Table 6.

Emergent themes from coded data analysis, aligned with stages of the CCM

Theme	CCM Stage	Code	Description	Quote
Theme 1: The importance of effective learning experiences in dental school training	Unconscious Incompetence	3	Admission to dentistry is due to a lack of other options.	“I got admitted to dentistry because I couldn’t secure admission elsewhere.” (FY7)
	Unconscious Incompetence	14	Inadequate supervision during dental training.	“Our clinical supervision is often by peers or house officers. Senior faculty interaction is minimal.“(DH8)
	Conscious Incompetence	26	Lack of practical experience in crown preparations and orthodontics	“We are good at the theoretical aspects of orthodontics, but practical applications are missing.”(FY9)
	Conscious Incompetence	25	Proficient in operative dentistry, endodontics, and oral surgery; lacking in molar endodontics.	“I’m confident in operative dentistry but lack experience in molar endodontics.“(FY2)
Theme 2: Intentional Practice and Professional Development	Conscious Competence	18	The continuous need for knowledge and updates.	“Dentistry is ever-changing, and new materials are constantly coming into the market…“(DH8)
	Conscious Incompetence	4	Future plans and postgraduate aspirations.	“I’m planning to pursue further specialisation to improve my skills.“(FY6)
	Conscious Incompetence	4	Future plans and postgraduate aspirations.	“I have postgraduate plans to pursue FCPS in periodontics”(DH1)
	Conscious Competence	5	Voluntary private practice internship.	“I’ve done internships in private clinics, which makes me feel somewhat prepared.“(FY6)
	Conscious Competence	2	Confidence gained from work experience	“I did an extra internship in operative dentistry for about six months, so I had a lot of exposure and experience of operative procedures, and I am very confident.“(FY5)
Theme 3: Care and management of patients	Conscious Incompetence	15	Pediatric treatment limitations	“We haven’t had enough exposure to pediatric patients, so I don’t feel confident treating them.“(FY1)
	Conscious Incompetence	17	Confusion and lack of confidence with elderly patients	“I get confused, and I am less confident in treating the elderly and immunocompromised.” (FY8)
	Conscious competence	40	Confidence in treating children and elderly	“I am very good at handling children and the elderly, as I have been living in a joint family system and have been used to communicating with the elderly and children.” (DH3)
	Unconscious Incompetence	17	Poor communication skills	“We judge the patient based on their socio-economic background and try to explain the dental treatment at par with their level of understanding and in layman’s terms.” (DH8)
	Unconscious Incompetence	17	Poor communication	“We should not give a lot of options to patients, as they get confused.” (DH1)
	Conscious Incompetence	8	Medical history and drug interaction knowledge	“I can write for normal patients, but those with comorbidities, or immunocompromised or if the patient is taking medications for heart disease. Then I would need supervision and advice accordingly. (DH7)
	Conscious Incompetence	12	Dependence on the supervisor for reading prescriptions with unknown drug brands.	“I often need help from seniors to understand unfamiliar drug brands.” (FY9)
	Unconscious Incompetence	13	Prescription writing confidence	“I am 100% confident in writing prescriptions.”(DH1)
	Conscious Incompetence	27	Inability to take X-rays independently.	“In dental school, the X-ray technician usually takes radiographs; I haven’t done it myself.“(DH4)
		28	X-ray knowledge & skills	“I do not know about radiation protection and how to use collimation to reduce radiation. We were taught these concepts theoretically, but in clinics, they are not shown or taught. (FY5)
	Conscious Incompetence	27	Inability to take X-rays independently	“We were taught radiography theoretically but had little hands-on experience.” (DH10)
Theme 4: Medical Knowledge and Emergency Preparedness	Conscious Incompetence	8	Medical history and drug interaction knowledge	“I am good at taking medical and dental history taking, and I am 100% confident in conducting a medical and dental history…… I can take drug history for common diseases such as blood pressure and diabetes drugs, and their drug interactions can be comprehended, but for rare diseases, I am unaware of them. For instance, recently, a patient came with a prostate problem, and he was taking medications which I was unaware of, and I had no idea about its interactions with dental interventions. (FY6)
	Conscious Incompetence	7	Medical emergency preparedness	“I’m not confident dealing with cardiac arrest as we haven’t had BLS training.“(FY10)
Theme 5: Financial, business and statutory requirements of clinic management	Unconscious Incompetence	31	Lack of financial planning education.	“Financial planning isn’t part of our curriculum; we weren’t taught about managing a clinic’s finances.“(DH2)
		31	Lack of financial planning education.	“I do not know how to negotiate with patients in terms of financial agreement. I am lacking in financial solving skills.” (DH5)
	Conscious Incompetence	31	Lack of financial planning education	“Nowadays, dental clinics have become studios, and we must sell unique products to attract patients. Dental schools do not teach this aspect.” (DH2)
		31	Lack of financial planning education	“Even if financial management is not part of our curriculum. All our clinical teachers have their own private clinics. These teachers could have shared their experiences about financial planning of private clinics.” (DH9)
		26		“We have not been taught Sindh healthcare regulations or vaccination requirements.”(FY7)
	Unconscious Incompetence	30	Unaware of healthcare regulations, vaccination requirements	“We haven’t been taught about state regulatory requirements or necessary vaccinations.“(DH8)
Theme 6: Ethical and Reflective Practice	Conscious Competence	34	Reflective skills, handling mistakes and mishaps	“If a file breaks during endodontic treatment, I believe we should inform the patient…” (DH2)
		33	The belief that general dentists can place implants, not practice orthodontics	“As far as practising orthodontics by general dentists is concerned, I believe that every orthodontist follows their own theory and rules.” (DH5)
		26	Lack of practical experience in crown preparations and orthodontics	“So, there are diversity and different schools of thought in terms of orthodontics. Practical skills in orthodontics are lacking.” (DH6)
	Conscious Competence	41	Importance of positive/growth mindset.	“Some students have positive mindsets and do not rely on the dental school for all their dental skills. Personal choices matter. Students need to think about their bread-and-butter skills and actively acquire them during their undergraduate and internship years rather than waiting for dental schools to feed them on a plate. A single institute cannot teach all the necessary skills.”(DH6)