The Undergraduate preparation of dentists: Confidence levels of final year dental students at the School of Dentistry in Cardiff

Objective To investigate the self-reported confidence and preparedness of final year undergraduate students in undertaking a range of clinical procedures. Methods A questionnaire was distributed to final year dental students at Cardiff University, six months prior to graduation. Respondents rated their confidence in undertaking 39 clinical procedures using a 5-point scale (1 = can undertake on own with confidence, 5 = unable to undertake). Students also responded yes/no to experiencing four difficulties and to three statements about general preparedness. Results 71% (N = 51) responded of which 55% (N = 28) were female. Over half reported being 'anxious that the supervisor was not helping enough' (57%) and 'relying heavily on supervisor for help' (53%). Eighty percent 'felt unprepared for the clinical work presented' and gender differences were most notable here (male: 65% N = 33; females: 93% N = 47). Mean confidence scores were calculated for each clinical procedure (1 = lowest; 5 = highest). Confidence was highest in performing 'simple scale' and 'fissure sealant' (mean-score = 5). Lowest scores were reported for 'surgical extractions involving a flap (mean-score = 2.28)', 'simple surgical procedures' (mean-score = 2.58) and the 'design/fit/adjustment of orthodontic appliances' (mean-score = 2.88). Conclusions As expected complex procedures that were least practised scored the lowest in overall mean confidence. Gender differences were noted in self-reported confidence for carrying out treatment unsupervised and feeling unprepared for clinical work

Professionalism in the dental practice: perspectives from members of the public, dentists and dental care professionals

Introduction This paper examines views on professionalism in the dental practice workplace through a thematic analysis of data from eight focus groups. Methods Focus groups were conducted with 19 dentists, 13 dental care professionals and 19 members of the public in England and Wales. The research was part of a larger mixed-methods study of professionalism in dentistry commissioned by the General Dental Council. Results The four most prominent themes in the focus group data were: communication, the cost of treatment, the role of the dental team and consequences of professionalism concerns. Participants agreed that these are fundamental professionalism issues, although there was some difference of opinion about addressing them. There was disagreement about the responsibilities of different members of the dental team in maintaining professionalism. Conclusion We conclude that communication skills training should be a central part of the professionalism at all levels of training. Education about team working could foster a more collaborative approach to professionalism across the dental team and support good, patient-centred oral healthcare. Support and guidance are required to help professionals reflect and learn from mistakes

A whole-team approach to optimising general dental practice teamwork: development of the Skills-optimisation Self-evaluation Toolkit (SOSET)

Introduction Studies across the health service reveal benefits of teamwork and barriers to its optimal use. Drawing upon the established Maturity Matrix Dentistry method, the Skills Optimisation Self-Evaluation Toolkit (SOSET) was developed to enable the whole dental team to critically review how they address skill-mix in delivery of patient-centred oral healthcare in their practice. This paper outlines the development of the SOSET and explores its usefulness to general dental practice teams. Methods Research literature and interview data from general dental practice teams were coded for high-level factors (positive and negative) influencing teamwork. We used this coding to identify skill-mix domains, and within each, define criteria. The SOSET process was refined following consultations with dental professionals and piloting. Results Eighty-four papers were coded and 38 dental team members were interviewed across six sites. The SOSET matrix was developed containing nine domains reflecting the use of skill-mix, each containing six development-level criteria. The domains addressed factors such as team beliefs on skill-mix and knowledge of team members' scope of practice, patient demand, the business case, staffing and training, and the practice premises. The process was piloted in 11 practices across South Wales, and feedback was received from 92 staff members. Results showed that the SOSET process was straightforward, that the whole team could contribute to discussion and that it would be used to improve practice. Following piloting, four domains were merged into two new domains, and the number of criteria within all domains was reduced and the wording simplified (seven domains, with four criteria each). Conclusion We used a systematic and rigorous process to develop the SOSET to support dental teams to progress their teamwork practices. Its usefulness was demonstrated in the pilot. The SOSET is now being offered to general dental practices across Wales

The dental core training experience: the views of trainees and their postgraduate training leads

Introduction Dental core training (DCT) is an optional, postgraduate programme with a duration of one to three years that dentists in the UK can pursue to further strengthen their skillset. Aims To understand career motivations and preferences of trainees pursuing DCT, and their perceptions and experiences of the programme. Methods Data were gathered from 176 DCT trainees across England through focus groups or individual paper-based responses to questions, as well as telephone interviews with ten associate postgraduate dental deans/training programme directors. Results Trainees were generally positive about their overall DCT experience. They developed confidence, self-reliance and skills in teamwork and clinical aspects, gaining from exposure to conditions uncommon in general practice. Limitations and challenges varied by post and unit. The importance of broad, cross-specialty experience was recognised. Although run-through training would eliminate unwelcome annual relocation, it was deemed unsuitable for all trainees, particularly those intending a career in general practice. Conclusion DCT appears to be advantageous for those intending careers in general dental practice, those aiming for specialist practice and those uncertain of their future career trajectory. Although trainees reported positive training experiences and significant gains, future considerations are suggested, including maintaining flexibility to accommodate different motives for DCT and limiting across-unit variation

Are the standards of professionalism expected in dentistry justified? Views of dental professionals and the public

Introduction: In the UK, the General Dental Council specifies nine principles of professional standards that dental registrants must follow. There are views that such standards are high, patients' expectations are rising, and the professionalism of dental professionals is increasingly scrutinised. This paper explores whether the high standards expected in dentistry are justified. Methods: We applied thematic analysis to 772 free-text responses from dental team members and the public to a modified Delphi survey. Respondents described their views of professional and unprofessional behaviours in dentistry. Data were obtained as part of a larger review of professionalism in dentistry. Results: Two lines of argument were identified: professionalism standards are high, but justifiably so; and professionalism standards are too high. Within these, four broad themes emerged: patient trust; comparison with other professions; a culture of fear; and perfection. Conclusion: High professionalism standards are justified in a profession where patient trust is paramount. However, a problem lies in the culture that surrounds professionalism in terms of litigation and dental professionals feel pressure to possess an unattainable, infallible nature. These negative impacts need minimising. We suggest that undergraduates and continuing professional development approach professionalism with care, to foster a supportive, positive and reflective culture of professionalism

Clinical skills of a new foundation dentist: the expectations of dental foundation educational supervisors

Aim To investigate dental foundation (DF) educational supervisors' (ES) expectations of the level of clinical ability expected of a foundation dentist (FD) on entry into foundation training. Methods Following ethical approval, a pre-piloted online questionnaire was circulated to ESs across England and Northern Ireland (n = 959), requiring respondents to rate their expectations of their FDs' ability at the beginning of the training year, in relation to undertaking 104 clinical skills. A five-point scale and descriptors were provided, ranging from 'on own with confidence' to 'unable to undertake'. Respondents were invited to comment further. Data were imported into IBM SPSS (v20) and descriptive analysis was undertaken. Expectations were assigned values and a mean, 'skill rank score' was generated for each skill. A ranking score closer to five indicated high expectation; closer to one indicated low expectation. Results A total of 510 (53%) questionnaires were completed. The study highlighted a range of expectations which were used to identify 'upper-level' (core) skills expected of a new FD. The majority of expectations were in line with UG curriculum guidance; however, certain skills were identified as having overly high expectations and these may need to be modified to align with current guidance. Conclusions Understanding the expectations ESs have of a new FD is useful for both dental schools and those involved in DF training. Findings add to the existing evidence base and should generate discussion for those within the education continuum to enhance the successful development of the FD

The blurred lines of professionalism in dentistry

Introduction Literature surrounding the definition, portrayal and teaching of professionalism in dentistry is widespread. However, there has been substantially less focus on the boundaries of professionalism and what constitutes unprofessional or a lapse in professionalism. Aims What about a dentist's conduct calls their professionalism into question? In exploring this, we shed light on where the boundary between professional and unprofessional conduct is blurred. Methods Drawing on data from a larger study, we conducted a thematic analysis on a series of statements surrounding professionalism and 772 open-text online survey responses from dental professionals and the public. Results Professionalism in dentistry and the circumstances where it is brought into question appears to centre around patient trust. Blurriness occurs when we consider how trust is established. Two lines of argument were constructed: patients' trust in the professionalism of their dentist is founded on any behaviour bearing a direct influence on clinical care or that challenges the law; and patients' trust also extends to aspects that reveal the inherent character of the dentist and that can threaten their integrity. Conclusion We recommend an approach to professionalism that mirrors a dentist's approach to clinical practice: learned and tailored interactions, and judgement and reflection

Skill-mix in the dental team: future directions and support mechanisms

It is a time of change: in patient demographics and treatment needs; in the composition of dental teams; and in NHS dental contracts and arrangements for Direct Access. Although studies across the health service reveal benefits from better use of skill-mix, there are significant barriers to the optimisation of skill-mix in dental practice. To help practices to optimise skill-mix, we developed and tested a whole-team self-evaluation tool. The Skills Optimiser Self-Evaluation Tool (SOSET) is a process that has a team meeting with a Quality Improvement (QI) tutor at its core. During the session, the team discusses the descriptions of four criteria or levels within each of the seven dimensions. The team celebrates areas where the practice is doing really well and agrees priorities for improvement. A ‘Sources of Help and Advice’ document is provided, and the QI Tutor may also offer further resources. The development of the SOSET was based on an analysis of existing evidence and its usefulness for setting objectives for optimising dental team skill-mix has been demonstrated in the pilot testing

Skill-mix in the dental team: future directions and support mechanisms

It is a time of change: in patient demographics and treatment needs; in the composition of dental teams; and in NHS dental contracts and arrangements for Direct Access. Although studies across the health service reveal benefits from better use of skill-mix, there are significant barriers to the optimisation of skill-mix in dental practice. To help practices to optimise skill-mix, we developed and tested a whole-team self-evaluation tool. The Skills Optimiser Self-Evaluation Tool (SOSET) is a process that has a team meeting with a Quality Improvement (QI) tutor at its core. During the session, the team discusses the descriptions of four criteria or levels within each of the seven dimensions. The team celebrates areas where the practice is doing really well and agrees priorities for improvement. A ‘Sources of Help and Advice’ document is provided, and the QI Tutor may also offer further resources. The development of the SOSET was based on an analysis of existing evidence and its usefulness for setting objectives for optimising dental team skill-mix has been demonstrated in the pilot testing