Readiness for Practice in Dentistry: From Competence to Trust

Health professions education makes a public promise: that its graduates are prepared to care for patients safely, ethically, and with appropriate independence. In dentistry, this promise is not fulfilled simply by completing required procedures, passing examinations, or demonstrating competence in isolated tasks. Readiness depends on whether a new graduate can integrate judgment, technical skill, communication, ethical responsibility, self‐awareness, and adaptability when caring for patients. This editorial argues that readiness should be understood not only as the achievement of competencies but also as a decision about whether graduates are prepared to assume responsibility for the core professional activities of dental practice.

Patients do not experience care as a checklist of competencies; they experience it through relationships, decisions, explanations, procedures, costs, fears, prior experiences, uncertainty, and outcomes. They need dentists who can diagnose and treat disease, while also understanding the person receiving care. A ready graduate listens closely to identify concerns, explains options clearly to support informed decisions, recognizes when clinical problems are complicated by social or other circumstances, and seeks help when patients need it. The relational dimension of readiness is therefore not secondary to clinical competence; it is central to patient safety, ethical care, trust, and equity.

This understanding of care has long been central to the health professions. The saying commonly attributed to Hippocrates, “It is more important to know what sort of person has a disease than to know what sort of disease a person has,” and Peabody's later reminder that “the secret of the care of the patient is in caring for the patient” [1] both emphasize that technical skill without attention to the person is insufficient.

The urgency of reexamining readiness is heightened by the changing landscape of dentistry [2]. Oral health disparities persist despite overall improvements in disease rates. Practice models are shifting toward large group practices, dental service organizations, community‐based care, and closer integration with broader health systems. Digital technologies are expanding what is possible while increasing the need for sound professional judgment, data stewardship, and accountability for decisions influenced by technology. Patient populations are also becoming more diverse and medically complex. These changes require graduates who can do more than perform procedures; they must reason, communicate, collaborate, adapt, and act ethically across varied and uncertain clinical contexts.

Readiness, then, is more than an educational outcome. It is the profession's assurance that graduates have demonstrated the competencies necessary to assume responsibility for patient care. This editorial examines how readiness for practice in dentistry has been conceptualized, how competency‐based dental education has advanced this work, and how trust‐based approaches to assessment may strengthen the evidence used to determine whether graduates are prepared for safe, independent practice.

1. Defining Readiness for Practice

Readiness for practice refers to being prepared and capable of engaging in the professional activities of a specific field [3]. In the health professions education literature, readiness has been described as including four interrelated dimensions: competence, self‐confidence, capability, and adaptability [4]. Competence refers to the knowledge, skills, and professional behaviors required for practice. Self‐confidence reflects the learner's belief that they can perform effectively. Capability extends beyond competence; it includes recognizing one's limits, seeking help appropriately, and functioning in clinical environments. Adaptability refers to the ability to respond to new situations, solve problems, and continue learning.

This broader view of readiness has important implications for how dental educators interpret learner performance. A graduate may be competent in familiar conditions but not yet capable of navigating uncertainty independently. Another may feel confident but lack the humility to recognize limits. Conversely, a learner who asks for help appropriately, reflects on mistakes, and adapts to complexity may be demonstrating behaviors essential for patient safety. Students’ perceptions of readiness matter, but self‐perception alone cannot establish readiness; it must be supported by evidence of performance over time, across contexts, and in relation to integrated patient care.

Several studies in dental education have examined what readiness entails. In a systematic review, Mohan and Ravindran [5] synthesized the literature on preparedness for practice among dental graduates and developed a framework organized around six domains: academic and technical competence, communication and interpersonal skills, adaptive and protective capacities, professional and ethical judgment, practice management and financial awareness, and social and community orientation. Together, these domains make clear that readiness for dental practice is multidimensional and extends beyond technical expertise.

Professionalism is essential to readiness for practice because it underlies the decision to trust a provider with responsibility for patient care. It reflects the profession's obligation to place patients’ interests first and to act with integrity, accountability, humility, and respect for human dignity [6]. Yet professionalism is not merely a set of required behaviors. As Epstein and Hundert argued, professional competence requires the habitual and judicious integration of knowledge, technical skill, clinical reasoning, communication, values, emotion, and reflection in daily practice [6]. It is developmental, context‐dependent, and visible in how clinicians exercise judgment, relate to patients and colleagues, recognize limits, and act responsibly.

Readiness also requires understanding practice systems and social realities. Dentists work within systems shaped by staffing, scheduling, documentation, insurance, productivity expectations, treatment costs, and payment structures. Graduates must understand how these forces influence clinical decisions, access, and ethical care. They must also recognize the social and structural conditions that shape oral health and be prepared to adapt recommendations to patients’ circumstances, discuss costs transparently, identify barriers to follow‐up, and participate in prevention and community health.

2. Competency‐Based Dental Education: Progress and Limits

Dental education has not ignored this broader view of practice. Over the past three decades, competency‐based dental education has sought to make graduate outcomes more explicit and align curricula and assessment with the abilities expected of new dentists. The American Dental Education Association (ADEA) Competencies for the New General Dentist have been central to this effort [7]. They have helped programs articulate expectations for graduates entering practice, including clinical care, critical thinking, professionalism, ethical judgment, communication, self‐assessment, and lifelong learning.

More recent ADEA domains of competence provide an important contemporary anchor for readiness by emphasizing that new dentists must function across integrated roles as clinicians, leaders, and advocates [8]. As clinicians, graduates are expected to integrate scientific knowledge, evidence, clinical reasoning, person‐centered care, prevention, quality and safety, and responsible use of information and technology. As leaders, they are expected to demonstrate professionalism, accountability, communication, teamwork, reflection, and attention to personal and professional well‐being. As advocates, they are expected to promote health, address disparities, improve access, and respond to the social and structural conditions that shape oral health.

These domains strengthen the connection between competency‐based education and readiness for practice because they describe integrated professional roles rather than isolated abilities. A graduate does not demonstrate readiness as a clinician, leader, or advocate without bringing knowledge, technical skill, judgment, communication, professionalism, adaptability, and accountability together in patient care. The question that remains for dental schools is whether the students are prepared to enact these roles with appropriate independence.

Competency‐based education has been a major advance. It has clarified expectations, supported curricular alignment, and helped dental schools describe the abilities graduates should possess. However, competencies and standards do not, by themselves, answer the readiness question. Dental education must still determine how to generate credible evidence that a student can integrate these abilities in actual patient care and can be trusted to assume appropriate responsibility as a beginning practitioner.

3. Measuring Readiness: Beyond Isolated Assessment

Dental education has long wrestled with how to determine whether a student is safe and ready for practice. Dawson et al. [9] challenged the adequacy of isolated competency assessments, arguing that single‐point evaluations cannot demonstrate consistent performance or appropriate independence. Instead, they advocated for repeated workplace‐based assessment that captures deliberate practice, progression, and increasing responsibility over time.

The key insight is that students do not progress uniformly. A learner may demonstrate strong technical performance in one context but struggle with reliability, documentation, communication, or judgment in another. Readiness is therefore not established by a single successful procedure or one passing grade. It is a judgment built on longitudinal observation across different contexts.

This raises a public‐facing question for dental education: If patients asked, “How do you know this graduate can care safely for someone like me, with my health conditions, fears, financial constraints, language needs, prior experiences, and reasons for mistrust?” how would we answer? A defensible answer requires more than grades, procedural requirements, self‐reported confidence, or isolated clinical checks. It requires evidence that the graduate can integrate knowledge, skill, communication, ethical judgment, adaptability, and patient‐centeredness across clinical situations that vary in complexity and uncertainty. Although the 2025 ADEA Survey of US Dental School Seniors found that 92% of respondents agreed or strongly agreed that they were ready for practice [10], confidence is only one dimension of readiness and must be triangulated with observed performance, faculty judgment, and patient‐care evidence.

4. Making Trust Visible: The Role of Entrustable Professional Activities

One promising path for strengthening readiness assessment is to reframe it around trust. The central question becomes: Can this learner be trusted to perform this professional task with an appropriate level of supervision? Unlike isolated competency checks, entrustment focuses on integrated units of professional work.

Entrustable Professional Activities, or EPAs, have been widely used in medical education and are increasingly relevant to dentistry [11, 12]. EPAs do not replace competencies; rather, they bring competencies together in the clinical activities that define professional practice. Competencies describe the abilities graduates should possess, while an EPA framework asks whether those abilities are being used consistently and safely in patient care. In dentistry, such activities might include completing a comprehensive patient assessment, developing and communicating a treatment plan, managing urgent dental needs, obtaining informed consent, providing preventive and restorative care, or coordinating care for a medically complex patient [13].

This shift matters because entrustment decisions have consequences for patient care. Granting a learner greater autonomy reduces direct supervision and increases responsibility. Supervisors therefore consider more than technical performance. They must also judge whether the learner is prepared, reliable, honest, accountable, responsive to feedback, aware of limits, and attentive to the patient's needs.

The ARICH framework, described by Ten Cate and Chen, offers useful language for these judgments [14]. It identifies five attributes commonly considered in entrustment decisions: agency, reliability, integrity, capability, and humility. In dental education, these attributes are visible in everyday clinical work. They appear in how students prepare for patient encounters, communicate with patients and team members, document the visit, follow safety practices, seek help when appropriate, respond to feedback, and take ownership of learning and patient outcomes.

ARICH captures dimensions of readiness that single‐point assessments may miss. A student may complete a procedure successfully yet fail to document accurately, ignore patient concerns, or avoid asking for help. Conversely, a learner may struggle with complexity but demonstrate sound judgment, preparation, communication, and appropriate help‐seeking. Incorporating ARICH into EPA‐based assessment can make readiness judgments more explicit and defensible. Observation tools can prompt faculty to document behaviors beyond technical capability; faculty development can support consistent use, and clinical competency committees can synthesize evidence across time, settings, evaluators, and patient‐care contexts. Consistent with the ADEA Compendium of Clinical Competence Assessments, readiness should be evidenced not by isolated successes, but by repeated demonstrations of increasingly independent performance [15].

Entrustment decisions require faculty development, calibration, and deliberate attention to bias. Yet subjectivity in assessment should not be equated automatically with bias, nor should structured tools be assumed to be bias‐free. As Kleijer et al. noted [16], in workplace‐based assessment the faculty rater is, in many ways, the assessment instrument. Clinical supervisors must interpret complex, contextual information that no checklist can fully capture. This interpretative work is essential when deciding whether a learner can safetly assume greater patient care responsibility with decreased supervision. The challenge is not to eliminate interpretation, but to support legitimate expert judgement while reducing unwanted bias through clear rubrics, shared behavioral anchors, faculty calibration, narrative assessment training, and regular review of assessment data [17]. ARICH can help make the basis for decreased‐supervision decisions more explicit and support synthesis of evidence across multiple observers and contexts.

5. The Relational Dimension of Trust

Because readiness is ultimately about patient care, assessment must address the relational dimensions of practice. Readiness is demonstrated in how clinicians listen, explain, collaborate, respond to distress, and navigate uncertainty with patients. In dentistry, where fear, cost, shame, prior negative experiences, and mistrust can strongly shape patient behavior, these relational abilities are central to safe and effective care [18, 19].

Person‐centered care is not an add‐on; it is a clinical safety and equity issue. Patients who trust their health care providers are more likely to engage with care and follow treatment recommendations, leading to better outcomes [20, 21, 22, 23]. A readiness framework that does not assess how students build rapport, elicit patient goals, communicate risks, respond to emotion, and honor patient preferences is incomplete.

EPA‐based assessment provides a structure for making these relational abilities visible. Faculty can observe whether students elicit patient concerns, explain options understandably, confirm understanding, discuss financial implications transparently, respond constructively to fear or refusal, and negotiate treatment plans that are clinically appropriate and personally meaningful. These behaviors are not peripheral to readiness; they are evidence that a learner can be trusted with patient care.

6. Implications for Dental Education

If readiness is multidimensional, contextual, relational, and longitudinal, dental education cannot assess it through isolated measures alone. Progression and graduation decisions must be built on evidence gathered over time, across settings, and in relation to the core activities of dental practice.

Programs may approach this work in different ways, depending on their curriculum, assessment systems, and institutional readiness. Regardless of whether a school has formally adopted EPAs, it may be useful to make explicit what readiness means locally. What evidence demonstrates that a graduate is prepared to assume responsibility for core activities of dental practice with appropriate independence? A shared definition, aligned with ADEA competencies and informed by entrustment principles, can help calibrate faculty expectations, inform students, and support defensible progression and graduation decisions. Emphasizing longitudinal observation across clinical settings, patient populations, procedures, and teams can reveal patterns that single assessments cannot.

Supervision scales can frame assessment in clinically meaningful terms: What level of supervision does this learner need to perform this activity safely and effectively? Linking assessment decisions to ARICH‐informed rationales can make feedback more actionable by identifying the behaviors needed for greater independence, such as consistent follow‐through, timely documentation, clearer communication, or earlier help‐seeking. Reflection and help‐seeking should be treated as patient‐safety and professionalism competencies, not as signs of weakness.

Importantly, an entrustment‐oriented approach need not require immediate adoption of a full EPA framework. Dental schools can strengthen readiness assessments within existing competency‐based systems by applying the same underlying principles: repeated observation over time, assessment of integrated performance in authentic clinical settings, attention to the level of supervision a learner requires, and explicit discussion of trust. For some programs, this may mean formal EPAs; for others, it may begin with identifying a small number of core clinical activities that require integration of multiple competencies, documenting supervision needs, and adding narrative feedback about reliability, judgment, and help‐seeking. When reviewed longitudinally, these steps can strengthen competency‐based education by making the evidence supporting readiness for practice more credible, integrated, and patient‐centered.

A useful way to view this work is as a continuum rather than a binary choice. At one end, schools may refine competency‐based assessments to include longitudinal observations and supervision‐level language. Further along the continuum, schools may map competencies to core clinical activities and use faculty committees to evaluate longitudinal evidence. Full EPA implementation represents one end of this continuum, and it is not the only meaningful step toward more defensible readiness decisions.

Faculty development, calibration, and attention to equity are essential. Assessment decisions are human judgments and are vulnerable to inconsistency and bias. Faculty need shared expectations, behavioral anchors, training in narrative assessment, and opportunities to calibrate judgments across learners and settings. Programs using entrustment‐based frameworks should also examine assessment data for patterns of bias [24], and ensure that expectations are explicit, observable, and equitably applied.

Finally, dental education should build stronger bridges into early practice [25]. Graduation should not be treated as the finish line. Early practice tests reliability, humility, and agency under new pressures, including productivity expectations, unfamiliar teams, financial constraints, and complex patient needs. Mentoring, structured onboarding, early‐career coaching, and partnerships among dental schools, employers, and organized dentistry could support the transition from supervised education to independent practice.

7. A Call to Reimagine Readiness

Competency‐based education has served dentistry well by bringing clarity to curricular outcomes and assessment. But the profession is now at an inflection point. Evolving care models, persistent inequities, rapid technological change, increasing patient complexity, and greater integration with health systems require a broader understanding of readiness for practice.

Readiness must mean more than procedural competence. It should be understood as the demonstrated ability to assume responsibility for core professional activities with appropriate independence. This requires not only knowledge and technical skill but also ethical judgment, communication, adaptability, humility, accountability, and commitment to equity in person‐centered care.

The question is how programs can better determine whether students can integrate competencies in patient care. For some schools, a formal EPA framework may provide that structure. For others, practical first steps may include incorporating clinical longitudinal assessments, narrative feedback, supervision‐level judgments, and faculty calibration into existing competency‐based systems. In either case, the goal is the same: to make readiness for practice a defensible judgment.

Entrustment‐oriented approaches, including but not limited to formal EPA frameworks, offer practical language aligned with what patients, employers, regulators, and the profession need to know. Multi‐observer, longitudinal workplace‐based assessment provides a pathway for generating credible evidence of readiness. ARICH helps make visible the attributes that supervisors already weigh when deciding whether a learner can be trusted to perform professional activities with decreasing supervision.

Ultimately, to graduate a dentist is to make a public claim: this graduate can be trusted to care for patients. Our responsibility is to ensure that this claim rests not on assumption, tradition, or accumulated requirements, but on credible evidence that graduates are prepared to enter practice safely, ethically, equitably, and professionally, with the capacity for lifelong learning.

Author Contributions

The authors reviewed and approved all final content.