Measuring the development of insight by dental health professionals in training using workplace-based assessment.

INTRODUCTION: For health professionals, the development of insight into their performance is vital for safe practice, professional development and self-regulation. This study investigates whether the development of dental trainees' insight, when provided with external feedback on performance, can be assessed using a single criterion on a simple global ratings form such as the Longitudinal Evaluation of Performance or Mini Clinical Evaluation Exercise. METHODS: Postgraduate dental trainees (N = 139) were assessed using this tool on a weekly basis for 6 months. Regression analysis of the data was carried out using SPSS, and a short trainer questionnaire was implemented to investigate feasibility. RESULTS: Ratings for insight were shown to increase with time in a similar manner to the growth observed in other essential skills. The gradient of the slope for growth of insight was slightly less than that of the other observed skills. Trainers were mostly positive about the new criterion assessing trainees' insight, although the importance of training for trainers in this process was highlighted. DISCUSSION: Our data suggest that practitioners' insight into their performance can be developed with experience and regular feedback. However, this is most likely a complex skill dependent on a number of intrinsic and external factors. CONCLUSION: The development of trainees' insight into their performance can be assessed using a single criterion on a simple global ratings form. The process involves no additional burden on evaluators in terms of their time or cost, and promotes best practice in the provision of feedback for trainees.

Revalidation of general dental practitioners in Scotland: the results of a pilot study. Part 2 - acceptability to practitioners.

AIM: To investigate the acceptablility of a pilot scheme of revalidation to general dental practitioners. METHOD: Ten general dental practitioners completed portfolios of evidence of being up to date and fit to practise. This portfolio was assessed by a panel of three experts, using an assessment tool developed specifically for that purpose. An action research methodology was used to evaluate participants' perceptions, consisting of a focus group and semi-structured interviews. The views of the assessors on the portfolio and its assessment were collected using a questionnaire. RESULTS: The views of the participants on revalidation, the pilot scheme portfolio and its use, who should assess it and how its use could be supported were collected. Also areas of difficulty in using the portfolio were identified, along with suggestions for improving it and alternative ways of evidencing competence. Assessors noted that the quality of evidence was adequate, but also made suggestions for improvement of the portfolio. CONCLUSIONS: The pilot scheme appears to have been acceptable to the dentists in this scheme, given some caveats. The assessors felt that appraisal would significantly enhance any substantive scheme.

Revalidation of general dental practitioners in Scotland: the results of a pilot study. Part 1--feasibility of operation.

AIM: To devise and operate a pilot scheme of revalidation for general dental practitioners. METHOD: A representative group of dental practitioners was convened to advise on an approach to piloting revalidation. Ten general dental practitioners volunteered and completed portfolios of evidence of fitness to practise. The portfolios were assessed by a panel of three calibrated experts, using a specially developed assessment tool. A single decision "evidence presented allowed revalidation to be recommended" was made. A timesheet was used to record the time spent producing the portfolio. RESULTS: Eight portfolios were assessed as sufficient for revalidation purposes. Two dentists were required to make supplementary submissions of evidence before they were found to be acceptable. An average of eight hours of dentist time and six hours of delegated time was spent producing the portfolios. CONCLUSIONS: The small number of dentists in this pilot were able to use the portfolio satisfactorily. The dentists were all volunteers and so may not necessarily be fully representative of the profession. The time spent completing the portfolio was not considered excessive. The assessors were adequately prepared and calibrated for their work.

Educational needs and employment status of Scottish dental hygienists.

AIMS AND OBJECTIVES: To investigate the educational needs and employment status of registered dental hygienists in Scotland. SUBJECTS: Three hundred and eighty one registered dental hygienists with postal addresses in Scotland. DESIGN: Structured questionnaire. RESULTS: A 76% response rate was achieved following two mailings. Of the respondents, 43% were in full-time employment albeit in more than one setting, mostly in the 'central belt' of Scotland. It was reported that 41% were employed in general dental practice with both NHS and private lists and 39% worked in a purely private setting. The introduction of extended clinical duties had been well received and 59% of subjects were interested in additional training in dental therapy, should this become available. Absence of funding for CPD was raised repeatedly, with only 41% reporting a degree of financial assistance. Greater accessibility to continuing education via distance learning, particularly in remote and rural settings, was requested by 73% of hygienists. CONCLUSIONS: This study identifies a number of issues in relation to this increasingly important group of healthcare professionals, which will inform the providers of oral healthcare. Although hygienists' involvement in CPD was commendable, results indicated that despite commitment to their profession, respondents did not always feel respected in terms of their employment status or support for continuing professional development.

The patient assessment questionnaire: a new instrument for evaluating the interpersonal skills of vocational dental practitioners.

This paper describes a pilot study aimed at evaluating a new instrument, the patient assessment questionnaire (PAQ), which uses patient ratings for the assessment of communication skills and professionalism in vocational practitioners (VDPs). The PAQ was developed as part of an assessment system designed to address all round competence. Acohort of 99 VDPs took part in the study. Questionnaires were distributed to consecutive patients in the general dental service at two time points in the training year. Data from the pilot study was analysed to determine whether the PAQ fulfilled the criteria for robust assessment. Results provide evidence of high levels of reliability, validity and feasibility of the PAQ instrument. All indications to date suggest that the PAQ will prove to be a valuable assessment tool. It is currently being evaluated as part of the system used to assess the all round competence of dental graduates undertaking vocational training in Scotland.

Satisfactory completion of dental vocational training in Scotland: a system of assessment.

Formal assessment of dental vocational training (DVT) has been an issue since 1993 when DVT became mandatory for graduates wishing to practice within the NHS. There have been a number of other drivers for change, including concerns about the capabilities of new graduates, a lack of standardisation of the training experience and accountability for standards of training. All of these factors contributed to the decision, by the Scottish Council for Postgraduate Medical and Dental Education (now part of NHS Education for Scotland--NES), to support a programme of research into the development of a competency-based system of assessment for DVT. During the life of this project the argument for introducing assessment of DVT and General Professional Training (GPT) has become ever stronger.

Comprehensive validation of competencies for dental vocational training and general professional training.

This paper outlines a study designed to validate competencies for dental vocational training (DVT) and general professional training (GPT) in order to ensure their accuracy and acceptability. A highly inclusive approach is described whereby all trainers in Scotland were invited to participate in the exercise. The 168 individuals recruited were drawn from all branches of the dental services and all regions in Scotland. Using online or paper questionnaires, quantitative and qualitative data were collected for each competency statement over 9 months, after which focus groups discussed and decided which changes should be made. A high response rate was observed and from the 160 competencies originally identified, almost half (47.5%) were redrafted as a direct result of the validation process. Sections of the competency document that required most attention are discussed, as are the nature of changes made to the competencies. As a result of this study, a fully validated competency document for DVT and GPT has been produced and will allow a high degree of standardization of training through the provision of essential consistent information to trainers and VDPs.

Facing the challenges of competency-based assessment of postgraduate dental training: Longitudinal Evaluation of Performance (LEP).

CONTEXT: The evaluation of competence in the health professions is of great importance to the public and professionals alike. Recent efforts to design dependable and accurate systems of assessment for demanding clinical roles are increasingly attempting to focus on all-round competence of practitioners. Many challenges are faced in this field as a balance between robust assessment methodology and feasibility in practice is crucial to implementation and adoption. OBJECTIVES: The authors discuss some of the challenges faced by educators and clinicians involved in the development of systems of assessment for the health professions, and describe a method which aims to address these issues in the assessment of postgraduate dental training in Scotland. DISCUSSION: Three of the major challenges facing educators and clinicians involved in the design of competency-based systems of assessment are considered: the requirement for evaluation in different areas of competence; the importance of association of assessment with the training objectives, and the types and focus of the assessment introduced. Issues around the use of formative and summative assessment, and the perception that these must always remain completely separate, are discussed in detail. SOLUTIONS: A proposal is made for the introduction of a method of assessment which has been designed keeping these challenges in mind. The rationale behind this assessment method is described.

The development of an assessment system for dental vocational training and general professional training: a Scottish approach.

The role of competencies in postgraduate dental education and training has been a major topic of interest in recent years. Concerns have been voiced from all sides of the profession about how the competence of trainees and the quality of training can be assured so that high standards of patient care can be maintained. A three year project which seeks to develop a competency-based assessment system for general professional training is underway which hopes to answer some of the concerns and provide an evidence-based system of assessment for the early postgraduate years. This paper looks at the reasoning behind the project, its aims, and the progress made to date.

Scottish consortium for development and education in dental primary care.

A national consortium for dental primary care in Scotland has been formed as a result of integrated planning by groups involved in managing and delivering postgraduate dental education in Scotland. In 1998 a partnership was formed with representatives from the Scottish Council for Postgraduate Medical and Dental Education (SCPMDE) and the three Scottish dental institutions at Dundee, Edinburgh and Glasgow Universities. The principal aim of the Consortium is to promote evidence-based dental care through postgraduate education and research. The activities of the Consortium will provide a broadly based adjunct to current postgraduate provision with partner institutions contributing in different ways. Since its inception the Consortium has focused on two main areas: 'Higher Training' for Primary Care. Scottish Dental Practice Based Research Network.

Young dentists--work, wealth, health and happiness.

OBJECTIVE: To determine the relationships between working conditions for new dental graduates and their mental and physical health. DESIGN: A cross-sectional postal survey. SUBJECTS: Graduates from the years 1991 and 1994 were selected to provide cohorts before and after the introduction of mandatory vocational training. A total of 232 graduates were sent questionnaires and 183 replied (77%): 90 men (49%) and 93 women (51%). SETTING: The cohorts came from all Scottish dental schools. When surveyed in 1996/1997, 66% were working in Scotland and 28% were in England. The rest were elsewhere in the UK or abroad. MEASURES: Measures included a wide range of conditions at work: number of patients seen, pace of work, hours worked, attitudes to work, financial arrangements, alcohol consumption, sickness-absence, physical and mental health. RESULTS: There were significant differences between those working in general practice and those in hospital in terms of the hours, numbers of patients seen, feelings of competence and senior support. Methods of payment for treatment in general practice also revealed differences in perception of work: most pressure at work was associated with part NHS and part private funding. Mental health and alcohol consumption were equivalent to age-matched junior doctors, but increased psychological symptoms in female dentists were significantly associated with the number of units of alcohol consumed. CONCLUSION: Selected working conditions are associated with reported competence, stress and health among young dentists.

Careers and patterns of work of Scottish dental graduates: 1991 and 1994.

OBJECTIVE: To describe current patterns of employment, career intentions and factors that influence career choice in young graduates. DESIGN: A cross-sectional postal survey. SUBJECTS: Graduates from the years 1991 and 1994 were selected to provide cohorts before and after the introduction of mandatory vocational training. A total of 232 graduates were sent questionnaires and 183 replied (77%): 90 men (49%) and 93 women (51%). SETTING: The cohorts all came from Scottish dental schools. When surveyed in 1996/1997, 66% were working in Scotland and 28% were in England. The rest were elsewhere in the UK or abroad. MEASURES: A questionnaire which had been piloted, applied to medical graduates and then adapted for dentists, was used. RESULTS: The most common post held was that of Associate in General Dental Practice (61% of the sample) and the majority (85%) were working full-time. Only small numbers indicated that they wished to undertake a career in academia (6) or the hospital dental service (17). In choosing a career, males were more influenced by financial factors (P = 0.009) and women by the availability of part-time employment (P = 0.000). CONCLUSION: Despite the recent adverse publicity about general dental practice, most young dentists see their future in this sector of the profession. More worrying is the comparatively small number who wish to work within the hospital service or in academia. Results also indicate the need to develop schemes to retain women in the workforce.

Postgraduate dental education and the 'new' graduate.

It is notoriously difficult to evaluate educational initiatives. Nevertheless, with the introduction of mandatory vocational training, it seems curious that there has been no formal, structured assessment of whether dental vocational training is perceived as having fulfilled its aims. Nor is there information on how participation in continuing dental education relates to feelings of competence or confidence in clinical practice. This paper reports on the experience of two cohorts of 'new' dental graduates from Scotland and provides evidence to inform the debate on vocational training, general professional training and recertification for the dental profession.

Studies on effects of nutritional factors on bone structure and osteoporosis in laying hens.

1. A modern hybrid strain of laying hen (Hisex) was fed from point of lay to 68 weeks on a control diet and diets containing oystershell, fluoride, 1,25-dihydroxycholecalciferol, ascorbic acid, a lower concentration of phosphorus and a combination of a lower concentration of crude protein and higher concentration of vitamin K. Hens from a much older strain (Brown Leghorn J-line) were fed on the control diet. 2. Plasma variables were measured during lay. End-of-lay trabecular and medullary bone volumes in the proximal tarsometatarsus and free thoracic vertebra were measured by histomorphometry. 3. The majority of Hisex hens were considered to be osteoporotic by the end of lay. In contrast, none of the J-line were osteoporotic. 4. None of the nutritional treatments affected trabecular bone volumes. Medullary bone volumes were increased significantly by feeding oystershell or fluoride. 5. There was no phenotypic correlation between egg production and trabecular bone volume in the Hisex hens. 6. The experiment provided evidence that osteoporosis in laying hens, as assessed by trabecular bone volumes, is not caused by calcium deficiency and could not be prevented by any of the nutritional treatments studied.

Unusual leiomyomatous hamartoma of the hard palate: a case report.

Harmartomas of the head and neck are common lesions, often taking the form of melanocytic nevi or vascular malformations such as hemangiomas and lymphangiomas. Hamartomas composed of other tissue types are much rarer and within the oral cavity are usually located on the tongue near the foramen cecum or on the anterior hard palate near the incisive papilla. Although most occur as isolated phenomena, a small number may be associated with other local developmental defects or with a syndrome complex. A normal 5-year-old girl had a 1 cm soft sessile swelling in the vault of the hard palate on the left side. Histopathologic examination showed bundles of smooth muscle embedded in fibrovascular stroma and accompanied by abundant mature fat and a small amount of salivary tissue. The features were regarded as those of a leiomyomatous hamartoma and could be distinguished from a smooth-muscle tumor, teratoma, and benign mesenchymoma by virtue of the clinical and histopathologic features. No recurrence has been seen after excision.

Effectiveness of dietary 25- and 1-hydroxycholecalciferol in combating tibial dyschondroplasia in broiler chickens.

1. Three experiments were carried out to determine the effects of feeding diets containing different concentrations of cholecalciferol, 1 alpha-hydroxycholecalciferol (1-HCC), 25-hydroxycholecalciferol (25-HCC), 1,25-dihydroxycholecalciferol (1,25-DHCC) and ascorbic acid on the incidences and severities of tibial dyschondroplasia (TD) at 3 weeks of age in male broiler chicks. 2. In experiment 1, replacing 75 micrograms cholecalciferol/kg with the same weight of 25-HCC decreased significantly (P < 0.01) the incidence of TD from 65 to 10%. 3. In experiment 2, the incidence of TD in the control group was lower, but feeding amounts of 25-HCC up to 250 micrograms/kg had a linear effect on the incidence of TD that was significant at P = 0.06. There was no effect or interactions with dietary addition of 250 mg ascorbic acid/kg. Dietary addition of 5 micrograms 1-HCC/kg decreased TD incidence from 21 to 5%, though the effect was not significant (P > 0.1). 4. TD incidence in experiment 3 was too low to determine an effect of25-HCC or 1,25-DHCC on TD incidence, though in this, as in both other experiments, the severities of TD lesions were always lower with diets containing cholecalciferol metabolites. 5. Hypercalcaemia was not observed after feeding up to 250 micrograms 25-HCC/kg in either experiments 2 or 3. 6. It is concluded that 25-HCC may be an effective practical means of improving broiler leg health by alleviating the incidence and severity of TD.

In vivo and in vitro effect of 1,25-dihydroxyvitamin D3 and 1,25-dihydroxy-16-ene-23-yne-vitamin D3 on the proliferation and differentiation of avian chondrocytes: their role in tibial dyschondroplasia.

1,25-Dihydroxyvitamin D3 (1,25(OH)2D3) is regarded as the most biologically active metabolite of cholecalciferol. It prevents tibial dyschondroplasia (TD) in chicks where inhibition of chondrocyte differentiation within the growth plate occurs. However, it is unclear whether its mode of action is through direct interaction with its chondrocyte receptor and its known regulatory role in cell differentiation or is mediated by increased calcium absorption and mobilisation. Synthetic analogues of 1,25(OH)2D3 such as 1,25-dihydroxy-16-ene-23-yne cholecalciferol (RO 23-7553) with increased differentiation properties but reduced calcaemic activity have been synthesised. In this study, the in vitro and in vivo effects of 1,25(OH)2D3 and RO 23-7553 on chick chondrocyte growth and differentiation were examined. In addition, the in vivo effectiveness of these steroids in preventing TD in chicks was assessed. 1,25(OH)2D3 and RO 23-7553 (10(-12)-10(-7) M) displayed biphasic concentration effects and had similar potencies in vitro in regulating chondrocyte proliferation and differentiation. However, while the incidence of TD in birds dosed with 1,25(OH)2D3 was lower (10%) than in control chicks (55%), RO 23-7553 was ineffective (50%). This may be the result of its reduced affinity (1000 times less) for the plasma vitamin D binding protein (DBP) and the chondrocyte receptor in comparison to that of 1,25(OH)2D3. A reduction in calcium supply to the chondrocyte may also result in decreased chondrocyte differentiation but blood ionised and plasma total calcium were normal in birds dosed with RO 23-7553. These data suggest that RO 23-7553 and 1,25(OH)2D3 regulate chondrocyte proliferation and differentiation similarly in vitro but not in vivo. This may be caused by differences in DBP binding and clearance rates of the two steroids in vivo.