by Lori Garland Parker, BS, MAOM

Effective tips and tools for training new clinical team members

When new team members come on board, it is vital that they get off to a good start. They need to understand their role in the practice as a whole, learn the expectations of the orthodontist and team, and practice the basic elements of the job as quickly as possible. Their experience in the first few weeks will have a significant bearing on their level of commitment and ability to quickly become productive.

It may be self-evident that new employees need to be trained, but it is all too rare that orthodontic teams provide carefully designed training programs that give new arrivals what they really need. A well-rounded training program should have three primary elements: 1) an orientation about the practice and team; 2) a training manual and the practice’s standard operating procedures (SOPs); and 3) a well-chosen, quality trainer.


Successful orientation speeds up the adaptation process by helping a new employee understand and adapt to the office’s practices and culture. A well-planned, comprehensive orientation process will be more likely to produce the type of work expected and develop a stronger sense of commitment in employees, while at the same time reducing employee turnover. The basics of new employee orientation should:

? welcome the new employee to the team;

? introduce the new employee to the practice goals, policies, procedures, and culture;

? convey the orthodontist and team’s expectations;

? relieve the new employee’s anxieties about starting a new  job;

? answer any questions; and

? inspire the new employee to retain a good attitude toward the practice and the new job.

Clear, well-defined expectations will pay dividends in the future by reducing possible misunderstandings between the employer and employee. By orientating the new employee properly, a smooth transition can be made to the training process. Here are some tips and tools for new employee orientation.

1) Use a customized office policy manual. A customized office policy manual is imperative to clarify the employer’s expectations in terms of work, behavior, and dress for the entire team. It also defines benefits and other necessary employee information. Having a well-written manual that presents clear guidelines in writing helps to prevent confusion.

2) Provide a welcome celebration. Showing a new team member that he or she is truly welcome is valuable for all. A fun luncheon and welcome gift is a great way to get started.

A Training Manual and SOPs

Every office should have a training manual and a collection of written SOPs that provide step-by-step procedure guidelines for each area of the practice. These documents serve as a vital reference tool for the employee and also provide a written reference to help the trainer organize the training process.

Without a standard procedure specified in a procedure manual, employees tend to do things their own way, whether right or wrong. Rather than learning the “proper” procedure, new employees are likely to be taught to do things according to the senior employee’s preferred approach, which may not align with the orthodontist’s requirements.  

On-the-job training and following the office policy manual make it easier for new hires to understand the job’s sequencing and to logically internalize the procedure. The manual also serves as an after-hours study guide. This will expedite learning, and it can go a long way to enhance patient/parent satisfaction as well as provide consistency between team members. Here are some tips and tools for training:

1) Standardize procedures. Whenever possible, having a “standard way of doing things” helps to make certain that procedures and patient experiences are consistently of high quality, regardless of who works with the patient. By following directions, everyone on the team will be able to do the job in the same manner. Of course, there will always be judgment calls as part of providing orthodontic care, but the more systems that are clearly defined to be easily executed, the more time there will be for training on work than cannot be standardized.

2) Use training modules. Organize training by dividing the information into “modules,” each with increasing complexity; using somewhere between 5–10 modules works well for many offices. Each time a trainee completes a module, a checklist should be dated and initialed by the trainer—and there should be a celebration. An example of a training module is on page 50.

3) Consider job-advancement titles. Some offices use “levels” of orthodontic assistants, such as Level 1 Assistant, Level 2 Assistant, and Level 3 Assistant, each with its own competency requirements.

Level 1 may encompass excellence in the basics: understanding basic nomenclature; and competency in simple procedures and most support functions, such as sterilization, procedure setups, and charting.

Level 2 may entail the ability to perform all procedures delegated to orthodontic assistants, as well as the ability to make good decisions and consistently demonstrate excellent verbal, patient education, and motivation skills.

Level 3 may involve demonstrating excellence in various leadership roles. Examples could be organizing and providing staff training, teaching the team to work effectively with the orthodontist, or designing a practice-improvement program. 

In the area of general dental assisting, the Dental Assisting National Board has teamed up with the American Dental Assistant Association to define and rank core dental assisting competencies to reinforce the concept of a viable career ladder for general assistants. Due to a large variation in state laws, this cannot be done for orthodontic assistants, but your office can design your own, based on state law and your orthodontist’s preferences.

4) Make flash cards. Flash cards have been around for a long time and are still an effective learning tool for memorizing instrument names, nomenclature, abbreviations, and more.

5) Use quick reference cards. Quick reference cards are bullet lists designed for job procedures, and they are an excellent reference guide for trainees as they are working. Cards should be small enough to fit into the trainee’s pocket for easy reference.

6) Integrate a dentoform mannequin. Dentoform mannequins provide an excellent opportunity to simulate working on a patient to gain practice and confidence prior to working on a “real” patient.

7) Make a clear practice appliance. Once a trainee has become competent on the mannequin, the next step can be working on a team member wearing a clear retainer with brackets attached. This will be the closest simulation to an actual patient. This training method allows for feedback on gentleness, ability, and confidence.

8) Consider videos, DVDs, audiotapes, and online courses. Using technology is also helpful when training. Off-the-shelf programs are good for basics, but they do not always reflect the exact way procedures are done in your office. A great way to customize your training is to videotape procedures that differ from the example. Also, listening to audiotaped patient instructions while driving can help a trainee reinforce what he or she will do during patient hours. This avoids the “ignore that part—we don’t do it that way in our office” comments so frequently heard in orthodontic practices without customized materials. Online learning is also becoming a popular option to help provide basic training.

A Sample Training Module

Module 1: Should be completed within 1–2 weeks. Train in OSHA compliance before exposure to saliva, blood, or other infectious material. New staff should help the trainer and practice on a training mannequin for 1–2 weeks before working on patients. All items should be signed and dated by the trainer when complete.

Orientation Day 1:
Welcome, tour, introduction to staff Orientation checklist (see list in manual)
? HIPAA compliance
? Importance of customer service
? Smile!
? Review job description
? Copy of procedure manual
? Morning preparation
? Morning meeting
? Closing meeting
? Chair adjustment, unit controls

Required Training Day 1:
? Blood-borne pathogens
? Exposure-control plan
? Hazard-communication plan
? Hazardous waste management plan
? Medical records file
? Emergency procedures
? Definitions of OSHA terms
? Postprocedure cleanup
? Hepatitis B vaccination dates set  (if needed)

? Exam
? Consult
? Initial records appointment
? Simple clinical adjustments and  check appointments
? Treatment card on computer
? Parent chat

Study and Learn: 
(Have trainer check off and initial when competent)
? Names of the teeth
? Surfaces of the teeth
? Numbers of teeth
? Know types of braces used in this  office 
? Flow chart for patient beginning   treatment
? New patient sequencing
? Potential risks and limitations of   treatment
? Names and uses of common   instruments
? Instrument sterilization procedure
? Handpiece sterilization procedure
? Parts of orthodontic appliances
? Dental specialists

Assist Trainer With:
? Seating the patient
? Preparing necessary supplies for   procedures: 
  Archwire change
  Retainer check
  Appliance check
  Banded appliance
  Initial band/bond
  Basic computer skills
  Charting basic procedures
  Postprocedure cleanup

? Chapters 1, 2, and 6, pages 1–3
? Patient Information Sheets
    New patient letter
    New patient packet
    Separator handout
   Toothbrushing and oral hygiene handout

Typodont Practice:
? Check for loose bands, brackets, long  distal ends, damaged archwires
? Remove elastic ties
? Remove ligature ties
? Place elastic ties
? Identify teeth

? Checklist for every patient
? Complement patient on good  cooperation

? Written exam on:
? Oral exam by trainer:
    Identifying instruments
? Trainee demonstrate:
    Tray setups

9) Script common questions and answers. Most of us have answered a patient or parent question incorrectly at some point during our careers. Having a list of the most common questions, along with the most appropriate answer, provides a great reference for a new employee. Role-playing these scenarios during nonpatient time will reduce the number of inappropriate responses from trainees.

10) Design lesson plans. When the trainee does not know what is expected at each training session, this can exacerbate the frustration level. Developing and using lesson plans in an orthodontic practice will also help use time effectively when training. The trainer should have a lesson plan for each training session, based on the practice standards for that procedure. To begin, ask yourself three basic questions: 1) What do you intend to accomplish in this session? 2) How do you intend to teach this information? 3) How will you know if the trainee has learned and understands the information or skill?

11) Use quizzes. Quizzes, whether written, verbal, or demonstration, are essential to confirm the trainee’s understanding. There should be no assumptions that information has been learned.

A Well-Chosen Trainer

A well-chosen trainer is another critical key to success. Excellent chairside assistants don’t always make great trainers, although the most experienced team members frequently make strong choices. An orthodontic trainer needs to be patient, organized, a good communicator and teacher, and someone who enjoys helping others succeed. Some tips and tools for the trainer are on page 51.

1) Determine the new employee’s current skill level. Prior to the training process, the trainer should determine the new employee’s skill level. Through interviewing, observing the employee’s skills and abilities, paying careful attention to questions asked (and not asked), and inquiring of previous employers and references, the trainer can develop a good sense of what the employee can do.

2) Discover the trainee’s learning preference. Identify each trainee’s learning preference (visual, auditory, and/or tactile), and emphasize that preferred style when training.

3) Include communication training. Many times, the focus of training is on technical orthodontic procedures. It is also important to include training on effective communication skills, patient education, motivation, teamwork, and the importance of being gentle and caring.

4) Establish daily and weekly goals. Learning a new career can be overwhelming. Discuss daily and weekly goals that will paint a picture of what will be taught, which will enable the trainee to know what is expected.

5) Include analogies. Analogies help make learning “stick” because the trainee can visualize and understand new concepts if they are similar to ones they already know.

6) Provide effective feedback. Ensure that feedback is clear, tactful, and constructive. Discuss strengths as well as development opportunities. Include a meeting at the end of the day for the first several weeks to find out how new employees feel about their progress, and identify areas where they feel confident or confused. Use this time to truly listen to trainees and acknowledge their feelings. (Use this information to adjust the training the following day if needed.) Provide encouragement and support.

7) Keep learning enjoyable. People learn best in a comfortable environment. Spend some time laughing at your own faux pas. Catch the trainee doing things “right.” Remember also that all trainees are going to make mistakes. Convey to the trainee that making mistakes is part of the learning process.

In conclusion, proper orientation and training of employees is an essential part of every smooth-running orthodontic practice. Providing a thorough orientation sets the stage for a satisfying experience for both the employer and employee. Well-planned and well-conducted training takes time and effort by the orthodontist, trainer, and trainee, in addition to support from the entire team. The results are positive, productive, motivated team members and satisfied patients.

Lori Garland Parker, BS, MAOM, is a clinical consultant and coach and cofounder of Consulting Network. She can be reached at (805) 552-9512 or