The standard of newly qualified dental graduates - foundation trainer perceptions

Preparedness and competency of New Zealand graduates for general dental practice - perceptions from the workforce

BACKGROUND

Dental graduates need to demonstrate clinical competency. This mixed-methods study explored the perceptions of clinicians who employ or work with new graduates from the University of Otago, New Zealand, and identified themes reflecting graduates' preparedness for independent practice.

METHODS

An online survey using a semantic differential scale and open-ended questions collected opinions and experiences from the workforce. Quantitative data were analysed using SPSS software, and qualitative data were analysed thematically.

RESULTS

A representative sample of the workforce was obtained with a response rate of 35% (N = 83). Most clinicians engage new graduates to support the profession and/or rural communities. They perceived that graduates were well prepared in most areas, could translate theory to clinical practice and demonstrate professionalism. Graduates were reportedly stronger in basic dentistry, communication, ethics, and record keeping however were less strong in complex treatment planning, molar endodontics, fixed prosthodontics and exodontia. Clinical exposure during dental training was perceived as more limited, and mentoring and guidance in the transition to practice were deemed to be important.

CONCLUSIONS

New Zealand dental graduates appear prepared for independent practice; however, maximising clinical opportunities during training, mentoring and early professional development in advanced areas of practice is essential to enhance competency and confidence.

Mind the 'GAPP': a pre-graduation assessment of preparedness for practice amid a pandemic

Introduction 'Preparedness for practice' refers to a multifaceted concept, encompassing not only clinical skills, but also broader, non-clinical skills, such as communication and professionalism. Previous graduates have reported feeling less prepared for complex procedures, such as molar endodontics and surgical extractions. Dental students typically utilise their final year to refine their clinical skills, however, the COVID-19 pandemic has meant that newly qualified dentists will have had around six months where they have not performed clinical dentistry before beginning dental foundation training (DFT).

Aims This study aimed to explore final year students' self-reported preparedness for practice, identify areas of relative weakness that may influence future training needs and to highlight any perceived impact of the pandemic on final year experience and potential impact on DFT.

Materials and methods The current Graduate Assessment of Preparedness for Practice (GAPP) questionnaire was adapted for our specific research aims and piloted and the PreGAPP questionnaire distributed via the social media channels of dental school student societies. Analysis was carried out using IBM Statistical Package for the Social Sciences software using descriptive statistics and the Mann-Whitney U test for two unrelated variables.

Results Responses were received from final year students across all 16 UK dental schools. Students reported increased preparedness across domains in which they had the most experience; for example, providing preventative advice and administering local anaesthesia. Male students reported feeling significantly more prepared than female students, mature students significantly more than younger students, and students on four-year courses significantly more than traditional five-year courses. The COVID-19 pandemic was expected to have a major-to-severe impact on undergraduate experience and future DFT prospects.

Conclusion Dental graduates in the COVID-19 era may have significantly different training needs to those before them. Complex clinical procedures remain the areas where students feel they are least prepared for practice. The importance of a clinical passport to highlight current experience level to trainers, alongside the creation of a personal development plan at the beginning of DFT, will ensure that targeted and personalised training can be implemented where required.

Illustrates the perceived effect of the COVID-19 pandemic on final year students' preparedness for practice and the impact it may have on dental foundation training through quantitative and qualitative methods.

Highlights and explores the differences in the perceptions of preparedness for practice of final year students across sex, age and course length.

Explores various aspects of clinical supervision and assessment and reinforces the importance of appropriate student-staff ratios to ensure clinical learning is effective.

From inputs to outputs: an analysis of the changes to learning outcomes for dental undergraduate education in the UK

Introduction/aims Preparing for practice (PfP) was thought to represent a significant shift in the expectations of dental undergraduates compared to its predecessor, The first five years (TFFY). This project aimed to explore requirement changes by comparing learning outcomes for undergraduate dentists in these two documents. Changes in curriculum requirements defining clinical, professional, or a blend of these skills were also investigated.

Methods Curriculum mapping was used to compare learning outcomes in PfP to requirements in TFFY.

Results The total number of learning outcomes increased from 101 to 149 in PfP compared to TFFY. There was a proportional reduction in outcomes describing clinical skills and an increase in the proportion of outcomes describing professional and blended skills. Three TFFY requirements did not appear in PfP and a further 23 learning outcomes in PfP were absent in TFFY.

Conclusions In the transition from TFFY to PfP, there has been an overall increase in the number of outcomes graduates must attain before they can register with the General Dental Council. There are more outcomes defining professionalism which subsequently has resulted in proportional but not actual decrease in outcomes related to clinical skills. While there is uncertainty over how schools have managed curricula to incorporate these changes and thus whether the perception of graduate preparedness can be directly attributable to these changes, it is timely to consider any changes within dental learning outcomes in the context of preparedness concerns.

Highlights developments in content and structure of learning outcomes for dentists in the revision from The first five years to Preparing for practice.

Considers how professional and clinical skills have been incorporated into curricula.

Acknowledges the importance of stakeholder involvement when revising learning outcomes so that there is a clear understanding of the skillset of the dental graduate.

An investigation into the oral surgery curriculum and undergraduate experience in a sample of DFT's in the UK

AIM

There is conflicting evidence concerning the ability of recent graduates to meet the standards required in exodontia to be independent practitioners. In particular, there is a lack of confidence in surgical extractions. This study evaluated Foundation Trainee's confidence levels in their oral surgery experience and the teaching of oral surgery in UK dental schools.

MATERIALS AND METHODS

Two separate studies were carried out, and the first was a survey to all foundation trainees in the Yorkshire and Humber Deanary in 2019 which analysed their oral surgery experience and confidence levels. The second study surveyed all Dental Schools in the UK with regard to their contact hours, assessment methods, instruments taught and number of extractions in oral surgery for their undergraduate programmes.

RESULTS

There was a response rate of 52% for the foundation trainees which showed that they were confident in performing non-surgical extractions but lacked confidence with surgical extractions. There was a positive correlation between the amount of undergraduate experience and confidence levels in exodontia. The second survey which had a response rate of 71% showed variations in the numbers of hours taught for oral surgery, instruments taught and assessment methods, with the structured clinical operative test used more commonly. On average, 41 non-surgical extractions were performed by students before graduation and two surgical extractions.

CONCLUSION

There is a need to identify how oral surgery teaching can be improved in UK dental schools to ensure that foundation trainees are more confident and competent in both surgical and non-surgical exodontia. In addition, teaching and assessment methods need to be developed to reflect such requirements.

Dental foundation training in the COVID-19 era - the national recruitment lottery

National recruitment has radically transformed the selection and allocation of dental graduates to dental foundation training (DFT) schemes across England, Wales and Northern Ireland, with recruitment in Scotland via a separate, independent process. It has been reported as a mostly positive change to the previous deanery-led model, in which nepotism allegedly featured too widely. A candidate's ranking is typically based on performance across two face-to-face assessments and a situational judgement test (SJT). The COVID-19 pandemic, however, has created a recruitment 'lottery' of sorts, in which ranking for 2021 is now solely based on the SJT. Subject matter experts assert that neither preparation nor revision for the SJT is required; yet, following the announcement of the adaptation to DFT recruitment for September 2021, a rapid rise of exorbitantly priced SJT question banks, mock papers, workshops and courses has ensued - a shameless monetisation of the collective angst and increased pressure faced by dental students. Preparation courses present a conceivable risk of SJT 'coaching' and 'faking'. Where medicine leads, dentistry usually follows and future selection to DFT needs to strongly consider the introduction of academic performance measures. SJTs remain one of the most well-accepted, reliable and cost-effective means of selection into healthcare roles, however, only when part of a wider selection process.

The potential no man's land for the 4th year dental graduate

The Royal College of Surgeons of England stipulates that to hold a substantive specialty or associate specialist (SAS) grade post a person must be a minimum of 4 years post-graduation and have at least 2 years' experience in their chosen speciality. We have noticed an increasing number of excellent applications for specialty doctor adverts posted by our trust without the necessary 4 years of post-graduate experience. Many of these applicants who do not comply with the RCS stipulations may be forced to take a job outside of their chosen career path. The reasons for this may be multifactorial, but it could have a worrying impact on their own future career and hospital service provision. We looked at the number of SAS grade adverts placed on NHS jobs in the year 2019 and the type of job advertised. We also considered the possible reasons for a rise in the number of applicants for SAS roles in oral surgery and oral and maxillofacial surgery, and what changes, if any, could be made to support this group of clinicians.

Perceptions of students on a stand-alone dental materials course in a revised dental curriculum

BACKGROUND

The Dental Materials (DM) course was introduced as a stand-alone course in 2013, at the University. Prior to that, DM was integrated into clinical courses.

OBJECTIVE

To determine the perceptions of the Bachelor of Dental Science (BDS2 to BDS5) students on a stand-alone DM course following curricular amendment.

METHODS

This was a cross-sectional study, in which a simple random sampling strategy was used, with forty-six students participating. The study was conducted in 2017. A self-administered, structured, validated questionnaire was used to collect data. The obtained data were summarised and analysed using descriptive and inferential statistics (one-way ANOVA).

RESULTS

The study was conducted on Bachelor of Dental Science (BDS2 to BDS5) students. A response rate of 49% from the administered questionnaires was achieved. The overall perception, total mean percentage score of 71.4% was obtained showing a generally positive view on the relevance of the course by students. A total mean percentage score of 74.1% showed the students' view that the DM course was well managed whilst a total mean score of 56.7% expressed the overall view on the reintegration of DM into clinical courses.

CONCLUSION

The students felt that DM was relevant and it could continue as a stand-alone course. They perceived that the course was run effectively and managed well, but they had conflicting views on reintegration of the course into clinical modules. Studies with larger sample sizes at other Dental Schools are recommended to determine similarity of results.

Preparing dental students for independent practice: a scoping review of methods and trends in undergraduate clinical skills teaching in the UK and Ireland

Introduction The governing bodies for dentistry in the UK and Ireland require dentists, at graduation, to possess the knowledge, skills and attributes which enable them to practise safely, without supervision. The means by which dental schools achieve this may differ and may undergo modification in response to changes in the expectations of governing bodies and challenges within the teaching environment. It is therefore important to identify which of these approaches works well and to disseminate good practice described in the literature.Objectives To use a scoping review to identify from the published literature the methods used to teach clinical dental skills, including innovations, motivations for changes, and factors affecting the delivery and quality of teaching.Method Scoping review methodology was used to select and analyse 57 articles published between 2008 and 2018.Results Innovations in didactic teaching were facilitated by advances in IT and development of virtual learning environments, which promoted independent, self-directed learning. Pre-clinical practical teaching took place in clinical techniques laboratories utilising mannequin heads, with a minority of dental schools using virtual reality simulators in addition. Clinical experience was gained mainly in multi-disciplinary clinics and offsite outreach teaching centres. Insufficient numbers of suitable patients, increasing student numbers and a fall in teaching staff contributed to a reported reduction in clinical experience of certain treatments.Conclusions Contemporary clinical dental skills teaching produces new graduates who possess excellent theoretical knowledge, are prepared and confident in basic clinical skills, but are lacking in experience of complex treatments which may result in a reduced preparedness for independent practice.

Current trends in endodontic irrigation amongst general dental practitioners and dental schools within the United Kingdom and Ireland: a cross-sectional survey

Aims To investigate current trends in endodontic irrigation amongst general dental practitioners (GDPs) and dental schools within UK and Ireland. Secondly, to evaluate if significant differences exist between the irrigant practices of National Health Service (NHS) and private GDPs.Methodology In 2019, an online questionnaire was distributed to the 18 dental schools within the UK and Ireland and 8,568 GDPs. These surveys explored current trends in teaching and usage of endodontic irrigants. Chi-squared tests were performed to make comparisons between NHS and private GDPs (α <0.01).Results All 18 dental schools (100%) and 495 GDPs (6%) returned valid questionnaires. Three hundred and thirty (66.7%) practitioners were NHS and 165 (33.3%) were private. There was strong consensus on irrigation teaching amongst dental schools. These results aligned with GDP responses in terms of irrigant selection (sodium hypochlorite [NaOCl]); NaOCl concentration (≤3%); ethylenediaminetetraacetic acid (EDTA) contact time (>0-5 minutes); final rinse protocols (penultimate EDTA rinse); irrigant temperature (room); and agitation techniques (manual dynamic activation; >0-60 seconds). There was, however, considerable variation in NaOCl contact time and GDPs infrequently used chelating agents or agitation techniques. Compared with private practitioners, NHS GDPs used significantly lower NaOCl contact times and concentrations, less EDTA and activation techniques, and more chlorhexidine (P <0.01).Conclusions Overall, irrigation teaching within the UK and Ireland is consistent and evidence-based. Furthermore, trends in irrigant usage amongst UK GDPs are now more aligned with these teaching practices. Significant differences were, however, observed between NHS and private practitioners.

Professionalism in undergraduate dental education: a pause for thought

Professionalism in dental education, as well as in the wider dental profession, is a regularly discussed and debated topic. It may seem obvious what is meant by 'professionalism' and in many situations it is clear what constitutes a professional approach or behaviour, but contention exists in how to articulate, measure and consider aspects of this complex and context dependent phenomenon. Getting 'it' right early on, with our students and new graduates, is a strategic priority, contributing to 'upstream' activities which have an intention of preventing future issues or harm. The aim of this article is to summarise the challenges faced by providers of undergraduate education (and the dental regulator) in the UK in defining and determining attainment of 'professionalism' before registration. It is timely to take an opportunity for pause, re-assess frameworks and consider future direction.

The Confidence of Undergraduate Dental Students When Undertaking Indirect Restorations

The General Dental Council expects United Kingdom graduating dentists to be competent at providing crown and bridge treatments and graduating students should feel confident to undertake these treatments. The aim of this study was to explore the confidence of undergraduate dental students when providing crown and fixed dental prosthesis treatments. An anonymous questionnaire was distributed to all (n = 198) undergraduate students in Years 3 to 5 at Bristol Dental School. The questionnaire comprised confidence interval ranked responses, and respondents’ data was analysed using SPSS. The response rate was 76%. Undergraduate perception of confidence increased throughout the three years of study (p < 0.01). There was a strong association between the amount of exposure students had to certain treatment stages and their perceived confidence levels. Confidence levels may be increased further with increased clinical experience.

Tier 2: A Warm welcome or a Cold Reality?

Since the introduction of the 2006 NHS dental contract, various waiting list initiatives and the subsequent release of NHS commissioning guidance for dental services, there has been a remarkable and rapid shift towards the provision of intermediate services within the profession. the complexity surrounding those non-specialist providers working within these services has lead to much confusion and the further development of competencies required to work within these settings. this paper focuses on explaining and exploring the topics that arise from an area that has attracted much discussion and debate.