Chairside learning on undergraduate clinics: general dental and human disease themes.

Introduction Chairside teaching is an important part of dental undergraduate clinical education. Bedside teaching is well-reported in relation to undergraduate medicine but few publications relate to undergraduate dentistry.Aims and objectives To investigate the experience and benefits from chairside teaching/learning in the clinical years of a five-year dental programme in a UK university. We asked about general dental topic learning as well as human disease (HD) learning.Materials and methods An online survey gathered dental students' opinions on their recognition, knowledge and experience of chairside teaching/learning. We asked about clinics and clinicians and where they gained most from chairside teaching/learning. We encouraged free-text responses.Results Altogether, 127 students took part (62% response). Response rates approximated 60% for all three years. In total, 93% felt that chairside teaching/learning helped to a moderate/great extent for general dental topics and 73% felt that chairside teaching/learning helped to a moderate/great extent for HD topics. Free-text comments revealed students valued chairside teaching/learning and from which grade/level of staff they learned most.Discussion and conclusion Chairside teaching/learning is largely unreported and unrecognised in undergraduate education. Although not formally timetabled, enthusiastic staff with enough time to engage in chairside teaching can have a positive impact on student learning.

Inclusion of clinical photographs with general dental practitioner electronic referrals of patients with oral mucosal disease to secondary care: a service review.

Introduction This service evaluation reviewed how the inclusion of photographs in dentist referrals to an oral medicine specialist service can improve the service for triage, prioritisation and diagnosis.Materials and methods Data were prospectively collected from e-referrals over a four-month period. Any change in appointment prioritisation resulting from review of photographs at the vetting stage was recorded.Results Only 29.5% (82 of 367) of referrals included a photograph. Of these, 5% were 'rejected with advice' since the photograph indicated the patient did not require a secondary care appointment. Additionally, 14% of all referrals were upgraded in urgency, five of which were due to concerns of malignancy, and three of five were upgraded solely based on the photographs as they showed features of possible malignancy, where the written element of the referral did not describe nor raise such concerns.Discussion and conclusions Including a photograph with a referral can often make up for inaccurate or insufficient written content, allowing appropriate and safe prioritisation, especially where the referrer has failed to recognise possible malignancy. Photographs can also prevent unnecessary referral upgrades, ensure an appointment is necessary and can be invaluable as a baseline comparator.

Dental trainee motivations for the acquisition and use of postgraduate qualifications in medical education.

Introduction Medical and dental education is increasingly professionalised. The expectation is that educators have appropriate training and qualifications. Entry to dental speciality training is highly competitive and applications are scored using defined criteria, including experience in education.Material and methods We surveyed a group of junior trainees who had enrolled on postgraduate medical education courses to find out more about their motivations and use of their knowledge and qualifications. An online survey tool was used with anonymous participants who had been in junior training jobs in a university dental school, with 117 possible participants.Results In total, 61% of respondents were enrolled in or had completed a postgraduate qualification in medical education, with 85% on a postgraduate certificate programme. Additionally, 77% were in the earliest part of general dental training, and 88% of programmes were distance-learning and cost £2,000 to £4,000. Motivations for enrolling included to 'improve knowledge in medical education' and 'increase my chances of progression through training'.Discussion and conclusions We found the most common intrinsic reason to gain a qualification was to improve knowledge in medical education and the most common extrinsic reason was career progression. Scoring of applications into dental speciality training has changed, with points no longer awarded for completing a postgraduate qualification in medical education.

Oral mucosal disease: dilemmas and challenges in general dental practice.

Oral medicine (OM) is a recognised component of all UK undergraduate dental programmes and practising dentists are expected to safely investigate and manage patients presenting with oral mucosal disease. Delivering OM care for patients in a general dental practice setting does however come with a number of challenges and dilemmas for practitioners.General dental practitioners may be limited in their ability to arrange diagnostic tests such as biopsies or blood tests, important in reaching a definitive OM diagnosis. Lack of operator skill or lack of access to appropriate laboratory facilities to process diagnostic samples will likely contribute to this. In addition, general dental practitioners may feel underconfident to reliably interpret test results. Management of OM patients can also be time-consuming and may not generate a significant remunerative reward under current NHS payment systems.OM is a subject that overlaps with several medical specialities, and up until 2010, required dual qualification in both undergraduate dentistry and medicine. Practitioners who have not undertaken OM training beyond undergraduate dentistry may lack confidence with the subject, and fear of misjudging a lesion of concern will certainly prompt referrals from primary care into hospital-based OM clinics.

Working and training through COVID-19 - completion of UK dental foundation training portfolios: a two-cohort study.

Introduction In March 2020, a cohort of dental foundation trainees (DFTs) were affected by the start of the COVID-19 pandemic. Then, in September 2020, a second cohort of DFTs began their training, with COVID-19 still affecting provision of primary dental care.Aims To study the effects of COVID-19 on these two cohorts by surveying Wales' dental core trainees (DCTs) who had been undertaking dental foundation training (DFTg) in 2019/20 and 2020/21.Materials and methods Following ethical approval, we conducted two online surveys for the 2019/20 and 2020/21 DFTs' cohorts. We compared and contrasted their reported completion of various DFTg curriculum components and any additional skills derived from redeployment.Results A response rate of 52% was achieved for both surveys. All participants successfully completed DFTg; although, some small differences were noted between the cohorts and their ability to fulfil all their portfolio requirements.Discussion Despite the effects of COVID-19, all DFTs were able to demonstrate completion of curriculum elements. The redeployment of three DFTs enhanced their learning. This was comparable to reports from other DFTs who were redeployed in the pandemic.Conclusions All DCTs surveyed from both cohorts successfully completed their DFTg portfolios. In some cases, additional skills were developed, which in the absence of the pandemic, may not have been the case.

NHS funding for dental undergraduate human disease teaching in the UK: a 20-year review.

Introduction This study identifies funding of NHS services supporting dental students' teaching over the last 20 years, focusing on human disease (HD) teaching.Aims To identify NHS funding for education in UK dental schools following publication of the 1997 General Dental Council curriculum introducing specific funding for HD teaching and the years 2015/16 to 2019/20.Material and methods Searches of the medical literature, grey literature (government and regulatory authority reports, legislative articles) and freedom of information requests to hospitals helping to deliver teaching.Results There are few publications describing current funding of dental undergraduate teaching. Freedom of information requests gave data for NHS hospital allocations for teaching both clinical dentistry and HD. HD funding has dropped by £2 million in five years.Conclusions NHS Trusts linked to dental schools receive monies to deliver teaching and offset costs of accommodating students. Tracking these funds over 20 years has seen some schools lose up to £1 million of HD funding and some lose it all. Greater transparency regarding funding for HD delivery would help improve teaching. Increasing numbers of older patients, with a greater chronic disease burden who are retaining teeth into later life, need graduating dentists with good medical knowledge to deliver safe care.

Dental and maxillofacial radiology: confidence, knowledge and skills in the newly graduated dentist.

Introduction The UK General Dental Council says that the new graduate will have the range of skills required to begin working as part of a dental team and be well-prepared for independent practice. This study examines the views of new dental graduates in the area of dental and maxillofacial radiology.Materials and methods A questionnaire survey of newly graduated dentists in Wales and South West England asked about their experience of undergraduate education in dental and maxillofacial radiology, and their confidence in the use and interpretation of imaging techniques in early independent practice.Results Most survey participants were confident in the teaching they had received in dental radiography and radiology, and that they could apply their knowledge and understanding to the more common investigations used in general dental practice. They were less confident in the uncommonly used techniques, such as oblique lateral and lateral cephalometric views.Discussion This study is encouraging in that new dental graduates say that their undergraduate education has given them the knowledge to be able to take, interpret and make clinical diagnoses using the commonest radiological investigations. This tends to validate the undergraduate education received and identifies areas to improve.Conclusion New dental graduates are confident in their knowledge and skills, and apply these to the most commonly used radiological investigations used in general dental practice.

Human disease/clinical medical sciences in dentistry: Current state and future development of undergraduate assessments in the UK and Ireland.

INTRODUCTION: The United Kingdom and Ireland teachers of Human Disease/Clinical Medical Science for Dentistry (HD/CMSD) group continue to work together and most recently collaborated to review current and future assessments. MATERIALS AND METHODS: The first part of the review of assessments in HD/CMSD took place at a face-to-face meeting with presentations from delegates on assessments in their home institutions. The second and larger part comprised an online survey where all eighteen schools in the UK and Ireland participated. RESULTS: All schools had some element of formative assessment, and the majority had a stand-alone summative assessment at the end of the HD/CMSD teaching block. Most schools had a written paper and practical elements to their assessments, most commonly a combination of a multiple-choice type question combined with an objective structured clinical examination (OSCE). There was a trend towards the use of single best answer (SBA) questions and a willingness amongst participants to share a question bank. All schools incorporated elements of HD/CMSD in their final examinations. DISCUSSION AND CONCLUSION: This collaboration promoted the sharing of developments in assessment for HD/CMSD and demonstrated a willingness to cooperate between institutions. Assessment in HD/CMSD in the UK and Ireland continues to be refined by those responsible for its content and delivery, and assessment methods are progressing following evidence-based best practice.

Special care dentistry trainee views on the medical and oral medicine elements of the specialist training curriculum.

INTRODUCTION: Specialty training curricula are subject to periodic update, and trainee views are an important element in identifying which areas need particular focus. In this study, we wished to examine specialty trainee opinions on two areas of a curriculum for special care dentistry, in particular oral medicine, and the component elements of related systemic disease and therapies (RSDT), namely pathology, pharmacology and therapeutics, and human systemic disease. MATERIALS AND METHODS: Following ethical approval, we identified 35 specialty registrars in special care dentistry in the UK and Ireland who were invited to use an online survey tool to gather demographic data and then to ask their views on the delivery of training in oral medicine and RSDT. Respondents were also asked whether sufficient importance was placed on these topics and whether they could be accessed and delivered appropriately. RESULTS: The 23 registrars surveyed comprised a representative group from all parts of the UK and Ireland and were at different stages of specialty training. The majority thought oral medicine and RSDT were key elements of the curriculum and could be given more prominence, especially in the context of an increasingly ageing population with associated oral manifestations of chronic disease, multiple drugs and disabilities. DISCUSSION AND CONCLUSION: The registrars surveyed felt that oral medicine and RSDT and were integral to training and that emphasis and opportunities for training in these areas could be improved, especially for those trainees based outside of a dental hospital setting.

Redefining Medical Competencies for an Oral Medicine Specialty Training Curriculum Using a Modified Delphi Technique.

This article describes the development of medical competencies for oral medicine specialty training in the UK and Ireland by a collaborative working group using a modified Delphi technique. The current specialty training curriculum for oral medicine (OM) in the UK was developed by a working group including members of the British Society for Oral Medicine (BSOM) and members of the Specialty Advisory Committee for Additional Dental Specialties (SACADS) and adopted by the UK General Dental Council (GDC) in 2010. When the curriculum was developed, the entry requirements for specialty training in OM included undergraduate degrees in both dentistry and medicine. At the time of adoption, the requirement for a medical degree was removed. Medical competencies were assumed to have been delivered in medical undergraduate and postgraduate training. Accordingly, there was a need to define the medical competencies for OM specialty training to benefit trainees, trainers, and assessors. In 2018, a group comprising specialty trainers, recent former specialty trainees, and current specialty trainees in OM held face-to-face meetings in addition to email discussions and developed an updated curriculum document to better reflect the medical competencies required in specialty training. A collaborative modified Delphi approach was used to evaluate medical foundation competencies and to include only those that were considered relevant to OM specialty training. A list of relevant and achievable medical competencies was determined that has been approved by SACADS and will be incorporated into a revised OM curriculum from the UK GDC. The newly agreed-upon document for medical competencies in OM specialty training will serve as a reference for trainees, trainers, and assessors and reflects a successful use of a modified Delphi approach.

Human disease/clinical medical sciences for dentistry in early-years dental graduates: Transition from undergraduate study to clinical practice.

INTRODUCTION: Dental bodies across Europe have published curricula aiming to guide the development of a graduating dentist who is safe and competent, and which also contain direction on what knowledge and understanding of patient's health, drugs and disease a recent graduate should have. MATERIALS, METHODS AND AIM: A questionnaire to survey Foundation Dentists in Wales regarding their undergraduate teaching and assessment in human disease/clinical medical science for dentistry and how this translates to their knowledge, attitudes and confidence in the dental management of patients who may have chronic disease or disability. RESULTS: A 97% response rate to the questionnaire from Foundation Dentists graduating from schools across the UK showed that the large majority felt their teaching and learning in human disease/clinical medical science for dentistry was appropriately delivered and assessed, and that they were well prepared for independent dental practice and to plan and safely manage treatments for all their patients. DISCUSSION: This survey of newly qualified dentists representing graduates from different types of dental courses and both newer and long-established schools across the UK reports the foundation dentists felt that they are competent and safe to care for all patients, including those with complex medical histories. CONCLUSIONS: The foundation dentists surveyed have completed dental undergraduate courses containing the appropriate education and assessment for human health and disease, such that they are prepared to manage their patient population safely, and are well placed to serve their patients as the population continues to age and the amount of medical morbidity increases.

Orofacial granulomatosis: an unsuccessful response to weekly azithromycin pulse therapy.

Treatment of orofacial granulomatosis (OFG) is difficult and unpredictable, and currently there is not a treatment with guaranteed success. Macrolides have been suggested to give dramatic improvements in idiopathic OFG; however, this was not our experience. Following on from remarkable findings with weekly azithromycin pulse therapy reported in JAMA Dermatology, 2015, we treated 5 male patients with idiopathic OFG with the same regimen. Case 1 had a slight improvement but stopped treatment after 5 weeks due to gastrointestinal upset. Cases 2 and 3 had an initial improvement; however, symptoms returned once treatment had ceased. Case 3 received a second course of azithromycin with no improvement. Cases 4 and 5 did not have any improvement at all. We concluded that weekly azithromycin pulse therapy was not a successful treatment for idiopathic OFG. It may provide some short-term improvement in symptoms but does not dramatically resolve symptoms.