Evaluating Pakistani dental graduates’ preparedness for practice: a mixed methods study using the conscious competence model

Dental graduates often feel underprepared for independent practice, particularly in challenging work environments. This mixed-methods study explored self-perceived preparedness among final-year dental students, recent graduates, and house officers training for full registration in Karachi, Pakistan. This study correlated preparedness with personality type and aligned it with the Conscious Competence Model (CCM), which is comprised of four stages of learner self-perception as they proceed toward acquiring new competencies: Unconscious incompetent (don’t know what you don’t know); conscious incompetent (now aware of skill deficits); conscious competent (performs skill but with conscious effort and deep concentration); unconscious competent (performs with minimal conscious thought). A total of 44 participants (86% female, mean age 23.2 ± 3.43 years) completed the Dental Undergraduates Preparedness Assessment Scale (DU-PAS), with high reliability (Cronbach’s alpha: overall = 0.89, Part A = 0.91, Part B = 0.82). Thirty of these 44 participants also completed a Myers-Briggs Type Indicator (MBTI) inventory, provided a global rating for self-perceived preparedness on a scale ranging from 0%–not ready to 100%–completely ready, and also engaged in semi-structured interviews. Quantitative data were analysed using chi-squared, Mann-Whitney U, and Kruskal-Wallis tests, while qualitative data (themes identified from interviews) were thematically analysed and mapped to the CCM. The mean overall DU-PAS score was 64.12 ± 5.18 (clinical skills 62.0 ± 5.04, non-clinical skills 65.95 ± 8.09). High confidence levels were reported for foundational skills, such as taking medical history (95%). Conversely, lower confidence was reported for specialised procedures, such as bitewing radiography (29.5%), and non-clinical skills, such as managing pediatric patients (25%) and anxious patients (31.8%). DU-PAS scores demonstrated a significant decline across training stages. Final-year students scored highest (67.9 ± 4.2), followed by house officers (62.4 ± 3.5), and recent graduates (59.4 ± 4.8). The differences were statistically significant (H(2) = 18.42, Kruskal–Wallis p < 0.001), indicating a progressive reduction in perceived preparedness with increasing training experience. Of the 30 participants who completed the MBTI, 60% were classified as extroverts, who reported a median global self-perceived preparedness score of 70% on the 0–100 scale, compared with a median score of 57% among introverts. Six themes were identified from the interviews: effective undergraduate experiences, deliberate professional development, patient care, emergency preparedness, practice management, and ethical reflection were identified that charted movement from unconscious to conscious incompetence once graduates faced real clinical demands. Although participants felt that basic skills contributed to some preparedness to practice, they did not feel equipped to manage complex clinical and managerial tasks. In relation to the CCM learning process, the progressively declining preparedness rankings among final year students, house officers and recent graduates suggests that the transition from unconscious to conscious incompetence did not occur until entering professional practice. Possible interventions were suggested by identifying enablers and barriers to preparedness. These include increased earlier supervised exposure to advanced endodontics, radiography, paediatric and anxious-patient care, along with structured modules in practice management and reflective mentoring, leading to consolidating conscious competence before graduation.