The Graduating European Dentist: A New Undergraduate Curriculum Framework.

With "The Graduating European Dentist", ADEE provides a new approach that reflects best academic practice for European undergraduate dental education. The new suite of documents sees increased emphasis on important curriculum components such as patient safety, working as a team and patient-centred care. There is also an increased emphasis on teaching excellence, student satisfaction and student preparedness and support. Guidance relating to methods of teaching and learning, and assessment (educational measurement), is also provided. It is anticipated that this new format will further increase accessibility and utility for educators, institutions, societies and regulators, across the sector.

The Graduating European Dentist: Contemporaneous Methods of Teaching, Learning and Assessment in Dental Undergraduate Education.

It is often the case that good teachers just "intuitively" know how to teach. Whilst that may be true, there is now a greater need to understand the various processes that underpin both the ways in which a curriculum is delivered, and the way in which the students engage with learning; curricula need to be designed to meet the changing needs of our new graduates, providing new, and robust learning opportunities, and be communicated effectively to both staff and students. The aim of this document is to draw together robust and contemporaneous methods of teaching, learning and assessment that help to overcome some of the more traditional barriers within dental undergraduate programmes. The methods have been chosen to map specifically to The Graduating European Dentist, and should be considered in parallel with the benchmarking process that educators and institutions employ locally.

Continuing professional development in implant dentistry in Europe.

INTRODUCTION: Training for dental practitioners in implant dentistry ranges from 1- or 2-day short Continuing Professional Development (CPD) courses to certificate/diploma programmes run by universities. In general, the teaching of implant dentistry in Europe lacks structure and standardisation. This paper aims to: (i) identify the current trends in CPD in implant dentistry in Europe; (ii) identify potential and limitations with regards to the design and implementation of CPD activities in implant dentistry; (iii) provide recommendations on the future structure and development of CPD activities in implant dentistry. METHODS: A search of the literature was undertaken in PubMed for manuscripts published in English after 2000 reporting on CPD in dentistry and in implant dentistry in particular. In addition, an electronic survey was conducted, investigating the attitudes towards CPD among a wide group of stakeholders in implant dentistry education. CONCLUSIONS: There is a wide diversity of educational pathways towards achieving competences in implant dentistry through CPD. At present, there is a need for improving the CPD structures in implant dentistry, strengthening the quality assurance and encouraging standardisation and transparency of the learning outcomes. Development of a structured CPD system with clearly defined educational objectives mapped against specific levels of competence is recommended.

Communication and professionalism skills of a new graduate: the expectations and experiences of dental foundation trainers.

AIM: The aim of this study was to investigate dental foundation year 1 (DF1) trainers' expectations of the dental graduate specifically in relation to non-clinical (professionalism and communication) skills and to explore whether these expectations were being met. METHOD: In the UK, dental graduates undertake 1 year of foundation training prior to being permitted to undertake NHS practice. An online survey was distributed to DF1 trainers via all 11 English deaneries and the Northern Ireland deanery. Demographic information and a general view of trainers' expectations of a new trainee were collected. Specific questions relating to six generic trainee problems were followed by 11 ability statements where trainers indicated their expectation of a trainee's ability to perform the skill on a 5-point scale (on own with confidence-unable to undertake). Statements were repeated and trainers were required to respond using the same scale in relation to experience of their current trainee. RESULTS: Five hundred and ten (53%) trainers completed the questionnaire with no missing data. Expectations were high with almost 50% of trainers expecting a new graduate to manage a full list of patients on their own. Experience of new graduates did not always match these expectations. Of concern was the ability to 'keep accurate patient records' and 'self-reflection and knowing when to seek help', where a small proportion of trainers experienced difficulties. CONCLUSIONS: Trainers' expectation and experience in relation to non-clinical skills of a new graduate were investigated. Although they had high expectations, the majority reported only minor problems overall. There were a few areas where concern was raised.

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.

An evaluation of CPD activity of dentists in Wales.

INTRODUCTION: Ongoing professional education is essential for dental professionals to maintain and update their clinical skills and knowledge. There is a current trend towards mandatory Continuing Professional Development (CPD) for dentists within Europe and beyond. Mandatory CPD will ensure high professional standards and enable mobilisation of the dental workforce within Europe. In 2002, the UK General Dental Council (GDC) implemented a system of mandatory CPD for dentists practicing in the UK. The Wales Deanery is situated in the School of Postgraduate Medical and Dental Education, Cardiff University. It provides verifiable CPD courses for dentists and dental care professionals (DCPs) currently practicing in Wales and has recorded professionals' attendance on these courses since 2001. The project aimed to investigate the CPD activity of dentists in Wales, using these data. METHODS: The Wales Deanery database holds data on the CPD courses undertaken by 1178 dentists working in Wales since 2001. A number of hypotheses were investigated using a variety of statistical methods. RESULTS: Dentists were undertaking significantly fewer hours of CPD in Mid and West Wales compared to the North and South of the principality. Sole practitioners were found to engage in less CPD than those in group practices, but these differences did not reach statistical significance. Dentists who employed a hygienist or therapist completed more hours of CPD than those who didn't employ either. There were no gender differences in engagement in CPD. CPD participation was consistently and significantly higher in mid and late career than in early career. CONCLUSIONS: This study provides a greater understanding of the CPD habits of the dental workforce in Wales. Practice staffing levels, location of practice and time since graduation were found to have the greatest impact on engagement in CPD activity. These findings will be used by the Deanery to inform future education provision for dental professionals in Wales.

Core continuing professional development (CPD) topics for the European dentist.

INTRODUCTION: In the context of free movement, EU-citizens need assurance that dental practitioners providing their care have a degree/license to practice that meets EU-standards and that they maintain their knowledge and skills through ongoing education. AIM: One aim of the 'DentCPD' project (HYPERLINK 'http://www.dentcpd.org' www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. This paper reports the consensus process and outcomes. METHODS: Agreement on core components of CPD was achieved through a three stage process: an online survey of dental educators' (n = 143) views on compulsory topics; a paper-based questionnaire to practitioners (n = 411); leading to a proposal discussed at the Association for Dental Education (ADEE) 2011 Lifelong Learning special interest group (SIG). RESULTS: From the online survey and practitioner questionnaire, high levels of agreement were achieved for medical emergencies (89%), infection control (79%) and the medically compromised patient (71%). The SIG (34 attendees from 16 countries) concluded that these three CPD topics plus radiation protection should be core-compulsory and three CPD topics should be core-recommended (health and safety, pain management, and safeguarding children & vulnerable adults). They also agreed that the teaching of all topics should be underpinned by evidence-based dentistry. CONCLUSION: Building four core topics into CPD requirements and making quality-approved education and training available will ensure that all dentists have up-to-date knowledge and skills in topic areas of direct relevance to patient safety. In turn, this will contribute to patients having access to comparably high standards of oral health care across Europe.

Guidelines for the organisation of continuing professional development activities for the European dentist.

AIM: Free movement of dental professionals across the European Union calls for more uniform continuing education in dentistry to ensure up-to-date, high-quality patient care and patient safety. This article provides guidelines for the management and delivery of high-quality continuing professional development (CPD) by European dental schools and other CPD providers. METHOD: The guidelines are based on an extensive literature inventory, a survey of existing practices (both available as separate publications), discussions during meetings of the Association for Dental Education in Europe in 2011 and 2012 and debate amongst the members of the DentCPD project team representing six dental schools. RESULTS: On the basis of the literature review, survey and discussions, we recommend that (i) every dentist should be given the opportunity for CPD, (ii) providers should be quality-approved and impartial, (iii) educators should be approved, impartial, suitably trained, and with educational expertise, (iv) the mode of CPD delivery should suit the educational activity, with clear learning objectives or outcomes, (v) effort should be made to assess the learning, (vi) participant feedback should be collected and analysed to inform future developments and (vii) uniform use of the pan-European system of learning credit points (ECTS) should be implemented. CONCLUSION: Implementation of these guidelines should make dental CPD more transparent to all relevant parties and facilitate the transferability of earned credits across the European Union. It will also enable better quality control within dentistry, resulting in enhanced dental care and ultimately the improvement in patient safety.

Core continuing professional development (CPD) topics for the European dentist.

INTRODUCTION: In the context of free movement, EU-citizens need assurance that dental practitioners providing their care have a degree/license to practice that meets EU-standards and that they maintain their knowledge and skills through ongoing education. AIM: One aim of the 'DentCPD' project (HYPERLINK 'http://www.dentcpd.org' www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. This paper reports the consensus process and outcomes. METHODS: Agreement on core components of CPD was achieved through a three stage process: an online survey of dental educators' (n = 143) views on compulsory topics; a paper-based questionnaire to practitioners (n = 411); leading to a proposal discussed at the Association for Dental Education (ADEE) 2011 Lifelong Learning special interest group (SIG). RESULTS: From the online survey and practitioner questionnaire, high levels of agreement were achieved for medical emergencies (89%), infection control (79%) and the medically compromised patient (71%). The SIG (34 attendees from 16 countries) concluded that these three CPD topics plus radiation protection should be core-compulsory and three CPD topics should be core-recommended (health and safety, pain management, and safeguarding children & vulnerable adults). They also agreed that the teaching of all topics should be underpinned by evidence-based dentistry. CONCLUSION: Building four core topics into CPD requirements and making quality-approved education and training available will ensure that all dentists have up-to-date knowledge and skills in topic areas of direct relevance to patient safety. In turn, this will contribute to patients having access to comparably high standards of oral health care across Europe.

Continuing professional development systems and requirements for graduate dentists in the EU: survey results from the DentCPD project.

INTRODUCTION: By maintaining skills and keeping dentists up-to-date, continuing professional development (CPD) supports safe clinical practice. However, CPD for dentists across Europe is not harmonised. AIM: One aim of the 'DentCPD' project (www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. As part of the process, data were collected on existing approaches to CPD for EU dentists. This paper reports those findings. METHODS: Informed by a review of the literature and internet search, the CPD for Graduate Dentists questionnaire gathered data from dental educators on CPD systems, requirements, provision and accreditation in Europe. It sought opinion on mandatory CPD and e-learning. RESULTS: Responses were received from 143 individuals from 30 EU countries. About half the countries had a compulsory CPD system which typically included mandatory core topics. Elsewhere CPD was optional or based on recommended hours. University dental schools and professional dental associations were the most common CPD providers. National regulatory bodies were the most common accrediting body. Only 41% of respondents thought they knew the criteria for successful accreditation of CPD. Eighty-one percent agreed that 'CPD should be obligatory for all dentists'. CONCLUSION: These results present an overview of the status of CPD for EU dentists. Despite a notable trend towards regulated CPD systems, current requirements for dentists to engage in CPD show variation. The harmonisation of requirements would enhance both dentist mobility and safe clinical practice.

Continuing professional development systems and requirements for graduate dentists in the EU: survey results from the DentCPD project.

INTRODUCTION: By maintaining skills and keeping dentists up-to-date, continuing professional development (CPD) supports safe clinical practice. However, CPD for dentists across Europe is not harmonised. AIM: One aim of the 'DentCPD' project (www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. As part of the process, data were collected on existing approaches to CPD for EU dentists. This paper reports those findings. METHODS: Informed by a review of the literature and internet search, the CPD for Graduate Dentists questionnaire gathered data from dental educators on CPD systems, requirements, provision and accreditation in Europe. It sought opinion on mandatory CPD and e-learning. RESULTS: Responses were received from 143 individuals from 30 EU countries. About half the countries had a compulsory CPD system which typically included mandatory core topics. Elsewhere CPD was optional or based on recommended hours. University dental schools and professional dental associations were the most common CPD providers. National regulatory bodies were the most common accrediting body. Only 41% of respondents thought they knew the criteria for successful accreditation of CPD. Eighty-one percent agreed that 'CPD should be obligatory for all dentists'. CONCLUSION: These results present an overview of the status of CPD for EU dentists. Despite a notable trend towards regulated CPD systems, current requirements for dentists to engage in CPD show variation. The harmonisation of requirements would enhance both dentist mobility and safe clinical practice.

The development of an exemplar e-module for the continuing professional development of European dentists.

AIM: To present the development of an exemplar e-module for dental continuing professional development (CPD) provided by dental schools and other dental educational providers. MATERIALS AND METHODS: The exemplar e-module covered the topic of 'Sterilisation and cross-infection control in the dental practice' as this is one of the most recommended topics for dental CPD in Europe. It was developed by a group of topic experts, adult learning and distance learning experts and a technical developer. Major concerns were pedagogy, interoperability, usability and cost reduction. Open-source material was used to reduce the cost of development. RESULTS: The e-module was pre-piloted in dental practitioners for usability and then evaluated by experts in the field and dental academics through an electronic questionnaire and an online presentation and discussion at the ADEE 2012 Special Interest Group on DentCPD-Lifelong learning. This facilitated refinement before final production. A Creative Commons License was implemented to ensure the developers' rights and facilitate wider distribution and access to CPD providers. DISCUSSION AND CONCLUSIONS: The e-module was developed according to well-defined pedagogical and technical guidelines for developing e-learning material for adult learners. It was structured to promote self-study by directing learners through their study, promoting interaction with the material, offering explanation and providing feedback. Content validity was ensured by extensive review by experts. The next step would be to expand the evaluation to practising dentists in various countries after relevant translations, and adaptations to local policies have been made.

Recommendations for the development of e-modules for the continuing professional development of European dentists.

AIMS: To provide evidence-based and peer-reviewed recommendations for the development of dental continuing professional development (CPD) learning e-modules. METHODS: The present recommendations are consensus recommendations of the DentCPD project team and were informed by a literature research, consultations from e-learning and IT expert, discussions amongst the participants attending a special interest group during the 2012 ADEE meeting, and feedback from the evaluation procedures of the exemplar e-module (as described in a companion paper within this Supplement). The main focus of these recommendations is on the courses and modules organised and offered by dental schools. RESULTS AND DISCUSSION: E-modules for dental CPD, as well as for other health professionals' continuing education, have been implemented and evaluated for a number of years. Research shows that the development of e-modules is a team process, undertaken by academics, subject experts, pedagogists, IT and web designers, learning technologists and librarians. The e-module must have clear learning objectives (outcomes), addressing the learners' individual needs, and must be visually attractive, relevant, interactive, promoting critical thinking and providing feedback. The text, graphics and animations must support the objectives and enable the learning process by creating an attractive, easy to navigate and interactive electronic environment. Technology is usually a concern for learners and tutors; therefore, it must be kept simple and interoperable within different systems and software. The pedagogical and technological proficiency of educators is of paramount importance, yet remains a challenge in many instances. CONCLUSIONS: The development of e-courses and modules for dental CPD is an endeavour undertaken by a group of professionals. It must be underpinned by sound pedagogical and e-learning principles and must incorporate elements for effective visual learning and visual design and a simple, consistent technology.

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.

Continuing dental education: evaluation of the effectiveness of a disinfection and decontamination course.

AIM: To evaluate a disinfection and decontamination dental postgraduate course run by the Wales Dental Postgraduate Deanery between 2008 and 2010. METHODS: Pre- and post-course multiple choice questionnaires were completed by 1177 course attendees. Mean scores before and after participation on the training course were compared and analysed. RESULTS: Mean pre-course score was 45.3%, rising to 87.0% in the post-course assessment, reflecting an improvement of 41.8%. Prior to training, 30.7% achieved a satisfactory score of 13/20 (65%) compared to 98.3% on completion of training. Dental technicians were found to score significantly lower than other occupation groups both before and after course attendance. Decade of graduation had no effect on results. Theoretical microbiology was the question area which showed least improvement. CONCLUSION: Attending the disinfection and decontamination course significantly improved participants' knowledge. Theoretical microbiology, as a topic area, may be targeted for improvements in future courses to improve results further.

A national survey of UK final year students' opinion of undergraduate oral surgery teaching.

BACKGROUND: A national survey was undertaken to establish a baseline of our final year students' perception of how their undergraduate oral surgery education has equipped them for key areas of general dental practice. MATERIALS AND METHODS: Questionnaires were distributed to the 13 UK schools with final year students, towards the end of the academic year in 2009. The questionnaires were completed anonymously and were optically scanned. RESULTS: In total, 632 questionnaires were returned, which represents 66% of the students of the graduating year. The majority (83%) of the respondents perceived that the teaching in oral surgery had given them sufficient knowledge to undertake independent practise. Most respondents (99%) felt confident to perform forceps exodontia, but confidence in the various aspects of surgical exodontia was lower. A majority (83%) had experience of an outreach scheme performing forceps exodontia (75%) and surgical exodontia (16%) in this environment. Twenty per cent indicated a desire to undertake a career in oral surgery, 6% in oral and maxillofacial surgery and 35% in another speciality. CONCLUSION: This survey suggests that the majority of the students perceive that the oral surgery education has prepared them well for key areas of general practice. It also suggests that there is, however, a need to provide further improvement in the delivery of surgical skills and knowledge.

Continuing dental education in radiation protection: knowledge retention following a postgraduate course.

OBJECTIVE: To evaluate medium-term knowledge retention of dental personnel following attendance at a postgraduate course in radiation protection. SUBJECTS AND METHODS: Knowledge was measured using identical pre- and post-course validated single best-answer multiple-choice instruments, administered immediately before and after training and at follow-up at 6 or 12 months. These comprise 16 questions each with 5 choices. The range of possible scores was from 0 to 16, and scores were scaled to percentages. Participants were predominantly dental practitioners, but a minority consisted of dental care professionals (dental nurses, hygienists and therapists). Of 285 participants, 272 (95.4%) completed both pre- and post-course questionnaires. One hundred and seventeen (43%) of these also completed the follow-up test, but only 109 (40%) individuals could be linked to the original course. RESULTS: Mean (standard deviation) pre-, post-course and follow-up-corrected percentage scores were 39.1 (16.1), 74.6 (16.9) and 58.9 (22.7), respectively. There was attrition in knowledge at follow-up: the average increase in adjusted score after training was 35.5 points, but only 56% of this was retained at follow-up. Paired t-tests confirmed that the mean score at follow-up was firmly intermediate between the pre- and post-course scores. Of the 109 participants, 7 (6%) achieved a satisfactory score pre-training, 82 (75%) immediately post-training and 41 (38%) at follow-up. There were gross differences between the levels of performance achieved for the eight subject areas tested. CONCLUSION: Immediate post-course assessments have indicated that current postgraduate courses in radiation protection are effective. However, a substantial amount of knowledge is lost by 6-12 months following course attendance. To achieve long-term knowledge retention, early or repeated reinforcement may be necessary.

Dental student suturing skills: a multicentre trial of a checklist-based assessment.

BACKGROUND: The assessment of clinical skills is essential to determine whether an undergraduate is competent to perform the tasks outlined in the curriculum. Such assessments in dentistry have historically not been subjected to large scale validity and reliability testing due the relatively small student numbers at each institute. The aims of this study were to test the validity and reliability of a standardised, checklist-based, suturing objective structured clinical examination (OSCE) and then to perform a multicentre trial to determine its performance over a large cohort of students. MATERIALS AND METHODS: A total of seven UK schools agreed to take part in the trial. To test the validity and reliability of the checklist, the examiner at each institution reviewed and scored video footage of 10 students performing the assessment. Each institution then carried out the assessment providing a checklist score and a global score for each of their own students. RESULTS: The assessment was well received by the staff, with acceptable inter-examiner variability. In total, 496 students completed the suturing OSCE with a success rate of 81% with a variation between schools of between 66% and 96%. A significant correlation was found between the checklist score and the global score (r = 0.361, P = 0.000). No one item on the checklist was found to be a determinant factor in the outcome of the OSCE. CONCLUSIONS: This checklist-based assessment of suturing skills was found to have face and content validity. Its reliability was promising, but merits further investigation. There may be an argument for the standardisation of the assessment of this core surgical skill throughout several UK-based dental schools.

Profile and competences for the graduating European dentist - update 2009.

This paper presents the profile and competences for the European Dentist as approved by the General Assembly of the Association for Dental Education in Europe at its annual meeting held in Helsinki in August 2009. A new taskforce was convened to update the previous document published in 2005. The updated document was then sent to all European Dental Schools, ministries of health, national dental associations and dental specialty associations or societies in Europe. The feedback received was used to improve the document. European dental schools are expected to adhere to the profile and the 17 major competences but the supporting competences may vary in detail between schools. The document will be reviewed once again in 5 years time. Feedback to the newly published document is welcomed and all dental educators are encouraged to draw upon the content of the paper to assist them in harmonising the curriculum throughout Europe with the aim of improving the quality of the dental curriculum.

A generic consensus assessment of undergraduate competence in forceps exodontia in the United Kingdom.

UNLABELLED: The assessment of competence in clinical skills has become more frequent in published healthcare curricula and syllabuses recently. There are agreed mechanisms for the assessment of competence in the post-graduate environment, but no consensus within the undergraduate curriculum. This paper seeks to develop an agreed generic checklist for the assessment of competence in forceps exodontia. MATERIALS AND METHODS: A modified Delphi process was undertaken with representatives from all UK dental schools (n = 13) to develop a generic checklist for the assessment of competence in forceps exodontia. A content analysis of the assessments employed by each school was used to help discussion and inform the Delphi process. RESULTS: Seven schools currently employ a summative assessment of competence in forceps exodontia, with the majority employing a structured clinical objective test (n = 6). From the seven assessments, there were a total of 29 putative items and 10 putative domains identified for a generic checklist. These were reduced to five domains and 19 items through the content analysis and Delphi process, and a generic overarching checklist was created. CONCLUSION: Using this generic checklist, it may now be possible to pool data inter-institution to perform more powerful analyses on how our students obtain, or fail to obtain competence in forceps exodontia.