Continuing education courses in dentistry: assessing impact on practice

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.

Assessing dentists' knowledge and experience in restoring endodontically treated teeth using post & cores

OBJECTIVES

The restoration of endodontically, heavily filled teeth has been a challenge for the dental profession for decades. The aims of this study were to investigate dentists' experience and knowledge in the use of post & core when restoring endodontically treated teeth.

METHOD

This was a mixed method study incorporating quantitative and qualitative data collection. An online questionnaire was developed and distributed, comprised of 18 questions. It was calculated that 93 respondents were needed to validate the study of which 60% should meet a minimum knowledge requirement.

RESULTS

173 respondents completed the questionnaire. 109 (63% (95%CI56%,70%) demonstrated proficient knowledge of post & core restorations. Recent graduates were more likely to follow current guidelines (F = 4.570: P<0.034). As the age of respondent dentists increases the number of posts placed (F = 18.85; p<0.001) and the perceived confidence level increases (Spearman's Rho 0.43: P<0.01). Experience of postgraduate education also positively influenced clinical confidence.

CONCLUSION

The placement of post & cores is influenced by age. Confidence is also influenced by age. More evidence on post usage is required and several questions remain to be answered on what drives decision making and perceived long-term success.

CLINICAL SIGNIFICANCE

There is a general acceptance of when a post and core restoration should be used. Clinician experience and age can have an impact on what type of restorations are used. Fibre posts are more commonly used due their accessibility and cost.

Participants' assessments of the continuing educational program with the delivery mode of a periodontal alliance

OBJECTIVE

To evaluate the effectiveness of the periodontal continuing educational delivery mode via a periodontal alliance.

METHODS

An innovative continuing educational delivery mode via a periodontal alliance has been conducted using a periodontal alliance of 30 hospitals in 18 provinces of China. This delivery mode integrates several instructional methods, including lectures, case presentations, and interactive question and answer sessions, all of which were conducted through online platforms. The effectiveness of the mode was evaluated via a questionnaire that was administered to the participants. The questionnaire consisted of 13 closed-ended questions and 2 open-ended questions.

RESULTS

Of the 450 participants, 343 (76%) returned the questionnaire. Of the returned surveys, more than 92% provided positive feedback regarding the instructional methods of the program, stating that the techniques helped them study more efficiently and saved them time and money. More than 85% of the participants were satisfied with the instructional content and more than 90% of the participants considered the educational value of the program to be high, as it helped them identify gaps in knowledge, promoted their ability to establish treatment plans, and encouraged them to network with one another and thereby establish a supportive environment. With respect to the responses to the open-ended questions, the participants claimed that the most useful aspects of the program were related to time and cost savings. The most frequent feedback with respect to improving the program was to include hands-on courses and to divide the program into different levels.

CONCLUSIONS

The participants responded positively to the program. The periodontal alliance delivery mode was determined to be an effective way to improve the quality of continuing dental education.

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.

Understanding continuous professional development participation and choice of mid-career general dental practitioners

OBJECTIVE

Participating in continuing professional development (CPD) activities is a requirement for dental practitioners to keep their skills and knowledge up to date. Understanding the ways dental practitioners engage with professional development and the impact on practice is not fully known (Eaton et al. 2011, http://www.gdc-uk.org/Aboutus/policy/Documents/Impact%20Of%20CPD%20In%20Dentistry.pdf). The aim of this study was to gain insights into the ways that dentists reflect on their professional development and what may be influencing their choices.

METHOD

Empirical qualitative data were collected by semi-structured interviewing of five mid-career dentists. Using grounded theory, the data were analysed for themes about CPD choice and participation.

RESULTS

Three themes were identified as influences to dentists' choices of CPD with pragmatic considerations of how new learning could benefit their patients and their practices. Dental practitioners were influenced by the requirements of external regulatory bodies which they did not consider to necessarily improve practice.

CONCLUSION

Dentists working in primary care in the UK are undertaking CPD which is influenced by the pragmatic requirements of running a small business and to meet regulatory requirements. In this sample, dentists are not critically reflecting on their education needs when choosing their CPD activity. Protected learning time and organisational feedback and support are recommended as a way to promote more meaningful reflection on learning and to improve professional development.

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.

Evaluation of a pilot hands-on course in surgical dentistry for primary care dental practitioners in Oxfordshire

OBJECTIVES

To evaluate the impact of a course in surgical dentistry on the confidence of 32 general dental practitioners, each of whom attended a one-day hands-on course.

DESIGN

Questionnaire survey.

SETTING

General dental practitioners attending a course on surgical dentistry, which was run over a day, for eight participants per day.

RESULTS

The course was rated highly by participants. The hands-on component was particularly well received. Confidence scores increased for several surgical procedures, particularly for removal of impacted teeth and for apicectomies of single-rooted teeth. There were concomitant decreases in the proportion of participants who said that they would refer patients requiring these surgical procedures. Confidence scores remained low for complex procedures such as molar apicectomies. However, it would be appropriate to refer these cases for specialist care.

CONCLUSIONS

The results of this pilot study indicated that a course in surgical dentistry was successful in increasing the confidence of a small group of general dental practitioners. More research is needed to determine whether this is the most effective way of helping practitioners maintain and improve skills and confidence in surgical dentistry.

Chiropractors' attitudes to, and perceptions of, the impact of continuing professional education on clinical practice

OBJECTIVES

As with other health care professions, there is a need for chiropractors to maintain their clinical competencies through continuing professional education (CPE) and development (CPD). This study set out to evaluate chiropractors' attitudes to, and opinions of, current CPE provision, and their perceived needs for the future. In particular, their perceptions of the impact of CPE on clinical practice were assessed.

DESIGN

A survey in which primary quantitative and secondary qualitative data were collected using a self-administered questionnaire. The questionnaire concentrated on four areas: (i) attitudes to CPE; (ii) impact of current CPE on practice; (iii) modes of delivery most likely to change practice; and (iv) future learning needs from continuing education programmes.

RESPONDENTS

A random sample of chiropractors registered with the British Chiropractic Association.

RESULTS

Overall, chiropractors were positive to CPE and cognisant of the need to keep up to date. However, in spite of several benefits, chiropractors did not perceive current CPE to be instrumental in changing practice. As might be expected, chiropractors perceived clinical updates and hands-on practical workshops to be most effective in changing clinical practice.

DISCUSSION

There is currently considerable debate surrounding the ability of CPE and CPD to actually make a difference to the way clinicians practice. This study describes a method of evaluating the impact of CPE/D in changing clinical practice from the viewpoint of the practitioners themselves.

A framework for the evaluation of continuing education short courses in dentistry

The objective of this paper is to propose an evaluation framework for short courses in continuing education for general dental practitioners (GDPs) (so called, Section 63 courses). Existing monitoring and evaluation procedures in the West Midlands deanery were examined and an improved evaluation framework was then devised, piloted and revised. A 5 phase method was used incorporating the examination of existing practice (Phases 1 and 2), development of a new framework (Phase 3), piloting (Phase 4) and revision of the evaluation framework in the light of the pilot. This approach will be implemented in the West Midlands and may be adapted for national use (Phase 5). It was found that existing monitoring and evaluation was inconsistent in prevalence and scope. Those involved in short courses were in favour of a more consistent and visible evaluation, including some assessment of impact-on-practice and cost-effectiveness. In conclusion, meaningful evaluation needs to include four key processes: data gathering; data analysis; dissemination and, action planning (reviewing provision in the light of the data analysis). Thus, this evaluation framework feeds into a quality development cycle designed to ensure high quality and relevant short course provision for general dental practitioners.