The benefits and costs of continuing professional development (CPD) for general dental practice: a discussion

Dental continuing professional development - Part II: The Malta CPD Pilot Project

INTRODUCTION

Continuing professional development (CPD) remains voluntary in nine European countries. Evidence suggests a move towards mandatory CPD across Europe with the objective of harmonisation of dental CPD. Although the importance of CPD is acknowledged, the literature regarding its effectiveness is limited and under debate.

AIMS AND OBJECTIVES

The main aim was to measure the effectiveness and success of a new CPD programme with the objective to devise a strategy, guidelines and recommendations for the establishment of a dental CPD programme in Malta.

METHODOLOGY

This project was divided into two phases; Phase 1 was the analysis of a survey sent out to 135 members of the Dental Association of Malta. Phase 2 involved the evaluation of eight verifiable CPD events, through pre-event and post-event tests and feedback forms, to investigate the effect on short-term knowledge retention and the respective satisfaction levels of participants at each event.

RESULTS

The survey had a response rate of 78%. The CPD events in Phase 2 all showed statistically significant improvement in short-term knowledge retention on each subject (p < 0.05). Satisfaction levels ranged from 70% to 99%.

CONCLUSIONS

The information gathered from this project was used to provide guidelines and recommendations for the local regulatory body and CPD providers for the set-up of a dental CPD framework and programmes in Malta, a country where dental CPD is still voluntary. This article is the second article from a two-part series of articles about the Malta Dental CPD Pilot project.

Dental Continuing Professional Development - Part I: Background on Dental Continuing Professional Development in Europe

INTRODUCTION

Continuing Professional Development (CPD) is mandatory in most European countries and evidence shows a move towards mandatory CPD across all Member States in the near future. Malta is one of seven Member States where dental CPD is still voluntary.

DISCUSSION

Although dental CPD is a legal requirement for recertification in many countries, integral aspects of dental CPD remain under debate, like whether CPD is truly effective. This is because the methods with which CPD programmes are evaluated are not sufficiently robust to give concrete evidence to determine whether CPD will actually improve quality of care, treatment outcomes and safety for the public. Evaluating the effect of CPD programmes on the public is an extremely difficult task that would require an enormous amount of resources and logistics. The minimum requirements for the number of compulsory CPD hours imposed by regulatory bodies are not evidence-based but purely arbitrary, and the core topics selected for CPD programmes, although supported by research to some extent, may not reflect the public's and profession's needs. The Dental Association of Malta recognised need for further research on dental CPD and embarked on a 3-year Dental CPD Research Project. This project will be presented in a two-part series of articles. This first article is focused on the background of dental CPD in Europe. An understanding of the current issues with CPD and flaws in methods of evaluation formed the basis of the Malta CPD Pilot Project, which will be covered in the next paper.

Dentists' responses about the effectiveness of continuing education activities

OBJECTIVE

To report the responses of dentists about the effectiveness of continuing education (CE) activities.

METHODS

This cross-sectional study involved the administration of a pilot-tested questionnaire amongst dentists from different cities of the eastern province of Saudi Arabia. A calculated sample of dentists (n = 323) was approached in person to collect their responses about CE activities they attended during the last one year. Descriptive statistics and multivariate logistic regression analyses were performed.

RESULTS

The response rate was 79.5% as 257 dentists returned completed questionnaires. There were 54.9% male and 45.1% female participants (mean age 31.18 ± 12.4 years). The majority of participants reported an improvement in knowledge (79.8%), a motivation for learning (79.8%), and quality of dental care (73.9%) as a result of CE activities. More than two-thirds recognised the importance of CE courses for maintaining licensure in dentistry, and 91.1% felt the need to increase CE activities. Logistic regression models showed that male participants were less likely (OR = 0.48, P = 0.05) than female counterparts to report an improvement in clinical skills. Having a private job (OR = 2.38 P = 0.005) and >10 years since graduation (OR = 1.84, P = 0.05) were associated with an improvement in clinical skills. Believing in the importance of CE activities for maintaining licensure was significantly associated with the effectiveness of CE activities in improving knowledge (OR = 2.76, P = 0.01), clinical skills (OR = 2.02, P = 0.04) and patient satisfaction (OR = 2.22, P = 0.01).

CONCLUSION

The majority of dentists recognised that CE activities were effective in improving their knowledge, clinical practice, quality of patient care and motivation for learning.

Awareness and knowledge of dental erosion among Yemeni dental professionals and students

BACKGROUND

This study explored Yemeni dentists' and dental students' knowledge about the associated factors, approaches to diagnosis and preventive methods of dental erosion (DE), as well as any associations between DE awareness and some potentially related variables.

METHODS

A self-administered questionnaire was distributed to general dental practitioners (n = 323) in Sanaa and to fifth year dental students (n = 97) at the University of Science and Technology, Sanaa, Yemen during the period from July to November 2013. Descriptive and logistic regression analyses were conducted.

RESULTS

Overall response rate was 79 %. Results indicated that 61 % of respondents learned about DE from dental school, 27 % from their own studies and the rest from continuing education courses and the media. DE was reportedly most frequently seen on incisors by 46 % of respondents and on premolars and molars by 24 %. While 48 % reported DE to be more common in male patients, no gender differences were reported by 20 % of respondents. Acidic drinks were believed to be causative factors for DE by 41 % of dentists and 52 % of students, while 90 % of respondents believed that patients' dietary history is important during DE diagnosis. As preventive measures for DE, reduction of acidic drink consumption was advised by 51 % of respondents while only 37 % advised their patients to use fluoridated toothpastes. Younger respondents (≤35 years) were more likely to identify the commonly-known causative factors for DE (P = 0.024). Twenty-seven percent of the respondents reportedly used an index to grade DE. Dental students were more likely than dentists to use such an index (P <0.001) and to more frequently advise their patients to reduce intake of acidic drinks (P = 0.02) compared to dentists.

CONCLUSIONS

In-depth knowledge about causative factors, diagnosis and preventive methods of DE was apparent among only half the respondents and approaches to early diagnosis were insufficient. There would appear to be an urgent need for enhancing awareness and knowledge about DE within the Yemeni dental community.

A review of continuing professional development for dentists in Europe(*)

AIM

  To summarise findings from a literature review of dentists' engagement in continuing professional development (CPD) and its effects on improving oral health care for patients.

METHOD

  The search strategy used key terms in a range of databases and an academic literature search engine, complemented by hand searching and citation follow-up.

RESULTS

  One hundred and fourteen papers were reviewed. The majority of dentists engaged in CPD. Factors affecting participation included time since graduation, costs, work and home commitments, postgraduate qualification, interest and convenience. Learning needs identification and reflection on practice were rarely evidenced. Common modes of CPD were courses and journal reading; no one delivery method proved more effective. Few papers directly explored recommendations for topics although suggestions related to common areas of error and gaps in knowledge or skill. Studies of CPD effectiveness and impact-on-practice suggested that courses can result in widespread new learning and considerable self-reported change in practice. However, significant barriers to implementing change in workplace practice were noted and included availability of materials, resources and support from colleagues.

CONCLUSION

  To ensure high standards of care, alongside recommending core or mandatory topics, more attention should be given to reflection on learning needs, the learner's readiness to engage with education and training and the influence of the workplace environment.

A review of continuing professional development for dentists in Europe

AIM

To summarise findings from a literature review of dentists' engagement in continuing professional development (CPD) and its effects on improving oral health care for patients.

METHOD

The search strategy used key terms in a range of databases and an academic literature search engine, complemented by hand searching and citation follow-up.

RESULTS

One hundred and fourteen papers were reviewed. The majority of dentists engaged in CPD. Factors affecting participation included time since graduation, costs, work and home commitments, postgraduate qualification, interest and convenience. Learning needs identification and reflection on practice were rarely evidenced. Common modes of CPD were courses and journal reading; no one delivery method proved more effective. Few papers directly explored recommendations for topics although suggestions related to common areas of error and gaps in knowledge or skill. Studies of CPD effectiveness and impact-on-practice suggested that courses can result in widespread new learning and considerable self-reported change in practice. However, significant barriers to implementing change in workplace practice were noted and included availability of materials, resources and support from colleagues.

CONCLUSION

To ensure high standards of care, alongside recommending core or mandatory topics, more attention should be given to reflection on learning needs, the learner's readiness to engage with education and training and the influence of the workplace environment.

Participation in continuing professional development by dental practitioners in Victoria, Australia in 2007

BACKGROUND

Mandatory continuing professional development (CPD) was introduced in 2005 in Victoria, Australia to ensure that dental practitioners maintained their skills, knowledge and kept up-to-date with current topics in dentistry. The aim of this study was to investigate the participation, impact on practice and attitudes of Victorian dentists and dental specialists to CPD activities since the commencement of mandatory CPD.

METHODS

A cross-sectional survey of a random sample of registered dentists and dental specialists (n = 895) was conducted from May to August 2008 using an anonymous, postal, self-administered questionnaire.

RESULTS

The response rate was 66%. More than three quarters of practitioners believed mandatory CPD is a reasonable requirement for continued registration. Dentists reported attending an average of 30.9 h of certifiable clinical CPD whilst specialists attended an average of 33.2 h of certifiable clinical CPD over a 12-month period. Nearly three quarters of respondents reported changing their practice as a result of CPD activities, whilst one quarter attended CPD mainly to meet the mandatory requirements.

CONCLUSIONS

Overall there was a positive attitude towards mandatory CPD and a high level of participation in CPD activities by Victorian dentists and specialists in 2007, although nearly half of the respondents attended <20 h of certified clinical CPD during 2007. A number of barriers exist, particularly for rural and female practitioners in accessing CPD, and further research is required to examine the benefits derived from mandatory CPD.

'Effectiveness of Continuing Professional Development' project: a summary of findings

This article reports on a study examining continuing professional development (CPD) for consultant doctors. The aim of the study was to identify what promotes or inhibits the effectiveness of CPD and met the following objectives: comparing and contrasting the experiences of CPD across the range of specialties; identifying and describing the range of different models of CPD employed across the different specialties and clinical contexts; considering the educational potential of reflective practice in CPD and its impact on professional practice and exploring how different professionals judge the effectiveness of current CPD practices. Using a mixture of qualitative (interviews, letters, observation) and quantitative (online questionnaire) methods, the views of CPD providers and users were surveyed. Findings suggested that the effectiveness of CPD, as inferred from the comments made by interviewees and questionnaire respondents, relates to the impact on knowledge, skills, values, attitudes, behaviours and changes in practice in the work place. The quality of CPD was seen as inextricably linked to any improvements in the quality of the professional practices required for service delivery. There was widespread consensus as to the value of learning in professional settings. There was recognition that there needs to be a move away from tick boxes to the in-depth identification of learning needs and how these can be met both within and external to the work place, with learning being adequately enabled and assessed in all locations. In conclusion, it can be said that CPD is valued and is seen as effective when it addresses the needs of individual clinicians, the populations they serve and the organisations within which they work. However, the challenge for CPD may lie in the dynamic interaction between educational opportunities and service delivery requirements, as there may be occasions where they vie with each other for resources.

An audit to assess the outcome of a 1-day acupuncture course for dentists

OBJECTIVE

The principal author has, during the last 4 years, given 45 1-day courses in acupuncture involving 450 dentists arranged under the umbrella of continuous post-graduate dental education. There is a paucity of evidence in the published dental literature regarding the outcomes after such courses, and the objective of this work was to analyse the outcome after a 1-day acupuncture course.

MATERIALS AND METHODS

In co-operation with the individual post-graduate centres, a questionnaire was posted to all participants to ascertain whether; (a) the dentist has taken up acupuncture; (b) how often acupuncture was used; (c) any reasons for not incorporating acupuncture into the daily practice. To further evaluate the quality of the course, the following questions were addressed; (d) overall rating of the course; (e) the relevance of the course, assessed on a scale from 1 to 6 (1, highly unfavourable; 6, very high favourable).

MAIN OUTCOME

A total of 209 (51.6%) questionnaires were returned, although 15 (3.7%) were subsequently excluded. The male:female ratio of respondents was 3:2, with an average age of 42 and 19 years of experience in dental practice. As many as 46% of respondents had incorporated acupuncture into their practice and 19% reported using acupuncture several times a month. The conditions treated were control of the gag reflex, stress management, sinusitis, headache and facial pain. The main reasons for not taking up acupuncture was 'the dentist never actually got round to starting' (83%) and lack of appropriate patients (60%). Regarding the evaluation of the course, the assessment forms were obtained from 47% of the participants. Participants from all centres rated the course in the top end, 5.3 of 6.0 possible.

The difficulty of recruiting speakers for continuing medical education

BACKGROUND

Obtaining speakers for various continuing medical education (CME) programs can be a challenging and sometimes frustrating process.

PURPOSE

The goal of this study was to quantify the difficulty in recruiting speakers for CME.

METHODS

A retrospective review of planning documents from three CME programs for family physicians was conducted. Descriptive analysis and analysis of variance testing was performed on the data collected.

RESULTS

In all three programs, obtaining speakers has become more difficult over the past 3 years with 1.75 [standard deviation (SD)=1.46] to 2.32 (SD=1.85) mean requests. Finding speakers for rural programs is more challenging than local CME sessions with 2.11 (SD=1.78) compared with 1.68 (SD=1.12) mean requests, respectively. University faculty represent 45.7% of CME speakers.

CONCLUSIONS

This is the first study to document the increasing difficulty of recruiting speakers for CME. This significant difficulty in speaker recruitment has several implications for the CME offices and physician learners.

A Survey of Self-Perceived Educational Needs of General Dental Practitioners in the Merseyside Region

Aim

The aim of this study was to evaluate the self-perceived educational needs of a randomly selected group of general dental practitioners (GDPs) in the Merseyside region (UK).

Materials and Methods

Eighty-seven GDPs were randomly selected from 850 in the region and asked to complete a self-evaluation questionnaire regarding their self-perceived educational needs.

Results

Seventy-five (86%) responded, of which 52 (69.3%) were male and 23 (30.7%) female. There was no significant difference in self-perceived knowledge in any of the dental disciplines when gender and period of time since qualification were used as predictor variables. The majority of the GDPs felt they had a good knowledge of restorative dentistry and dental radiography. Some of the GDPs felt they had poor knowledge in implant dentistry, oral medicine, orthodontics, dental sedation techniques, oral surgery, endodontics, periodontics and dental radiography. None of the respondents felt they had poor knowledge in restorative dentistry, prosthodontics and paediatric dentistry. Seventy-four (98.7%) of the responding GDPs were motivated to attend continuing professional development (CPD) courses because of an interest in a particular dental discipline and only one reported attending out of personal learning needs. Implant dentistry was indicated by 30 (40.0%) of the respondents as their training programme of choice.

Conclusions

The respondents had high self-perceived knowledge of restorative dentistry, dental radiography, periodontics, endodontics, paediatric dentistry and prosthodontics. The respondents had low self-perceived knowledge of implant dentistry, orthodontics, oral medicine and dental sedation techniques. Of GDPs surveyed, 98.7% applied for courses they liked to attend, rather than needed to attend. Fifty-two per cent of male GDPs surveyed expressed a desire for training in implant dentistry.

Attendance at and self-perceived need for continuing education among Mongolian dentists

In May 2000, a questionnaire-based survey was targeted at all Mongolian dentists practising in the capital city of Mongolia in May 2000 with the aim of evaluating attendance at and the self-perceived need for continuing education (CE) in relation to their background characteristics and to their attitude towards CE. The response rate was 98% (n = 245), with 38% of the dentists reporting a CE learning opportunity in at least one of the clinical disciplines of dentistry during the 2 years prior to the survey. A need for CE in at least one of the disciplines was perceived by 58%. A dentist's field of practice and attitude towards CE were the significant factors for attendance, whereas length of working experience, field of practice, holding a postgraduate degree, and having attended CE courses were significant factors for perceiving a need for CE, when controlling for all other variables in the logistic regression analyses (P < 0.05). There seems to be a need for an increased attendance at CE courses among the dentists and a need for preparing them to have a positive attitude towards CE. On the other hand, creating an organized CE system which produces courses for dental practitioners, based on their need, will be at present a challenge for the Mongolian dental profession.