Key Questions (+Answers)

A residency is a formal and recognized apprenticeship-type program which provides the new graduate dentist the opportunity to work with others in a learning environment while honing clinical skills and acquiring new clinical, professional and interpersonal skills. The programs are generally one year in length, however, many programs offer the resident an opportunity to stay on for a second year. A program provides a supervised learning and training environment for the resident while giving him/her an opportunity to work more independently than in the dental school environment. One can learn more in-depth complex dentistry in an AEGD (Advanced Education General Dentistry) or gain more experience in hospital, geriatrics or special needs through a GPR (General Practice Residency) program. The programs are varied and the experience gained depends on the specific program that the resident chooses.

A residency program also allows newly graduated dentists to work among his/her peers in a collegial environment which is conducive to sharing ideas, comparing treatment philosophies and encouraging lifelong learning as well as multidisciplinary approaches to patient care.

One of the biggest advantages is to be able to continue to hone clinical and soft skills (such as communication, interpersonal skills) in a learning environment without the obligation of overhead costs and with the shared responsibility of liability with your attending/mentor dentist. It’s a great opportunity to become skilled in different dental procedures, learn how to manage medically-compromised patients, interact with medical, nursing, pharmacy colleagues and/or network for the future. Additionally, this is an opportunity to build and strengthen your treatment planning skills in a group setting where you can learn from your peers and their cases.

What you get out of a residency will depend largely on the program that you decide on and the amount of effort and initiative you show. If you hope to live in a certain area or apply to a specialty program, it may be advantageous to choose a program in a city where a program is offered or where there is greater emphasis on the area of dentistry where your interests lie.

Overall, many educators and practice owners feel that a year’s worth of residency is like having 5 years of experience in private practice.

A GPR is a program that is typically in a hospital-based setting. There is greater exposure to medically-compromised patients. There may be more opportunity to rotate through specialties such as, but not limited to anesthesia with medical residents and oral and maxillofacial surgery. A dentist that can treat medically-compromised or special needs patient has to be a competent dentist and manage these situations with confidence.

An AEGD program is most often housed in a university clinic since the intent is to provide residents with the opportunity to perform more advanced and complex clinical procedures. These may include more complex periodontal surgery, endodontic surgery, etc. This program gives those dentists who are more inclined to working in private practice or graduate school an edge.

It is best to contact each of the programs that you are interested in to see if it falls under the GPR, AEGD model or if it is a blend of both. Of the 15 programs in Canada, fewer lean towards the

AEGD model and focus more on special needs, cancer etc.
The reality is that although different residency programs may focus on different elements of dentistry, no knowledge is ever wasted because the learning will translate into the practise of dentistry at some point in time. For example, a residency that has a heavy emphasis on oral surgery could make you more comfortable and adept at extractions, minor surgery and trauma in private practice.

Generally speaking, all residents are paid during the residency year. However, there is a large variation across Canada in terms of the salaries. In Western Canada, the salary can be as high as $50K, whereas in Quebec the salaries are much lower (in the $15K range). Other programs in other provinces pay residents approximately $30K. At McGill, residents also pay tuition at McGill University. So you need to explore the various programs to get an accurate idea of compensation.

When assessing a residency program, it is important to find out whether the particular programs actually deliver on what they say in their marketing claims. The best way to do this is to visit the program before applying to it (when possible) and to speak to past and current residents of the program. Most of the residency interviews in Canada take place in early November (in the US, usually early January) and can be an ideal time to speak to current residents and attending dentists in the clinic. However, on top of the general  “open house” events held by various programs, it is advisable to enquire directly with the specific program(s) you are interested in to see if they will be hosting such an event.

Continuing education (CE) is governed by each province’s regulatory authority (college). Most provinces do have CE cycles. In Quebec, the cycle begins after the residency year finishes. In Ontario, the Royal College of Dental Surgeons of Ontario (RCDSO) provides an educational certificate. The residency rounds and education may be counted as Category 3 credits. However, it is best to verify this with your specific regulatory authority.
Some organizations like the Academy of General Dentistry (AGD) will count the residency year towards obtaining a fellowship, especially if you are a member at the time of your residency.

For Canadian programs, the Canadian Dental Association (CDA) website has links to programs offered in each province. Additionally, the Commission of Dental Accreditation of Canada (CDAC) also has an online search engine for accredited training programs.

For the US residency programs, the American Dental Education Association’s (ADEA) ADEA PASS program will have the essential information required for applying to a residency program. There is also an online search engine for accredited US programs provided by the Commission on Dental Accreditation (CODA).

Most postdoctoral programs utilize either or both of the Postdoctoral Application Support Service (PASS) and Postdoctoral Dental Matching Program (MATCH). These two services help to facilitate the application process and match applicants to a program. Applicants must register for each service separately through the PASS portal. The applicant should verify with the program(s) he/she is interested in to find out whether it participates in PASS/MATCH.

As a starting point, all candidates will be vetted through their academic records as programs want a candidate with a strong clinical and medical background. However, after this initial assessment, equally important qualities include the candidate’s initiative, drive, and interest in the program.
When possible, do your own research about programs that interest you and contact the program to find additional information. It is advisable to visit the program and shadow the clinic for a day. Program directors want someone who is interested and open to learning especially since they must spend a full year with the resident(s). They must be confident that the resident(s) will be responsible, capable, a good team player and care appropriately for the patient population.

If there is a reciprocity agreement with certain countries like Australia, New Zealand or Ireland, there is no issue. However, it is uncommon in other situations because it is hard to know details about the training credentials of a foreign-trained dentist. It is best to contact the program directly to see what its stipulations are and to find out about any licensing issues that there may be. Additionally, it will be the responsibility of the applicant to inquire about any language requirements of the program.

The location or country you choose to go to during your residency year is up to you. The most important factor is that you pick a program that offers what you are looking for and as much experience as you can get.

Working as a private practitioner outside of the residency is generally not encouraged and may also be difficult. Residents usually have on-call emergency duties and rotations. The residency year is busy and can be very tiring. Additionally, depending on the type of dental license you hold, you may or may not be able to practice outside of the residency program. As an example, Canadian dentists training in a US-based residency may not be able to practice outside of the program without a valid US dental license.

While it is not expected, it can be an advantage to have a residency year completed before you apply to a specialty program. The residency year allows dentists to understand more broadly the care that is involved in treating patients. Also, residents get a lot of face-to-face experience in treatment planning, and discussing treatment with patients which can be more challenging than in dental school.

At the end of your residency year, you are more well-rounded and more confident as a clinician having had the chance to see and do things that you would not be able to do in dental school or private practice.

Upon graduation, most of your classmates are on a level playing field. Currently, it is quite difficult to find full-time employment after graduation especially given the only dental experience you’ve had comes from dental school. In the large urban centres, newly graduated dentists will likely hold 2 or more associateship positions to equate to full-time hours and many of these hours will include evenings and weekends.

This will also hold true for anyone who has recently graduated from a residency program. However, the extra year of training is generally looked upon as being favourable and may give someone an advantage when looking for an associateship position.

The process begins as early as the summer after 3rd year. Applications are submitted to the programs via PASS and MATCH. In most Canadian schools, the applications are submitted directly to the Dean’s office or the program director’s office. For other programs, especially the American residency programs, the applications are sent to a central “warehouse” through PASS. Using MATCH, an entity that develops and administers “matching” programs, there is a centralized mechanism for processing placements using a common set of rules. It helps ensure optimal results for the programs as well as the applicants. Further, it reduces the chance of applicants being “scooped up” by programs prematurely. It is important to understand that the interviews and evaluations are independent of MATCH. All MATCH does is allow programs and applicants to rank their choices in order. Then, it uses an algorithm to “match” the applicant with the program. The decision made by the system is binding for both the applicant and program.

Once the applicant has been matched to the program, a welcome package containing information about the program, supporting documentation, a letter of offer and registration information will be sent to the candidate. Additionally, it will be the responsibility of the applicant to discuss visa requirements with the program administration and arrange them prior to starting the program.

Both AEGD and GPR programs are offered in the U.S. The AEGD programs are geared towards day-to-day practice with fewer rotations and less hospital-based dentistry. The GPR programs are most often based in a hospital setting and treat medically-compromised patients. It is important to consider your long-terms goals before deciding which program is best for you. Either way, the experience you will gain from the program (whether you use all or few of the skills later) will not be lost or wasted.

The board exams that may be required will depend on the program(s) you are applying for. This information is generally found on the MATCH website. Some residency programs will require applicants to have taken the National Board Dental Examination (NBDE) exams. This exam is different from regional board exams such as the Florida State, California State or North East Regional board exams, etc.

Many people choose to do a GPR as a means to become familiar with the US and then, perhaps, stay in the US. The rules differ state by state. For example, you may not be able to practise in certain states if you aren’t a resident of that particular state. However, doing a residency in a state where you wish to practise later on may be helpful, as you often have a chance to write the state board exams using patients from your clinic. You can also get helpful tips and information from your fellow residents and attending staff.

For Canadians planning to go to the US for their residencies, a work visa is required. The candidate is solely responsible for obtaining the visa. However, many programs will provide the supporting documentation, acceptance letter and/or contract to enable the process.

Usually, the candidate can obtain a nonimmigrant NAFTA Professional (TN) visa or other special visa (check Customs and Immigration). The TN visa can be obtained at a U.S. border crossing. It is advised that the visa be obtained in advance of actually crossing the border in order to circumvent any issues that will prevent you from arriving at your program on time. Additionally, it is best to call ahead and find out the hours that the TN visa office/officer(s) will be available before driving to the border.

This is a difficult question to answer. But YES! For anyone that has completed a residency program, it is a resounding yes. For anyone who has not chosen the residency path, the question can’t be answered with any certainty.

A residency year allows new dentists to build confidence, gain comfort level with patient management and clinical skills in a safe environment. Some programs offer a second year. Anecdotally, some past residents feel it may not be worth doing the second year unless you are finishing complex treatment plans etc., there are others who feel that there is a distinct advantage in doing an additional year. Starting the new cycle as a second year, you are already familiar with the expectations and procedures of the program which allows you to be more productive with this head start. Every year in practice is valuable experience.

There are no official rankings of GPR programs. Word-of-mouth is primarily how programs develop a reputation. It is best to speak to past residents to gain insights about their experiences.

Yes, different programs may focus on different aspects of dentistry or patient demographics. It is best to do a little fact-finding to find the program that will best suit your needs.

No, there is no formal process for recognition of a residency program. However, the experience will be recognized. In some instances, the reputation of the program will precede it and those in the know may realize that residents from ‘Program X’ are exceptionally proficient at extractions etc.

A residency is the ideal transition from graduating dental school. You’re allowed to further enhance your clinical skills in the right place, under the right supervision and with the right teaching staff.

It is unfair to expect one year of residency to be equivalent to intense continuing education (CE) in a specific area such as placing implants, because it is one year and it is focused on general dentistry rather than a specific discipline or set of procedures.

A better cost-benefit analysis would consider comparing the amount of money and experience made in the first year of private practice immediately after graduation with the amount of money and experience gained in a one-year residency program. Most would agree that there may be a difference in earnings, but in the long run, the opportunity cost is negligible when you consider the amount of clinical experience that is gained along with speed.

This will differ for each person. Each individual has a different end-game: private practice, public service, lifelong associate, specialist, etc. However in general, you want an environment that is open to different styles of learning, supervision that gives you some freedom to think and plan your own cases, an interesting patient pool as well as engaged and diverse teaching staff which includes various specialists. Additionally, don’t forget that each residency program will provide a different degree of oversight or supervision, so try to choose wisely to allow yourself to learn and grow in an environment where you feel comfortable.

The focus of the program is whatever the university/hospital/program director’s vision or mandate is. This will vary from program to program. As such, it is the candidate’s responsibility to do some research and find out how the program’s offerings will meet his/her needs.

The number of residents in a program vary also. Usually, there are smaller numbers of residents in Canadian programs (4-6) and some American programs may have larger numbers of residents.

The programs try not to favour one resident over another by assigning patients randomly. But it may seem like your colleague gets all the “cool” cases or treatments. It may be acceptable to share or transfer patients (if they are willing) to another colleague so he/she can also get some experience doing wisdom teeth extractions or certain surgeries, etc., but this will depend on the program. Unfortunately, the reality is also that the patient’s finances and insurance coverage may also determine the extent and type of treatment that he/she is willing to undergo.

Yes, in some programs the attendings are also seeing their own patients so they may not be readily available; however, in other programs, the attendings may be 100% dedicated to overseeing residents without any obligations to see patients. Most programs will also have OMFS back-ups for emergencies.

The patients seen in resident clinics may or may not have the ideal financial coverage. Generally, these patients are attracted to the lower fee structure, but some may still opt to have more comprehensive or complex treatment.

In any residency program, the emphasis is on doing clinical work. However, patient consultations are required and help to build communication skills and instill confidence for challenging patient management situations that will undoubtedly arise in the future.

If the program is set up to have several rotations throughout the year, this may hurt a resident’s ability to form a “bond” with patients. Usually in this sort of program, the patients are shared so there is no continuity of care in a true sense. However, in other programs where there are fewer rotations, residents may have patients which they will see for the entire course of treatment. With respect to patients coming into the GPR program, this is usually “luck of the draw” and patients are “assigned” to a resident based on availability.

Because residency programs are accredited and have a set structure, it is difficult for the program to be molded to the needs of the resident. In addition, the goal of the program is to ensure that each resident has the same experience(s) or opportunity(s) as preceding or succeeding ones. This is why it is so important for dental students to do their own research and figure out what they want from a program. Hospital-based programs have a financial responsibility to cover their costs from the revenues that are generated from clinical services.

However, if a resident shows more interest in a particular area such as pediatrics, oral surgery etc., the program may allow the resident to do extra work or have an extra rotation in one of these areas. However, this is entirely at the discretion of the program.

This is dependent upon the type of program. The advantage of moving between different clinical rotations or locations is that you interact with different clinicians and patient populations. The rotations help to round out your clinical skills and expose you to new skills. For example, you may have the opportunity to start IV lines and learn to intubate patients on an anesthesia rotation. The different rotations also help to give dentists confidence when interacting with their medical counterparts and help physicians gain an understanding of what dentists’ responsibilities entail in treating patients. We’re not just “fixing teeth.”

In most residency programs, there is a obligation to take call after hours for dental emergencies. Depending upon the program and its location, the nature of the call may range from minor dental issues (broken tooth) to major trauma (facial or jaw fractures). The call schedule is usually made by the chief resident of the program. There may be opportunities to switch call duty with resident colleagues. Typically, weekend call is from Friday evening to Monday morning, but some programs may split the weekend into individual call days. Your on-call responsibilities and the frequency of call will vary from program to program. Additionally, the number of call days you take will be lower if there is a larger pool of residents in the program.

Dental residents usually are 1st call and therefore, the first person called to triage and assess the patient. In situations where the patient has a complicated medical history, severe trauma etc., the resident may call the back-up (2nd call) or even the attending for assistance. Typically, most patients with minor issues may be referred back to the dental department for care the next day for treatment. If the resident on 1st call is occupied with an emergency and another emergency presents, the 2nd call may be asked to step in and assist.

Residents are usually very well-supported by their programs and the emergency room staff. The call in some programs may be very intense in terms of fielding emergencies, and if there are fewer residents, the call duty may also be more frequent. In most instances, the patients treated while on call are extremely appreciative of the care they receive.

This will depend upon each individual residency program. The best answers will come from past or current residents of the program.

Residents usually work an 8-hour day unless they are on-call or have other study club or academic obligations after hours.

Some programs will incorporate didactic lectures into their resident’s learning experience. This may include journal clubs, lectures or seminars on specific and relevant topics in dentistry. The residents may be asked to participate in grand rounds or early morning rounds especially if they are based in a hospital. In addition, some programs may offer special certifications for residents such as nitrous oxide administration.

This will, again, depend on the location and focus of the program. Most often, hospital-based residents will have rotations in areas such as anesthesia, ENT, oral and maxillofacial surgery, trauma/rehab and pediatric dentistry. On most of these rotations, the resident will only observe, but often, in anesthesia may be given opportunities to start IV lines or intubate patients.

The culture of the clinic and program will vary depending on the leadership and the personalities of the staff, attendings and residents. The best way to learn about the environment is to spend time in the clinic for a day as an observer and to speak to staff and residents. Given that attending staff are usually sacrificing their own billing days to work with residents, they are usually engaged and willing to impart knowledge to residents who are willing to learn.