Practice; Their Experiences And The Changes In Their Relationship With Evidence-Based Practice

  • Waraf Al-Yaseen

Student thesis: Doctoral ThesisDoctor of Philosophy


Introduction: The transition from undergraduate studies to professional practice is just one of the many transitions that dentists undergo during their professional life. It is a vital process for new graduates, during which they adapt to a new workplace environment and strive to fulfil expectations around their new role. This important period has been extensively researched in other medical disciplines. However, there is a scarcity of evidence in relation to the dental graduate transition journey.

Evidence-based Practice (EBP) is regarded as the gold standard in quality care delivery. It also an important competency required of General Dental Practitioners (GDPs) by the Professional Regulating Body. However, there is evidence suggesting that GDPs are sometimes reluctant to incorporate evidence in their practice, especially if it involves new knowledge and a change in practice. In recent years there has been an emphasis on EBP training within the undergraduate curriculum with associated learning outcomes to achieve. Hence, it can be assumed that new dental graduates receive sufficient training on EBP and, on graduation, have reached a level of competence. Little is known about whether dental graduates go on practice this, or whether their relationship with EBP changes in response to being exposed to professional practice and placed in a business environment..


•Systematically review of the literature to identify and synthesise the existing evidence to develop an understanding of the transition journey of dental graduates to professional practitioners;
•Questionnaire assessment of the dental graduates’ changing relationship with EBP to explore dental graduates’ knowledge and relationship with EBP, as they transition through their VDT as VDPs; and
•Exploring participants’ perceptions and experiences through qualitative data collection methods: To explore changes in dental graduates’ opinions on their transition experiences and their behaviour towards EBP, through their VDT period.

Methods: To develop a better understanding of dental graduates transition journey to professional practice and their relationship with EBP, a mixed-methods longitudinal approach was employed:

•A literature review and evidence synthesis:
•scoping review of literature to give a preliminary assessment of the volume and scope of available literature; and
•systematic review of the literature and data synthesis, informed by a scoping review, to investigate dental graduates' experiences of transition during their first year of practice using qualitative and quantitative data.
•A combination of two pre-validated questionnaires to explore five domains related to EBP (self-perceived self-efficacy, attitude, confidence, accessing evidence and actual knowledge of EBP concepts and guidelines); and
•Semi-structured interviews and Longitudinal Audio Diaries (LADs) to explore dental graduates’ experiences and perceptions of their transition to Vocational Dental Practice, and also changes in their behaviour in relation to EBP.

Results: Twenty-two studies were included for the systematic review and data synthesis process. The transition process of dental graduates has not been fully explored in the literature and “preparedness for practice” concept was repeatly associated with the transition process only eight of the studies used “. This was the closest outcome measure to transition. Vocational Dental Training (VDT) had a positive impact on the transition, as dental graduates developed new relationships and confidence in their skills sets.

Thirty-four dental graduates volunteered to participate in the Round 1 questionnaire and 21 in Round 2. Dental graduates had a modest level of knowledge of EBP principles, albeit they reported a fairly positive attitude towards EBP role in improving quality of care. During their first six to nine months in practice, there was a general decrease in the scores of the examined domains indicating a decrease in engagement of EBP use over time .

Both the interviews and LADs suggested that although dental graduates initially had some concerns regarding their transition, they were excited about practicing professionally and enjoying the advantages of professional life. However, this excitement declined over time, as the graduates became more aware of what practicing professionally involved. They also described mixed perceptions and attitudes towards EBP upon graduation. Most of the participants did not actively incorporate evidence into their practice, and none had searched for evidence to support any clinical decision making or appraised it using recognised EBP steps. Many reasons were explicitly or implicitly highlighted. It seems that dental graduates’ attitudes, along with the financial/time constraints imposed by the new setting, influenced their behaviour towards integration of EBP into practice. Participants’ attitudes may stem from their assumptions that EBP is an expensive, time consuming approach. Hence, they can only provide it through private treatment routes.

Conclusion: Transition to practice is one of numerous transitions that dental graduates will go through during their professional life. It is a vital process of their career, allowing for a period of skill development in a safe environment, provided by VDT. However, dental graduates were not enthusiastic to keep their practice evidence-based, in which was manifested in their actual practice when they stated their VDT. This raise concerns over several aspects; including: the lack of the necessary knowledge and attitude to adopt EBP in routine practice, the influence of the attitude towards EBP of the dental graduates and their educational/supervisory figures, and also whether merits attained at the undergraduate level represent a true reflection of a student’s true abilities in relation to EBP. These elements may have a direct or indirect impact on the dental graduates’ relationship with EBP. Hence, further research is should look into how to reduce the negative impact of those factors.
Date of Award2020
Original languageEnglish
SupervisorNicola Innes (Supervisor), Sucharita Nanjappa (Supervisor) & Divya Jindal-Snape (Supervisor)


  • Evidence-Based Dentistry
  • Transition
  • Dental new graduates
  • Mixed methods
  • Audio diaries
  • Dental education

Cite this