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Learning, Discovery and Excellence: The Dynamic Adventure of Navigating Residency by Brittany Degen

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5, 6, 7, 8 … The counts for the upcoming dance routine replayed in my head just before I stepped on stage for the final dance audition. I was 14. My braces had been removed a week earlier and I still couldn't get over the feeling of smooth enamel against my tongue.

A few years earlier, I hadn't even bothered with tryouts because my classmates ridiculed my smile. My orthodontist frequently commented on the benefit of braces. He often mentioned how my severe crowding, malocclusion, and horizontally inclined canine eruption would no longer hinder my confidence. He was right. As my audition ended I exited stage left, heard applause in the background, and was approached by the varsity coach. She offered me a coveted spot on the team, laying the foundation of confidence necessary for me to become a professional dancer for the National Basketball Association (NBA) and Arena Football League (AFL), and achieve an orthodontic residency at A.T. Still University. Most profoundly, the confidence garnered from my orthodontic treatment has become the driving force behind my passion for artistically shaping the dentition of my own patients.

A change of choreography
In July 2014, I walked through the doors of the A.T. Still University postgraduate orthodontic program overwhelmed, excited, and enthusiastic. My dream was a reality, and a new adventure lay before me. The graduating class contained five strangers—three men and two women—as well as a visiting international student joining us for the year. Each brought a unique style to the group, some coming from the other side of the country, others coming from around the world. We immediately bonded over our desire to shape the lives of our patients, united in our cause to become the best orthodontists we could be. Almost at once, my classmates re-coined my dental school nickname, “the dancing dentist,” to “the dancing orthodontist.” This immediately established the jovial atmosphere that we still enjoy.

Participating in a residency program is distinct from any other educational experience in my history. Every week is filled with a stress to successfully master material at the forefront of orthodontics. It is dissimilar from the halls of dental school in that the experience is self-driven and relatively unpaved by previous classes. Each student is in his or her own control—testing out new procedures, investigating and researching questions of our own choosing, and navigating the dense literature required to perform procedures correctly.

Dental school is largely standardized. Dental students do not have the same type of environment to research any topic they desire and then apply it to the patients they treat. Students are given the material they are required to know, rather than being encouraged to seek out the topics and experiences they wish to build into their education. Expectations are tapered and dental students are still professionally maturing.

A change of expectations
As an ortho resident, however, the expectations are elevated. Stressors shift from taking didactic examinations to publishing peer-reviewed papers, presenting, and educating your peers. You are no longer a consumer of information—you are now also a generator of ideas and knowledge.

Residency is hardly as consistent or predictable as dental school. We juggle a myriad of tasks on top of our responsibilities as students, including ABO certification, and patient compliance. And, much like with dental school, we're managing our personal lives on top of a challenging curriculum. It's important to remain passionate and dedicated to truly be successful throughout the program. Students must rely on each other for encouragement, humor and support. Only your classmates can partake in the humor of a professor's particular methodology, the amount of new-patient exams you completed that day, or the overbearing “helicopter mom” who sits in your operatory at every appointment, analyzing your every move. December 2016 seems distant; however, our time as A.T. Still University's orthodontic residents will pass quickly. Soon the inside jokes regarding tongue thrusters will no longer be a daily occurrence as we continue on our individual paths of success.

A change of perspective
The experience-centric and unique atmosphere of residency is rare and special. A big part of it can be attributed purely to the phenomenal commitment of faculty and adjunct mentors. The traditional student-teacher hierarchy is pushed aside for an atmosphere that emphasizes colleague-to-colleague interaction. Our professors teach us the necessary skills to understand and dissect information, rather than rely on our memorization skills that dictated success in dental school. The professors encourage and pride themselves on helping each student form an educated opinion based on empirical evidence.

This working professional relationship allows students to form their own conclusions regarding the clinical implications and outcomes of various treatment modalities, in addition to creating an environment that permits experimentation and failure. The relationship is a dynamic conversation based on collaborations, rather than segmented lectures with predetermined conclusions. A student's merit is no longer based just on a score, but on his or her ability to solve complex problems, collaborate, and execute a plan.

Success in residency is dependent on willingness to learn, experiment, and take calculated risks. The endgame is independence as a practitioner. Several of my successful cases began with failure and frustration. As a first-year student you are under the impression that there is a general recipe for treating your patients; however, you quickly learn that the diversity of cases dwarfs your experience level and, at times, your confidence level. The first step in being successful in your residency is to understand that it takes time to develop your skills. Do not rely on what was given to you in class—step out of the comfort zone established by dental school, explore the literature, and begin identifying a personal style.

The beauty of orthodontics is that each patient's case is unique, giving you ample time to practice problem solving. A variety of options, appliances, and sequences can be applied in different ways to successfully treat a case. We are exposed to an overwhelming number of tools and philosophies. As a student, your success is dependent on your ability to blend each of these philosophies into a form that is palatable and useful for you.

A changing confidence
Residency is about learning, discovery and excellence. With each new patient, you learn something new. Each treatment plan is distinct and requires the student to draw on different experiences. You discover new techniques and ways to cope with the stress of being a professional and an expert.

Residency shapes you to handle complex problems with steadfast confidence. It pushes you to perform at the consistent level of excellence that your patients depend on. We are granted the powerful tool of shaping someone's smile and self-confidence.

With the knowledge and rigor of my residency, I can forge long-term relationships with my patients and contribute to their evolution and development as a person. The personal connections I have made thus far with my patients have been life-changing and reinforce my determination to become a compassionate and artistic practicing orthodontist. Residency is not easy, but the relationships with my patients, my classmates and my mentors make it all worthwhile. These are unforgettable.

I will never forget the struggles, as they have resulted in unparalleled growth. Thank you Sireesha, Michael, Gabriela, Raphael and Jared—our class is truly a special group of individuals and I look forward to the day we graduate and finally achieve our dream of becoming orthodontists.



Brittany Degen is a first-year resident at A.T. Still University in Mesa, Arizona. She is originally from Vancouver, Washington and earned her bachelor's degree in biochemistry from the University of Washington in 2008. She graduated from Midwestern University's Dental School in Glendale, Arizona in 2014, earning her doctorate of dental medicine. Brittany hopes to find an associate position with a local orthodontic office when she graduates in December 2016, and dreams of one day owning her own private practice.


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