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.

'It's the stuff they can do better than us': case studies of general practice surgeries' experiences of optimising the skill-mix contribution of practice-based pharmacists in Wales.

OBJECTIVE: Pharmacists are increasingly joining the general practice skill-mix. Research is still in relative infancy, but barriers and facilitators to their integration are emerging, as well as indications that pharmacists' skillset remain underutilised. This study explores first-hand experiences and perspectives among general practice teams of the processes that underpin the effective integration and sustained contribution of pharmacists in general practice. DESIGN AND SETTING: This research employed a qualitative case study approach involving general practice teams in Wales. Data were collected from eight general practices where each practice represented one case study. Data were collected via online interviews (one-to-one or group) and written feedback. Data were pattern coded and analysed thematically through a constant comparative approach. Data interpretations were confirmed with participants and wider general practice teams. PARTICIPANTS: Eight general practice teams across Wales (comprising combinations of practice and business managers, general practitioners (GPs) and general practice pharmacists) represented eight case studies. Cases were required to have had experience of working with a general practice pharmacist. RESULTS: Data were yielded from five practice managers, two GPs, three general practice pharmacists and a business manager. A total of 3 hours and 2 min of interview data was recorded as well as 2038 words of written feedback. Three foundations to pharmacists' effective contribution to general practice were identified: defining the role (through identifying the right pharmacist, mapping skillset to demand and utilising the increasing need for specialist skills), appropriate infrastructure and workforce review, and an appropriate employment model. CONCLUSION: Pharmacists are becoming increasingly critical to the general practice skill-mix and utilisation of their specialist skillset is crucial. This paper identifies how to enable the effective integration and sustained contribution of pharmacists to general practice.

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.

An analysis of glaucoma repeat measures assessment results: Are core competencies enough?

PURPOSE: The need to validate core competency skills in qualified optometrists wishing to take part in extended roles in glaucoma care has been questioned. This analysis examines the ability of qualified optometrists to perform relevant core competency skills under standardised objective assessment conditions to explore whether such validation is justified. It also investigates if there are associations between performance, gender and length of time since qualification. METHODS: Anonymised data from the Cardiff University assessment programme for the Wales Optometry Postgraduate Education Centre (WOPEC) Local Optical Committee Support Unit glaucoma referral filtering and monitoring pathway delivered between January 2017 and March 2020 were analysed. Results were combined with demographic data from the General Optical Council register of optometrists in the UK to investigate associations between performance and practitioner characteristics, namely length of time since qualification and gender. RESULTS: The assessment results of 2215 optometrists practising in England (approximately 15% of all UK registered optometrists and 30% of all optometrists registered in England) were analysed. Failure rates for first time assessment in each of five objective structured clinical examination style practical assessments were 8.5% (van Herick); 8.8% (slit lamp binocular indirect ophthalmoscopy); 10.1% (Goldmann applanation tonometry calibration); 21.9% (Goldmann applanation tonometry) and 23.3% (case scenario interpretation and management). There were either no associations or at most very weak associations between performance and practitioner characteristics. CONCLUSIONS: Our results suggest that these competencies are not universally present in optometrists practising in England and that ongoing training and assessment of these competencies is justified for entry into extended roles. There are no meaningful associations between performance in these assessments and gender or time since qualification.

Well-rounded pharmacists: a longitudinal evaluation of a multi-sector pre-registration programme.

INTRODUCTION: Pharmacists traditionally work in either hospital or community settings and increasingly in primary care. As demands on health care continue to rise, pharmacists need a well-rounded understanding of the patient journey and transfer of care and be capable of working in any setting. In response, Health Education and Improvement Wales (HEIW) launched a multi-sector pre-registration pharmacy training programme. Trainees experience all three pharmacy settings throughout the year, in contrast to the traditional, single-sector programmes. OBJECTIVES: To explore the views of the now-qualified pharmacists, their tutors and line managers on the multi-sector programme and how it prepares pharmacists for practice. METHODS: This longitudinal study followed pharmacists through the multi-sector programme, to approximately 1 year post-registration. Data were collected via interviews (n = 27) with pharmacists, tutors and line managers. All data were pattern coded and analysed thematically. KEY FINDINGS: Pharmacists maintained that they benefited from the multi-sector training programme and would choose this option again. Pharmacists, tutors and line managers considered that the programme provided a more holistic perspective of pharmacy than single-sector programmes and a greater understanding of patient journeys and transfer of care. Nonetheless, there remains a lack of consensus on how the programme is best structured, and there is scope to increase the hands-on experience in primary care settings. CONCLUSIONS: Greater communication across sectors and smoother transfer of patient care benefit employers and patients as well as the pharmacists. Recommendations for future multi-sector programmes are suggested.

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.

'I thought it would be a very clearly defined role and actually it wasn't': a qualitative study of transition training for pharmacists moving into general practice settings in Wales.

OBJECTIVE: Pharmacists are increasingly contributing to the skill mix of general practice surgeries to help alleviate pressures faced by UK doctors working in primary care. However, they need support in overcoming barriers to their integration. The purpose of this work was to evaluate a programme designed to support pharmacists' transition to working in general practice settings. We explored the learning needs of pharmacists', the barriers and enablers to their integration and provide recommendations based on our results. INTERVENTION: A qualitative evaluation of a 1-year transition programme in Wales starting in September 2018 to support pharmacists' transition to working in general practice settings. DESIGN AND SETTING: We employed an interpretative phenomenological approach involving 10 pharmacists across Wales enrolled on the transition to general practice training programme, and their tutors. Data were collected across two sequential phases: in phase 1 telephone interviews were held with pharmacists midway through their training; in phase 2, focus groups were conducted with both pharmacists and tutors towards the end of the programme. RESULTS: Pharmacists enter general practice settings with a variety of prior experience. The programme provided a framework that pharmacists found helpful to map their experience to but the programme needed to be flexible to individual learning needs. The tutor role was typically regarded as the most valuable component, but interaction with the wider general practice team was critical to ease the transition. Pharmacists encountered a lack of clarity about their role which impeded their integration into the workplace team. CONCLUSIONS: A formal programme with a designated tutor can support pharmacists' transition into general practice settings. The programme's competency framework facilitated reciprocal understanding of the pharmacist's role in the team, helped to manage expectations and enhanced collaborative practice. Recommendations to facilitate pharmacist integration into general practice settings are provided.

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.