Peer assisted learning: teaching dental skills and enhancing graduate attributes.

This study describes a pilot project in which peer assisted learning (PAL) is used to teach dental clinical skills. A cluster randomised controlled trial compared opinions of Bachelor of Dental Surgery (BDS) students from peer-led groups versus staff-led groups in a clinical (impression taking) and a pre-clinical (handpiece skills) task. BDS5 (peer tutors) in their final year delivered teaching to BDS1 (tutees) for each task. Quantitative data from tutees and the peer tutors was gathered from questionnaires, along with open written comments. PAL was well received by both tutees and peer tutors. BDS1 tutees rated BDS5 peer tutors highly for delivery of information, and level of feedback. The tutees considered peer tutors more approachable and less intimidating than staff. Peer tutors reported their own knowledge had increased as a result of teaching. In a summative OSCE (objective structured clinical examination) four months following the teaching, no statistical significant difference between the performance of peer-led and staff-led groups was found at stations related to the subject matter in question. It is argued that PAL, as well as being a useful method of delivering subject-specific teaching, is able to contribute to the development of graduate attributes.

The role of primary healthcare professionals in oral cancer prevention and detection.

AIM: To investigate current knowledge, examination habits and preventive practices of primary healthcare professionals in Scotland, with respect to oral cancer, and to determine any relevant training needs. SETTING: Primary care. METHOD: Questionnaires were sent to a random sample of 357 general medical practitioners (GMPs) and 331 dental practitioners throughout Scotland. Additionally, focus group research and interviews were conducted amongst primary healthcare team members. RESULTS: Whilst 58% of dental respondents reported examining regularly for signs of oral cancer, GMPs examined patients' mouths usually in response to a complaint of soreness. The majority of GMPs (85%) and dentists (63%) indicated that they felt less than confident in detecting oral cancer, with over 70% of GMPs identifying lack of training as an important barrier. Many practitioners were unclear concerning the relative importance of the presence of potentially malignant lesions in the oral cavity. A high proportion of the GMPs indicated that they should have a major role to play in oral cancer detection (66%) but many felt strongly that this should be primarily the remit of the dental team. CONCLUSION: The study revealed a need for continuing education programmes for primary care practitioners in oral cancer-related activities. This should aim to improve diagnostic skills and seek to increase practitioners' participation in preventive activities.

Lessons learned from the development of a distance-learning programme.

The development of an effective educational programme, i.e. one that not only delivers education but which also fosters change, requires both educational skills and subject expertise from the producers. This paper looks at the key lessons learned when developing a distance-learning programme. These seven key lessons, which focus heavily on needs assessment as well as team working and the need to consider a multiprofessional approach, offer practical advice to those in the medical and dental professions wishing to produce their own educational programmes.

A survey of Scottish primary care dental practitioners' oral cancer-related practices and training requirements.

OBJECTIVE: The study sought to investigate current examination habits and preventive practices of Scottish dental primary care professionals, with respect to oral cancer, and to determine any training needs of these practitioners in relation to the disease. BASIC RESEARCH DESIGN: A questionnaire was sent to a random sample of 331 general dental practitioners and community dental officers throughout Scotland, achieving an overall response rate of 68%. MAIN OUTCOME MEASURES: The study investigated examination and health promotion practices in relation to oral cancer. Confidence in, and barriers to, participating in these activities were studied, and information sought both on past training and future education needs regarding oral cancer. RESULTS: Although 58% of respondents reported examining regularly for signs of oral cancer in those aged >16 years, 63% indicated they felt less than confident in detecting oral cancer, with only 43% expressing confidence about discussing suspicious findings with patients. Practitioners were well aware of the importance of smoking and alcohol as risk factors, but had mixed views on the health-promoting role of the dentist regarding these issues. Furthermore, while only 3% reported training on these topics, over half expressed a desire to develop appropriate counselling skills. Overall, 87% and 79% of respondents wanted further training in oral cancer detection and prevention, respectively. CONCLUSION: The study indicated a need for continuing education programmes for dental primary care practitioners in oral cancer-related activities. Postgraduate education, utilising a variety of media formats, should aim to improve diagnostic skills and seek to increase practitioners' participation in both smoking and alcohol counselling.

Reasons for tooth extraction in Scotland.

OBJECTIVES: A 1984 study investigated the reasons underlying the extraction of teeth in Scotland. The survey described in this paper, used a similar methodology and aimed to determine the reasons for the extraction of permanent teeth by general dental practitioners and investigate changes in the influences on tooth extraction over a 10 year period. METHODS: During a 1 week period in November 1994, 139 general dental practitioners working throughout Scotland, recorded the reasons for all permanent tooth extractions. RESULTS: A total of 917 permanent teeth were extracted from 613 patients, the reason for extraction being stated as dental caries (51%), periodontal disease (21%), orthodontics (11%) and failed endodontics (4%). Trauma, pericoronitis and other reasons accounted for 5.5% of extractions whilst, in 7.5% of cases, patients requested extraction in preference to other treatments. The proportion of extractions attributed to periodontal disease increased from age 31-60 years, but declined thereafter. CONCLUSIONS: Comparing the results with those obtained in the 1984 study, whilst the mean number of teeth extracted by each practitioner had reduced, the overall relative contribution of different reasons for extraction was similar.

Dentists, pills and pregnancies.

Unplanned pregnancies may occur if antibiotics are prescribed to women using the combined oral contraceptive pill. To investigate awareness of the potential for this interaction among general dental practitioners, the authors designed a cross-sectional questionnaire based study and sent it out to a random sample of GDPs in Scotland.

A survey of general anaesthesia, sedation and resuscitation in general dental practice.

The Poswillo Report, published in 1990, made recommendations regarding general anaesthesia (GA), sedation and resuscitation in dentistry. The aims of the present study were to examine the level of provision of GA and sedation by general dental practitioners (GDPs) a few years after the publication of the report, and to estimate the degree of compliance of GDPs with a number of its principal recommendations. In May 1994, a questionnaire was sent to 268 GDPs in two Scottish Health Boards, and a response rate of 80% was achieved. Thirteen per cent of respondents had treated GA cases during 1993-94 while 18% indicated that they had stopped providing a GA service since the immediate pre-Poswillo years. However, 91% had referred some patients elsewhere for treatment under GA. There was very little evidence of a replacement of GA by sedative techniques. The percentages of respondents using inhalation or intravenous sedation during the previous year were 9% and 27%, respectively. Almost all of the respondents reported that they had been trained in cardiopulmonary resuscitation and 60% stated that resuscitation exercises were practised at least once a year. While over 80% of the practitioners indicated that their dental surgeries stocked the emergency drugs recommended in the Poswillo Report, 12% expressed concern regarding the length and content of the drug list.

Smoking cessation counselling--a role for the dental profession?

Whilst several studies have investigated the views of North American dentists on providing advice to patients on stopping smoking, the role of their UK counterparts in this area is uncertain. Thus this study aimed: 1. to examine dentists' awareness of the effect of smoking on general and oral health, 2. to determine their views on counselling patients to give up smoking, 3. to investigate the extent to which they currently engage in this activity, and 4. to survey barriers to providing such advice. Data were collected via a postal questionnaire mailed to 587 Scottish dental practitioners, of which 448 (76.3%) were completed and returned. The importance of smoking as a cause of ill health and death was acknowledged universally, and most were aware of the adverse consequences of smoking on the oral tissues. Over half the respondents (245 or 54.7%) thought dentists had a role in counselling patients to give up smoking and whilst 107 (23.8%) were uncertain, the remaining 95 (21.2%) felt this was outside their remit. Nonetheless, 384 (85.6%) reported that, at least occasionally, they advised patients to quit. Lack of time was seen as an important barrier to tobacco counselling, as was lack of training. Further studies are required to determine the most useful strategies or approaches, and to determine their effectiveness.