CATEGORY 108 AUSTRALASIAN DENTIST BEYOND CLINICAL There is a sentence I hear from clinicians all the time: “I’ll do it when I feel more confident.” I’ll place the implant when I’m more confident. I’ll start presenting larger treatment plans when I’m more confident. I’ll take on the surgical case when I’m more confident. I’ll speak up when I’m more confident. I’ll have that difficult conversation when I’m more confident. The problem is that we have the order backwards. Confidence rarely arrives first. We act, we learn, we collect evidence — and confidence follows. I think this is one of the most important things we can teach clinicians, because confidence is often treated as though it is a personality trait. Some people apparently “have it” and others don’t. I don’t believe that’s particularly useful, and it certainly isn’t how I see confidence develop clinically. Confidence is built. And it is built through an interaction between competence, self-discipline, selftrust, self-belief and self-worth. Your brain needs evidence You cannot simply tell yourself that you’re confident and expect your nervous system to believe you. The brain learns through experience. It makes predictions, encounters outcomes, detects differences between what was expected and what actually happened, and uses that information to update future predictions and behaviour. This happens constantly in dentistry. You look at a radiograph and predict what you are going to find clinically. You plan an extraction and anticipate where the difficulty will be. You assess the available bone and predict whether you will achieve primary stability. You present a comprehensive treatment plan and anticipate how the patient might respond. Then reality gives you feedback. Sometimes you were right. Sometimes you weren’t. Either way, you have acquired information. Do this enough times, with appropriate reflection and feedback, and your brain begins to recognise patterns. What initially required enormous conscious processing gradually becomes more familiar and efficient. Think about your first crown preparation. Or your first surgical extraction. Or your first implant. Remember how much mental bandwidth it consumed? Every movement was deliberate. Every bur change mattered. You were thinking about the assistant, the patient, your hand position, angulation, depth, water, suction and what came next — often simultaneously. Then compare that with a procedure you have performed hundreds of times. The procedure hasn’t necessarily become simpler. Your brain has changed. Through neuroplasticity, practice and repeated exposure strengthen the neural representations associated with a task. Components of the skill become increasingly automatic, reducing demands on working memory and freeing cognitive resources for higher-order judgement. That is part of what competence feels like from the inside. And competence gives confidence something very important to stand on: evidence. Self-trust is also evidence But there is another form of evidence we don’t talk about enough: the evidence you accumulate about whether you can rely on yourself. We tend to make self-discipline unnecessarily dramatic. It doesn’t have to mean waking at 4 am, taking an ice bath and running a marathon before breakfast. In dentistry, self-discipline can be remarkably boring. It is reviewing the CBCT when you said you would. Treatment planning the case properly rather than doing it five minutes before the patient arrives. Taking the photographs. Practising the procedure. Following up the patient you promised to call. Asking for help when something exceeds your current competence. Doing the course — and then actually implementing something from it. Having the uncomfortable conversation instead of avoiding it. Looking at the complication rather than pretending it didn’t happen. Every time you do what you told yourself you were going to do, you create another piece of evidence: I can rely on myself. That is self-trust. And I think self-trust is one of the most underestimated foundations of confidence. If I repeatedly make commitments to myself and don’t follow through, I am also collecting evidence. I’ll treatment plan that tonight. I’ll submit that case tomorrow. I’ll start taking proper photographs next week. I’ll have that conversation eventually. I’ll ask my mentor next time. We think these are isolated behaviours. But cumulatively, they contribute to the story we hold about ourselves. You are always collecting evidence. The question is: what is the evidence proving? Then there is identity Behaviour, however, is only half of this. There is another conversation happening underneath it. Who do you believe you are? We all carry internal narratives. Some are useful. Some have been rehearsed for so long that we rarely stop to question them. u “I’m not naturally confident.” u “I’m not surgical.” u “I’m terrible at treatment presentation.” u “I’m not an implant dentist.” u “I’m too inexperienced.” u “I’m not someone who speaks in front of a room.” u “Patients won’t accept comprehensive treatment from me.” The brain does not passively record the world like a camera. Perception and decision-making are influenced by prior experience, expectations, attention and learned models of what is likely to happen. That means an established belief can influence what we notice and how we interpret what happens next. If my underlying narrative is “I’m terrible at presenting treatment”, the patient who declines my plan becomes powerful evidence: See? I knew it. Meanwhile, the three patients who accepted may receive considerably less psychological weight. This is where confidence becomes Confidence is built, not found Where clinical confidence really comes from — and what neuroscience can teach us about building it By Dr Shahana Abed Dr Shahana Abed
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