a curriculum for uk dental foundation programme training foundation programme... · the concept of...

A Curriculum for UK DentalFoundation Programme Training

UK Dental Foundation Programme Curriculum

ForewordThis work was commissioned by the Department of Health (England) and the contract was awarded to agroup from NHS Education for Scotland. Members of the group are as follows:-

Dr. Linda Prescott-Clements

Dr. D.H. Felix

Dr. Y. Hurst

Miss K. Jack

Dr. J.S. Rennie

The curriculum is endorsed by

The Faculty of Dental Surgery, The Royal College of Surgeons of Edinburgh

The Faculty of Dental Surgery, The Royal College of Physicians and Surgeons of Glasgow

The Faculty of Dental Surgery, The Royal College of Surgeons of England

The Faculty of General Dental Practice (UK)


ContentsPART 1

Introduction

Modernising Medical and Dental Careers 2

The benefits of Modernising Dental Careers 2

Career Pathways 3

Model of Learning 6

Curriculum development project -background & scope 7

Rationale and Curriculum Development

Purpose of the curriculum 8

Educational Philosophy 8

Use of the curriculum within differentFP structures 9

Curriculum Development andValidating Competencies 9

Terminology 10

Links to previous and subsequentstages of training 11

Sequencing 11

Content (syllabus) - Dental FoundationProgramme Competencies

Overview 12

Clinical domain 16

Communication domain 32

Professionalism domain 36

Management & Leadership domain 40

PART 2

Assessment

Recommendations for an approachto assessment 48

Methods 53

Development, pilots & evaluation 55

Implementation

Training for trainers, evaluators and trainees 56

Learning Opportunities 56

Maintaining Quality 57

Administration 57

Appendix 1

Definition of ’curriculum’ and 'syllabus’ 58

Appendix 2

Steering group members 60

Appendix 3

Consultation Group - Stakeholders 62


1

Part 1


2

IntroductionModernising Medical and Dental Careers

In February 2003 the UK Health Departments published a policy statement on 'Modernising MedicalCareers'1 which outlined agreed principles for the reform of postgraduate medical training. This policyarose out of further work on an earlier report on the same issue, ’Unfinished Business’

2. In April 2004

’Modernising Medical Careers – The Next Steps',3

was published which contained further detail on thepolicy direction for the management of the early postgraduate years in medicine.

The concept of a two year foundation programme is broadly comparable to the structured two yearGeneral Professional Training (GPT) Programme currently available for a proportion of dental graduates inthe UK.

The Benefits of Modernising Dental Careers

‘Modernising Dental Careers’ envisages improved care for patients where clinical governance and patientsafety are central to modern practice. In the future it is envisaged that a greater proportion of care will bedelivered by fully trained dentists rather than training grade staff. The introduction of ‘Modernising DentalCareers’ will bring significant improvements to career pathways. The principal benefits of a dentalfoundation programme are as follows:-

• Improved care for patients with a particular emphasis on safety and standards

• Improved training opportunities for the future workforce in the UK

• Flexible training pathways tailored to meet the needs of the service and personal development needs ofyoung dental graduates

• Streamlined training to enable a greater proportion of care to be delivered by trained staff

• Improved recruitment and retention of the workforce in the UK

1 Modernising Medical Careers. The response of the four UK Health Ministers to the consultation on Unfinished Business: Proposals for reform of the Senior House Officer grade. February 2003.2 Unfinished Business. Proposals for reform of the Senior House Officer grade. August 2002.3 Modernising Medical Careers. The next steps. The future shape of Foundation, Specialist and General practice Training Programmes. April 2004.

Experience of two year structured training programmes has highlighted the fact that this type of trainingprovides trainees4 with a wider range of opportunities to develop their communication, team-working andclinical skills when compared to stand alone posts in each service. Trainees' expectations are exceeded bytheir experiences in several areas including opportunities to develop communication skills (with patientsand colleagues), improved skills in patient management, time-management, research and auditmethodology as well as problem-solving and decision-making. Overall a two year structured trainingprogramme confers the following benefits5:-

• dynamic training environments

• dentists with more advanced clinical skills and good generic skills

• an improved understanding of referral systems

• better appreciation of the work of the salaried dental service

• better communication between the different branches of the dental service and the breakdown ofartificial barriers between primary and secondary care

• dentists with informed career options and greater adaptability

• an enhanced commitment to lifelong learning and continuing professional development

• improved recruitment and retention

Accordingly this system has significant advantages for the future dental workforce within the UK.

The principles of Modernising Dental Careers will have an impact on all training grades and in duecourse training will be delivered through structured programmes with few, if any, stand-alone posts.

Career Pathways

Foundation Year 1 (FY1)

For the majority of trainees this will equate to one year vocational training based in General DentalPractice.

Foundation Year 2 (FY2)

This will build upon the existing two year GPT schemes. However as most dental graduates have a finalcareer in primary care, with a minority having a career in secondary care, additional models will bedeveloped with an increased emphasis on training within primary care, as this will provide the mostappropriate environment for the graduates’ future needs.

Figure 1a gives an outline of dental education and training in the UK. Figure 1b shows the UKModernising Medical Careers Framework.

4 Throughout this document, the term ‘trainee’ refers to a postgraduate trainee.5 A Bridge to the Future: An evaluation of General Professional Training for Dentistry in Scotland. Scottish Council for Research in Education. February 1999.

3


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Model of Learning

Postgraduate education and training in the health professions represents a dynamic and complex systemin which a range of styles of learning, teaching and assessment are employed in order to try to achievemaximum benefits to trainees, patients and the NHS. Based primarily on the apprenticeship model,postgraduate dental training (as with postgraduate medical training6) involves an emphasis on experientiallearning within the workplace, involving elements of coaching through appropriate supervision andmentorship, supplemented by formal educational events and self-directed learning. In addition, modernday training programmes have an increasing focus on learning within clinical teams, which bring into playsocio-cultural learning theories7.

Dental foundation programmes enhance trainees’ learning by providing context for clinical practice acrossdifferent environments, experience in ‘real time’ and exposure to aspects of care that cannot be recreatedin the classroom e.g. time constraints and heavy demands on workload, continuity of care and asupportive working environment. One to one teaching sessions and the provision of constructive feedbackhave been identified by postgraduate trainees as particularly valuable8.

Other educational models described recently, classify education as a product, process or as research9. Usingthese models, the education and training within dental foundation programmes is predominantly seen asa ’process’, where teaching is centred around the complex relationship between educational supervisor(s)and the trainee and the learner actively seeks knowledge. Vital to this model is the positive educationalimpact of assessment, which should be formative as well as summative, providing valuable feedback onperformance and progress. Whilst the ‘process’ educational model matches dental foundationprogrammes well, elements of the ‘product’ and ‘research’ models also feature within foundationprogrammes, suggesting again that this complex and dynamic training environment does not easily fitinto any single category. Such features include the frequent use of a detailed list of competencies todescribe the programme content or syllabus in postgraduate medical and dental training (product model).Although the limitations of this approach (being reductionist, and less able to reflect the true nature ofcognitive expertise that is desirable at this stage in the professional training) are well documented, the useof competencies is well established within the health professions, perhaps reflecting the recent shifttowards increased accountability and the need to demonstrate fitness for purpose. In addition, formalteaching activities (albeit in limited quantities) supplement experiential learning in postgraduate dentaleducation - another feature of the ‘product’ model. Elements of the ‘education as research’ model mayalso apply, such as the move towards more learning within clinical teams i.e. alongside others.

To achieve maximum educational benefits to the learner, it is recommended that dental foundationprogrammes;

• provide a wide range of experience within the workplace (providing the necessary range of clinical casesand generic tasks)

• support trainees’ learning through appropriate and regular contact with experts and relevant teammembers (regular meetings with an educational focus)

6 Grant, J et al [2004]. Standards for curriculum development: background paper. PMETB.7 Bleakley, A. [2006]. Broadening conceptions of learning in medical education: the message from teamworking. Medical Education.8 Barnard, K et al. [2001]. Life as a house officer. Academic Medicine 76 [10], S8-S10.9 Fish D. and Coles C. [2005]. Medical Education: Developing a curriculum for practice. Open University Press.

• provide regular feedback on performance

• enhance knowledge through formal educational events

• allow time for self-directed learning through independent study and reflection.

Curriculum Development Project – Background & Scope

Following widespread support throughout the dental community for the changes to postgraduate medicaltraining currently being implemented through Modernising Medical Careers, the General ProfessionalTraining (GPT) Liaison Group UK was asked by the Department of Health (England) to take forward thedevelopment of a curriculum for Foundation Programmes in Dentistry in the UK.

Following a tendering exercise in October 2005 to appoint a specialist educationalist (on a fixed resourcebasis for approximately forty days only), this project formally began on 14th December 2005. The remitof this work was identified as follows:

• to compile and review the literature on GPT and FP as it would apply to dentistry

• to complete the draft of the curriculum for FP in dentistry based on the existing Scottish model

• to propose a system of assessment including relevant tools

• to modify the document after consultation to produce the final curriculum

Given the present level of uncertainty regarding the move towards dental foundation programmes acrossthe UK, and the current lack of nationally agreed structure(s) for the training, this curriculum document ispresented as a selection of recommendations based on existing evidence. It is acknowledged therefore thatfurther detail may need to be added to these proposals once the exact nature of the dental foundationprogramme has been established. The definitions of ‘curriculum’ and ‘syllabus’ are provided in appendix1 for reference.

It is anticipated that dental foundation programme structures will inevitably vary in the type and durationof training and experience offered, and may also differ according to the location of individual posts. Hence,this document describes a generic curriculum relevant across all potential foundation programmestructures, containing competencies that are relevant to, and achievable by, all foundation programmetrainees regardless of the structure of programme they have completed.

It is important to note that the competencies within this document represent those considered essentialacross different foundation programme structures and training environments, and we anticipate that insome training environments (e.g. a dental foundation trainee within an Oral and Maxillofacial Surgeryunit) additional competencies may be required. However, the purpose of this document is to providerecommendations for a generic curriculum for the UK dental foundation programme, and any additionalrequirements within specific rotations should be identified locally.

7


8

It is envisaged that dental foundation programmes will provide a positive and well-rounded educationalexperience for postgraduate trainees. Specific advantages of this training will include:

• Working within different clinical environments, in both primary and secondary care

• Experience of a wide range of clinical cases, and continuity of care

• Experience of a wide range of patient types and case complexities

• Introduction to specialised skills

• Experience of a range of clinical teams

Purpose of the Curriculum

The GPT Liaison Group has described the aim of education and training within a dental foundationprogramme as the production of:

“A competent, caring, reflective practitioner, able to develop their career in any branch ofdentistry to the benefit of patients.”

Educational Philosophy

As dental foundation programmes represent a mixture of education and training, both cognitive andbehavioural objectives have an important role in the curriculum. In this training, it is envisaged thatcognitive and behavioural development go hand in hand, and the demonstration of competence willrequire the coordinated use of both knowledge and skills in the appropriate performance of the ‘wholetask’. With this and assessment in mind, the competencies within this curriculum are all written from abehavioural perspective. However, although this approach is useful within syllabuses in describing thecontent of curricula in detail, it can unfortunately give the impression of a reductionist approach. Althoughthe competencies can be considered a blueprint for assessment in terms of addressing content validity, itis important to remember that when developing assessment for this training, competence is much morethan the sum of its parts. It would be inappropriate (and totally impractical) to think of assessing eachcompetency within the syllabus one by one, seeing each domain as a separate checklist to be ticked offonce the behaviour has been observed. Rather, assessment will focus on trainees’ whole task performance(across a variety of contexts), which will inevitably involve assessing a range of individual competenciesfrom across different domains, during the management of any particular case. This is described in moredetail in the sections below.

Rationale and CurriculumDevelopment

Use of the Curriculum within Different Foundation Programme Structures

At present, the specific structures within dental foundation programmes have yet to be identified. Whilstmany within the profession agree that a period within the general dental services at the start of thefoundation programme is desirable, the limited number of posts and places available in other trainingenvironments at any one time in some regions may make this difficult to implement for all trainees10. As aresult, the overall organisation of the syllabus is necessarily heterogeneous, with limited identification of‘horizontal’ and ‘vertical’ structure or ‘sequencing’ of content. In addition, there will inevitably be a rangeof foundation programme structures implemented across the UK, and this flexibility will allow astandardised syllabus across different training environments.

The competencies within this document are therefore considered relevant to, and achievable by, allfoundation programme trainees regardless of the specific programme they have completed. Similarly, thissyllabus describes the competencies considered essential across different foundation programme structuresand training environments, and will therefore not be ranked in any way. We recognise that in sometraining environments additional competencies may be required, and any requirements of specificrotations not covered within this generic syllabus should be identified and implemented locally.

Curriculum Development and Validating Competencies

In maintaining the highest standards of patient care and quality training, training programmes should bedesigned through consideration of a valid curriculum, rather than the other way round. In other words,the curriculum aims and content identified as necessary to achieve those aims should drive the process ofprogramme development. If a particular skill or task is considered essential to being a competentpractitioner, but rarely experienced in practice (e.g. life support) then it should remain in the curriculumand additional efforts put in place to give trainees training in this area. The priority in this curriculumdevelopment process has therefore been to identify the competencies and attributes required of apractitioner having successfully completed a dental foundation programme11. Once agreed by theprofession, these may then be used as a guide for the development of training programmes.

The GPT Liaison Group specified that having been well researched and extensively validated the ScottishCompetencies for VT / GPT should be used as a starting point for the foundation programme curriculum12.However, other work published in this area was also considered as part of the research/developmentprocess and a comprehensive mapping exercise using existing documents from both dentistry andmedicine (for generic competencies) was carried out to produce the first draft. The documents consideredwere:

FGDP Key Skills document

Values-based curriculum

ADEE Competencies for the European Dentist

Standards for Dental Professionals (GDC)

USAF Advanced Education in General Dentistry Competencies

10 However, it is acknowledged that dental foundation programmes will most likely involve 1 year in general practice at some stage – equivalent to the VT year.11 As indicated in the outcomes statement agreed by the GPT Liaison Group.12 Prescott L E, Hurst Y and Rennie J S. [2003]. Comprehensive validation of competencies for dental vocational training and general professional training. European Journal ofDental Education 7: 154-159.

9


10

CANMeds 2005 Framework – Medical Experts

Curriculum for the Foundation Years in Postgraduate Education& Training (MMC)

Skills required for House Officers and SHOs (COPDEND)

GDC First Five Years

Standards for Better Health

Following internal consultation by our steering group (Appendix 2) and the GPT Liaison Group, the draftcompetencies were distributed widely across the UK for consideration by stakeholders. Approximately 250individuals were directly invited to take part in this consultation, representing stakeholder groups asoutlined in Appendix 3. Comments received from stakeholders were considered by the steering group andGPT Liaison Group, and amendments made where necessary.

Terminology

Standard terminology used throughout the syllabus is explained below.

“Demonstrate….to an appropriate standard”

“Describe…in appropriate detail”

These phrases precede the competency statements and provide vital context for the purpose ofassessment, whereby a particular standard of performance for these competencies will be required. Thestandard required for performance should be made clear as part of the assessment process.

One good example of the importance / relevance of such phases within the competency statements iswhere overlap in content (necessarily) exists with competencies identified for undergraduate training.Clearly, such competencies are also relevant and would be performed within foundation programmes.However, a different standard of performance would be required from a foundation programme traineethan from an undergraduate. For example during the management of caries, although technicalcompetence would (of course) be expected as a graduate, a practitioner completing a foundationprogramme would perhaps be expected to tackle more complex clinical cases, in a more efficient manner,perhaps with the co-integration of other competencies such as communication with the patient and dentalteam and / or practice management issues.

Domains, Major Competencies and Supporting Competencies

A Domain represents a “group” of related competencies – hierarchically the highest order. A Domain(e.g. ‘Communication’) may be further divided into “Major Competencies” ….such as “Communicationwith the patient”, “Communication with the Dental team” etc. Individual competency statements withinthese groups are known as ‘supporting competencies’.

Links to Previous and Subsequent Stages in Training

Many competencies within this foundation programme curriculum are equally relevant to undergraduatedental training13. This is because professional training represents a continuum, and such tasks will berequired throughout practice, albeit in different contexts, and in many cases to a different standard ofperformance as described above. Similarly, although all UK undergraduate dental programmes follow theGDC standards ‘The first five years’, it would be incorrect to presume that all courses are merely clonesand no differences existed between dental school curricula. Universities are individual in terms of allaspects of curricula, offering different syllabi, clinical experiences and assessment systems. Clearlygraduates from dental schools will enter foundation programmes with a range of different experiences,strengths and weaknesses. It would be invalid (not to mention impractical) to attempt to identify merelythose aspects of performance that were ‘new’ to this level of training.

It is envisaged that trainees having successfully completed dental foundation programmes will be fullyprepared to develop their career further in any branch of dentistry, with the ability to move seamlessly intospecialist training if required.

Sequencing

Although it is likely that certain tasks within dental foundation programmes will be performed by traineesbefore others that are more complex, formal sequencing of this curriculum is not possible – or desirable –due to the heterogeneity of the programme structure. For example, some of the more challenging casesencountered within the hospital dental services may be experienced by many trainees in dental foundationyear (DFY) 2, whereas others may begin their DFY1 in this environment.

13 This perhaps highlights one of the limitations of describing training outcomes in terms of individual competency statements - the concept of ‘competence’ is very muchmore than the sum of its parts.

11


MANAGEMENT & LEADERSHIP

DOMAIN

PROFESSIONALISM DOMAIN

COMMUNICATION DOMAIN

CLINICAL DOMAIN

COMPETENCE

12

Overview

The domains and major competencies within this curriculum are outlined in the figures below;

Figure 2 – Domains within the dental foundation programme syllabus

Content (Syllabus) –Dental FoundationProgramme Competencies

CLINICAL DOMAIN

Patient examination & diagnosis

Treatment planning & patient management

Health promotion & disease prevention

Medical & dental emergencies

Anaesthesia, sedation, pain & anxiety control

Periodontal therapy & management of soft tissues

Hard & soft tissue surgery

Non-surgical management of the hard & soft tissues of the head & neck

Management of the developing dentition

Restoration of teeth

Replacement of teeth

13


Figure 3: Major competencies within each domain

PROFESSIONALISM DOMAIN

Ethics

Professionalism with regard to… Self

Professionalism with regard to… Clinical team & peers

Professionalism with regard to… Patients

COMMUNICATION DOMAIN

Communication with… the patient & family

Communication with… the clinical team & peers

Communication with… other professionals

14

15


MANAGEMENT & LEADERSHIP DOMAIN

Personal & practice organisation

Financial

Leadership & management

Legislative

16

Domain - ClinicalM

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17


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dia

gnos

tic im

agin

g te

chni

ques

.

13.

Reco

gnis

e th

e ne

ed f

or a

nd r

eque

st t

he r

elev

ant

clin

ical

lab

orat

ory

and

diag

nost

ic t

ests

whe

n ap

prop

riate

, an

d lia

ise

with

appr

opria

te p

erso

nnel

to

acqu

ire a

n ac

cura

te in

terp

reta

tion

and

reco

rd o

f th

e re

sults

.

Domain - Clinical

18

Maj

or

Co

mp

eten

cy

(1)

Pati

ent

Exam

inat

ion

and

Dia

gn

osi

s(C

on

t)

Sup

po

rtin

g C

om

pet

enci

es

14. R

ecor

d im

pres

sion

s fo

r th

e pr

oduc

tion

of a

ccur

ate

diag

nost

ic c

asts

, rec

ord

the

occl

usal

rel

atio

nshi

p an

d us

e a

face

bow

to

rela

teth

e m

axill

ary

cast

to

the

cond

ylar

axi

s.

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

15.

Gen

erat

e a

diffe

rent

ial d

iagn

osis

and

tre

atm

ent

/ m

anag

emen

t pl

an b

ased

on

evid

ence

thr

ough

the

cor

rect

inte

rpre

tatio

n of

clin

ical

fin

ding

s.

16.

Ass

ess

the

influ

ence

of

syst

emic

dis

ease

s an

d ot

her

disa

bilit

ies

(and

ass

ocia

ted

trea

tmen

t) o

n or

al h

ealth

and

the

del

iver

y of

dent

al t

reat

men

t.

17. I

nter

pret

dia

gnos

tic c

asts

and

mou

nt o

n ch

osen

app

ropr

iate

art

icul

ator

usi

ng n

eces

sary

occ

lusa

l and

oth

er r

ecor

ds.

18.

Det

erm

ine

patie

nts’

den

tofa

cial

aes

thet

ic r

equi

rem

ents

, id

entif

y th

e de

gree

to

whi

ch t

hey

can

be m

et,

disc

uss

the

diffe

rent

optio

ns, a

nd m

anag

e pa

tient

exp

ecta

tions

.

19. K

eep

clin

ical

rec

ords

(co

nven

tiona

l or

elec

tron

ic)

in li

ne w

ith r

ecog

nise

d st

anda

rds

20.

Perf

orm

an

accu

rate

ass

essm

ent

of t

he p

atie

nt t

o en

able

the

ear

ly d

iagn

osis

of

orof

acia

l ne

opla

stic

cha

nge,

and

be

know

ledg

eabl

e of

ref

erra

l pro

toco

ls t

akin

g in

to a

ccou

nt a

ppro

pria

te u

rgen

cy.

Domain - Clinical

19


Maj

or

Co

mp

eten

cy

(1)

Pati

ent

Exam

inat

ion

and

Dia

gn

osi

s(C

on

t)

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

escr

ibe

in a

pp

rop

riat

e d

etai

l:

21.

The

sign

s of

abu

se o

r ne

glec

t in

vul

nera

ble

grou

ps,

and

the

loca

l pr

oced

ures

tha

t sh

ould

be

follo

wed

whe

n re

port

ing

such

circ

umst

ance

s.

22. T

he s

igns

and

sym

ptom

s of

per

iodo

ntal

dis

ease

s, a

nd id

entif

y co

nditi

ons

whi

ch m

ay r

equi

re t

reat

men

t or

onw

ard

refe

rral

.

23.

The

clin

ical

fea

ture

s as

soci

ated

with

ora

l m

ucos

al d

isea

ses,

and

ide

ntify

con

ditio

ns w

hich

may

req

uire

tre

atm

ent

or o

nwar

dre

ferr

al.

24.

The

spec

trum

of

patie

nt b

ehav

iour

whi

ch m

ay c

ontr

ibut

e to

oro

faci

al p

robl

ems

and

iden

tify

cond

ition

s w

hich

req

uire

prev

entio

n or

man

agem

ent.

25. T

he in

vest

igat

ions

and

ass

essm

ent

proc

esse

s re

quire

d pr

ior

to g

ener

al a

naes

thes

ia.

Th

e tr

ain

ee c

an d

emo

nst

rate

ap

pro

pri

ate:

26.

Know

ledg

e an

d un

ders

tand

ing

of t

he p

rinci

ples

of

perf

orm

ing

a ba

sic

clin

ical

exa

min

atio

n, i

nclu

ding

blo

od p

ress

ure,

pul

se,

resp

iratio

n an

d te

mpe

ratu

re.

27. K

now

ledg

e of

(an

d w

here

app

ropr

iate

, per

form

) di

agno

stic

pro

cedu

res,

incl

udin

g bi

opsy

.

Domain - Clinical

20

Domain - ClinicalM

ajo

rC

om

pet

ency

(2)

Trea

tmen

t Pl

ann

ing

&

Pati

ent

Man

agem

ent

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. P

rese

nt t

o th

e pa

tient

(an

d ch

eck

thei

r un

ders

tand

ing

ther

eof)

the

find

ings

res

ultin

g fr

om t

he h

isto

ry a

nd e

xam

inat

ion,

incl

udin

gcl

inic

al

and

radi

ogra

phic

re

sults

, di

ffere

ntia

l di

agno

ses,

tr

eatm

ent

optio

ns,

prog

nose

s,

sequ

ence

d tr

eatm

ent

plan

an

din

divi

dual

ised

rec

all i

nter

vals

in a

man

ner

that

the

y ca

n un

ders

tand

.

2. D

evel

op a

nd d

iscu

ss w

ith t

he p

atie

nt (

or c

arer

) in

a m

anne

r th

ey c

an u

nder

stan

d, a

com

preh

ensi

ve a

nd a

ccur

ate

care

or

trea

tmen

t pl

an w

here

opt

ions

are

bas

ed o

n th

e in

divi

dual

nee

ds o

f th

e pa

tient

.

3. F

orm

ulat

e in

divi

dual

ised

car

e or

tre

atm

ent

plan

s fo

r pa

tient

s ac

cord

ing

to t

heir

indi

vidu

al c

ircum

stan

ces,

nee

ds a

nd s

elec

ted

trea

tmen

t op

tions

.

4. D

iscu

ss w

ith t

he p

atie

nt (

in a

man

ner

they

can

und

erst

and)

the

ir re

spon

sibi

litie

s as

soci

ated

with

the

tre

atm

ent

plan

, in

clud

ing

prev

entiv

e ed

ucat

ion,

tim

e re

quire

men

ts f

or t

reat

men

t, f

ees*

and

pay

men

t m

etho

ds.

* in

gen

eral

pra

ctic

e (U

K) a

nd S

DS

(Eng

/Wal

es)

Th

e tr

ain

ee:

5. C

an o

btai

n va

lid in

form

ed c

onse

nt f

or t

he p

ropo

sed

trea

tmen

t fr

om t

he p

atie

nt /

par

ent

/ gu

ardi

an a

s ap

prop

riate

.

6. U

nder

stan

ds w

hich

item

s of

tre

atm

ent

fall

with

in N

HS

regu

latio

ns*

and

thos

e w

hich

do

not,

and

can

dis

cuss

the

con

sequ

ence

sof

thi

s w

ith t

he p

atie

nt in

a m

anne

r he

or

she

can

unde

rsta

nd.

* Re

leva

nt t

o th

e lo

catio

n /

coun

try

of t

rain

ing

7. Is

abl

e to

man

age

effe

ctiv

ely

and

prof

essi

onal

ly a

ny s

ituat

ions

whe

re th

e pa

tient

’s w

ishe

s an

d th

e re

com

men

datio

ns o

f the

den

tist

diffe

r, an

d pr

oper

ly d

ocum

ent

the

conv

ersa

tion

and

outc

ome.

21


Maj

or

Co

mp

eten

cy

(2)

Trea

tmen

tPl

ann

ing

&Pa

tien

tM

anag

emen

t(c

on

t.)

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee:

8. Is

will

ing

to c

omm

unic

ate

with

oth

er p

rofe

ssio

nals

whe

n ap

prop

riate

in o

rder

to

obta

in a

dditi

onal

info

rmat

ion

and/

or t

reat

men

tfo

r th

e pa

tient

. Th

e tr

aine

e ca

n de

mon

stra

te t

he a

bilit

y to

ref

er p

atie

nts

for

spec

ialis

ed t

reat

men

t or

adv

ice

in a

man

ner

that

caus

es t

he le

ast

anxi

ety

poss

ible

.

9. D

emon

stra

tes

appr

opria

te m

anag

emen

t of

the

pat

ient

fol

low

ing

disc

harg

e fr

om s

peci

alis

ed c

are.

10.

Mon

itors

the

rape

utic

out

com

es a

nd e

nsur

es t

hat

appr

opria

te f

ollo

w-u

p ca

re i

s ar

rang

ed.

Reco

gnis

es c

hang

es i

n th

e cl

inic

alpi

ctur

e an

d re

view

s di

agno

ses

and

man

agem

ent

plan

s re

gula

rly.

The

trai

nee

can

dem

onst

rate

the

abi

lity

to a

ct a

ppro

pria

tely

and

quic

kly

whe

n pr

oble

ms

aris

e.

Domain - Clinical

22

Domain - ClinicalM

ajo

rC

om

pet

ency

(3)

Hea

lth

Pro

mo

tio

n &

Dis

ease

Prev

enti

on

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. R

ecog

nise

opp

ortu

nitie

s fo

r an

d pr

ovid

e pa

tient

s /

pare

nts

/ ca

rers

with

com

preh

ensi

ve a

nd a

ccur

ate

prev

entiv

e ed

ucat

ion

and

inst

ruct

ion

in s

elf-

care

met

hods

tai

lore

d to

the

indi

vidu

al n

eeds

of

the

patie

nt.

2. P

erfo

rm p

reve

ntiv

e an

d re

stor

ativ

e tr

eatm

ent

proc

edur

es t

hat

will

con

serv

e th

e to

oth

stru

ctur

e, p

reve

nt h

ard

and

soft

tis

sue

dise

ase

and

prom

ote

hard

and

sof

t tis

sue

heal

th.

3. Id

entif

y de

trim

enta

l ora

l hab

its a

nd p

rovi

de p

atie

nts

with

an

effe

ctiv

e st

rate

gy f

or t

heir

cont

rol.

Th

e tr

ain

ee c

an d

emo

nst

rate

:

4. K

now

ledg

e an

d un

ders

tand

ing

of t

he r

elat

ions

hip

betw

een

dent

al d

isea

ses

in p

opul

atio

ns a

nd r

isk

fact

ors.

5. K

now

ledg

e an

d un

ders

tand

ing

of p

reve

ntio

n of

den

tal

dise

ase

in p

opul

atio

ns i

nclu

ding

pre

vent

ive

prog

ram

mes

and

wat

er

fluor

idat

ion.

Th

e tr

ain

ee c

an:

6. P

rovi

de p

reve

ntiv

e ed

ucat

ion

for

patie

nts

in a

man

ner

that

the

y ca

n un

ders

tand

and

whi

ch e

ncou

rage

s se

lf-ca

re a

nd m

otiv

atio

n,

and

chec

k th

eir

unde

rsta

ndin

g.

7. D

escr

ibe

in a

ppro

pria

te d

etai

l the

hea

lth r

isks

of s

ubst

ance

s su

ch a

s to

bacc

o an

d al

coho

l on

oral

hea

lth, a

nd p

rovi

de t

he p

atie

nt

with

app

ropr

iate

adv

ice.

8. P

rovi

de h

ealth

pro

mot

ion

advi

ce w

ithin

the

con

text

s of

div

erse

soc

ial n

orm

s, a

nd v

alue

the

div

ersi

ty a

nd e

thni

city

of t

he p

atie

nt.

9. D

emon

stra

te a

n un

ders

tand

ing

of s

afe,

effe

ctiv

e an

d le

gal p

resc

ribin

g an

d m

onito

ring,

incl

udin

g ap

prop

riate

use

of

the

Briti

sh

Nat

iona

l For

mul

ary.

23


Maj

or

Co

mp

eten

cy

(4)

Med

ical

&D

enta

lEm

erg

enci

es

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. R

ecog

nise

the

nee

d an

d pr

ovid

e ca

re f

or d

ento

faci

al t

raum

a pa

tient

s re

quiri

ng im

med

iate

att

entio

n qu

ickl

y an

d ef

fect

ivel

y.

2. R

ecog

nise

, m

anag

e, (

and

whe

re r

equi

red,

pro

vide

) ba

sic

and

imm

edia

te l

ife s

uppo

rt f

or m

edic

al e

mer

genc

ies,

in

line

with

guid

elin

es f

rom

the

UK

Resu

scita

tion

Cou

ncil.

3. I

dent

ify,

pres

crib

e an

d ad

min

iste

r (w

here

app

ropr

iate

) ph

arm

acol

ogic

al a

gent

s co

rrec

tly f

or t

he m

anag

emen

t of

med

ical

emer

genc

ies.

4.

Dia

gnos

e an

d ef

fect

ivel

y m

anag

e co

mm

on

med

ical

an

d de

ntal

em

erge

ncie

s,

incl

udin

g th

ose

resu

lting

fr

om

trea

tmen

t

com

plic

atio

ns o

r fa

ilure

s, in

fect

ion,

alle

rgic

res

pons

e or

tra

uma.

5. Id

entif

y an

d re

fer

with

an

appr

opria

te d

egre

e of

urg

ency

, med

ical

and

den

tal e

mer

genc

ies

whi

ch a

re b

eyon

d hi

s or

her

sco

pe o

f

man

agem

ent.

Th

e tr

ain

ee c

an d

emo

nst

rate

:

6. A

tho

roug

h un

ders

tand

ing

of p

oten

tial d

rug

inte

ract

ions

and

sid

e ef

fect

s, a

nd m

anag

e si

tuat

ions

app

ropr

iate

ly w

hen

they

occ

ur.

7. A

n un

ders

tand

ing

of t

he r

equi

rem

ents

and

pro

cedu

res

invo

lved

in s

elec

tion

and

mai

nten

ance

of

an e

mer

genc

y dr

ug s

uppl

y.

8. A

n un

ders

tand

ing

of t

he im

port

ance

of

the

team

man

agem

ent

of m

edic

al e

mer

genc

ies,

and

can

fac

ilita

te s

uch

an a

ppro

ach.

Th

e tr

ain

ee c

an:

9. F

orm

ulat

e pr

otoc

ols

to m

inim

ise

risk,

and

dea

l with

med

ical

em

erge

ncie

s.

Domain - Clinical

24

Domain - ClinicalM

ajo

rC

om

pet

ency

(5)

An

aest

hes

iaSe

dat

ion

, Pa

in&

An

xiet

yC

on

tro

l

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. U

se lo

cal a

naes

thes

ia t

echn

ique

s fo

r cl

inic

al d

entis

try

as a

ppro

pria

te t

o en

sure

pai

n co

ntro

lled

trea

tmen

t of

pat

ient

s.

2. S

elec

t an

d pr

escr

ibe

appr

opria

te d

rugs

for

the

relie

f of p

ain

and

anxi

ety

in a

saf

e an

d ef

fect

ive

man

ner

with

an

unde

rsta

ndin

g of

the

risks

invo

lved

.

3. U

se s

uita

ble

beha

viou

ral,

psyc

holo

gica

l and

inte

rper

sona

l tec

hniq

ues

for

the

relie

f of

fea

r an

d an

xiet

y.

Th

e tr

ain

ee i

s ab

le t

o d

escr

ibe

in a

pp

rop

riat

e d

etai

l:

4. T

he b

enef

its, l

imita

tions

and

ris

ks o

f us

ing

gene

ral a

naes

thes

ia a

nd s

edat

ion.

5. T

he in

dica

tions

, co

ntra

indi

catio

ns a

nd t

echn

ical

req

uire

men

ts f

or c

omm

only

use

d co

nsci

ous

seda

tion

tech

niqu

es,

incl

udin

g th

est

eps

in a

chie

ving

saf

e ef

fect

ive

seda

tion

and

post

-sed

atio

n ca

re a

nd m

inim

isin

g th

e ris

ks o

f un

wan

ted

effe

cts

from

thi

str

eatm

ent.

25


Maj

or

Co

mp

eten

cy

(6)

Peri

od

on

tal

Ther

apy

&M

anag

emen

to

f So

ft T

issu

es

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. E

valu

ate

the

perio

dont

al t

issu

es a

nd d

iagn

ose

a pa

tient

’s p

erio

dont

al c

ondi

tion.

2. M

easu

re a

nd r

ecor

d pe

riodo

ntal

indi

ces

accu

rate

ly, a

ccor

ding

to

curr

ent

guid

elin

es.

3. I

nteg

rate

per

iodo

ntal

fin

ding

s in

to t

he p

atie

nt’s

com

preh

ensi

ve t

reat

men

t pl

an a

nd u

nder

stan

d ho

w t

he p

erio

dont

al s

tatu

s of

the

patie

nt w

ill im

pact

on

his/

her

trea

tmen

t pl

an.

4. E

stab

lish

a pr

ogno

sis

for

indi

vidu

al p

erio

dont

ally

invo

lved

tee

th a

nd in

form

the

pat

ient

of

this

.

5. P

resc

ribe,

del

iver

and

mon

itor

the

use

of a

ntim

icro

bial

age

nts,

whe

re a

ppro

pria

te, t

o ai

d th

e tr

eatm

ent

of p

erio

dont

al d

isea

ses.

6. A

sses

s th

e re

quire

men

t fo

r an

d pe

rfor

m o

ral h

ygie

ne in

stru

ctio

n, s

calin

g an

d m

echa

nica

l roo

t de

brid

emen

t.

7. E

valu

ate

the

resu

lts o

f pe

riodo

ntal

tre

atm

ent

and

esta

blis

h an

d m

onito

r a

suita

ble

reca

ll m

aint

enan

ce p

rogr

amm

e fo

r pa

tient

s.

8. A

sses

s th

e re

quire

men

t fo

r sp

ecia

lised

adv

ice

and

/ or

per

iodo

ntal

tre

atm

ent

and

refe

r th

e pa

tient

app

ropr

iate

ly.

Th

e tr

ain

ee:

9. Is

abl

e to

iden

tify

corr

ectly

and

dem

onst

rate

und

erst

andi

ng o

f th

e ae

tiolo

gy o

f a

patie

nt’s

per

iodo

ntal

pro

blem

s, a

nd t

he a

bilit

y

to e

duca

te t

he p

atie

nt in

the

se m

atte

rs a

nd t

he p

reve

ntio

n of

dis

ease

.

10. U

nder

stan

ds t

he r

ole

of d

enta

l car

e pr

ofes

sion

als

in p

erio

dont

al t

hera

py a

nd is

abl

e to

pre

scrib

e tr

eatm

ent.

11. T

he r

ole

of p

erio

dont

al s

urge

ry in

the

man

agem

ent

of g

ingi

val o

verg

row

th a

nd a

dvan

ced

perio

dont

al d

isea

se.

12. T

he c

onse

rvat

ive

man

agem

ent

of g

ingi

val r

eces

sion

.

Domain - Clinical

26

Domain - ClinicalM

ajo

rC

om

pet

ency

(7)

Har

d &

Soft

Tis

sue

Surg

ery

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he:

1. E

xtra

ctio

n of

eru

pted

tee

th, a

nd t

he a

ppro

pria

te d

iagn

osis

and

man

agem

ent

of a

ny c

omm

on c

ompl

icat

ions

.

2. E

ffect

ive

man

agem

ent

incl

udin

g ex

trac

tion

whe

re a

ppro

pria

te o

f bu

ried

root

s (w

heth

er f

ract

ured

dur

ing

extr

actio

n or

ret

aine

dro

ot f

ragm

ents

), u

neru

pted

, im

pact

ed, e

ctop

ic a

nd s

uper

num

erar

y te

eth.

3. E

ffect

ive

man

agem

ent

of p

atie

nts

with

ble

edin

g di

sord

ers

incl

udin

g th

ose

on o

ral a

nti-c

oagu

lant

the

rapy

.

4. E

ffect

ive

man

agem

ent

of b

enig

n so

ft t

issu

e le

sion

s in

clud

ing

sim

ple

surg

ical

pro

cedu

res

whe

re a

ppro

pria

te.

5. A

bilit

y to

car

ry o

ut a

n ac

cura

te p

re a

nd p

ost

oper

ativ

e as

sess

men

t of

the

pat

ient

.

6. A

bilit

y to

rec

ogni

se a

nd m

anag

e ef

fect

ivel

y (in

clud

ing

refe

rral

whe

re a

ppro

pria

te)

any

com

plic

atio

ns t

hat

may

aris

e du

ring

oraf

ter

a su

rgic

al p

roce

dure

, inc

ludi

ng t

he e

ffect

ive

man

agem

ent

and

trea

tmen

t of

oro

-ant

ral d

efec

ts.

Th

e tr

ain

ee c

an d

escr

ibe

in a

pp

rop

riat

e d

etai

l:

7. T

he p

rinci

ples

and

tec

hniq

ues

invo

lved

in t

he s

urgi

cal p

lace

men

t of

den

tal i

mpl

ants

.

Th

e tr

ain

ee:

8. U

nder

stan

ds w

hich

inst

rum

ents

to

use

in d

iffer

ent

surg

ical

pro

cedu

res.

27


Maj

or

Co

mp

eten

cy

(8)

No

n-

surg

ical

Man

agem

ent

of

the

Har

d&

So

ft T

issu

eso

f th

e H

ead

& N

eck

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. T

ake

an a

ccur

ate

drug

his

tory

incl

udin

g cu

rren

t /

self-

med

icat

ion,

and

enq

uire

, re

cogn

ise

the

sign

ifica

nce

of a

nd m

anag

e an

yhi

stor

y re

gard

ing

alle

rgic

rea

ctio

ns.

2. D

iagn

ose

and

trea

t lo

calis

ed o

dont

ogen

tic in

fect

ions

and

pos

t-op

erat

ive

surg

ical

com

plic

atio

ns w

ith t

he a

ppro

pria

te t

hera

peut

icag

ents

, and

dia

gnos

e an

d re

fer

maj

or o

dont

ogen

ic in

fect

ions

with

the

app

ropr

iate

deg

ree

of u

rgen

cy.

3. U

nder

stan

d an

d as

sist

in t

he in

vest

igat

ion,

dia

gnos

is a

nd e

ffect

ive

man

agem

ent

of o

ral m

ucos

al d

isea

se.

4. U

nder

stan

d th

e pa

thol

ogy

of n

eopl

astic

and

non

-neo

plas

tic d

isea

se o

f th

e he

ad &

nec

k.

5. R

ecog

nise

dis

orde

rs i

n pa

tient

s w

ith c

rani

ofac

ial

pain

tha

t re

quire

spe

cial

ised

man

agem

ent,

and

to

refe

r su

ch c

ondi

tions

appr

opria

tely

.

6. R

ecog

nise

and

ant

icip

ate

the

pote

ntia

l dru

g in

tera

ctio

ns t

hat

may

occ

ur b

etw

een

med

icat

ions

pre

scrib

ed b

y th

e pa

tient

’s d

octo

ran

d th

ose

used

in d

enta

l pra

ctic

e.

7. A

sses

s th

e ne

ed f

or, p

resc

ribe

and

whe

re a

ppro

pria

te a

dmin

iste

r ph

arm

acot

hera

peut

ic a

gent

s in

the

saf

e tr

eatm

ent

of a

ll de

ntal

patie

nts.

Domain - Clinical

28

Domain - ClinicalM

ajo

rC

om

pet

ency

(9)

Man

agem

ent

of

the

Dev

elo

pin

gD

enti

tio

n

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. D

iagn

ose,

ass

ess

and

diffe

rent

iate

bet

wee

n m

aloc

clus

ions

tha

t ca

n be

tre

ated

in

gene

ral

prac

tice

and

thos

e th

at r

equi

resp

ecia

lised

adv

ice

and

/ or

man

agem

ent.

2. A

sses

s oc

clus

ion

and

diag

nose

mal

occl

usio

n fo

r th

e pu

rpos

e of

car

ryin

g ou

t in

terc

eptiv

e tr

eatm

ent

or o

nwar

d re

ferr

al a

t th

eap

prop

riate

dev

elop

men

tal s

tage

.

3. R

ecog

nise

det

rimen

tal o

ral h

abits

and

occ

lusa

l tra

uma

and

whe

re a

ppro

pria

te in

terc

ept

corr

ectly

.

4. R

ecog

nise

pro

blem

s re

late

d to

ort

hodo

ntic

tre

atm

ent,

rel

ieve

tra

uma

and

disc

omfo

rt d

ue t

o ap

plia

nces

and

arr

ange

em

erge

ncy

repa

irs t

o or

thod

ontic

app

lianc

es w

hen

requ

ired.

Th

e tr

ain

ee c

an d

emo

nst

rate

ap

pro

pri

ate

kn

ow

led

ge

and

un

der

stan

din

g o

f:

5. H

ow t

o fo

rmul

ate

and

impl

emen

t a

plan

to

prov

ide

spac

e m

aint

enan

ce w

hen

requ

ired.

6. H

ow t

o de

sign

, ins

ert,

adj

ust

and

mon

itor

sim

ple

rem

ovab

le a

pplia

nces

.

7. F

acia

l gro

wth

and

den

tal d

evel

opm

ent

(and

the

abi

lity

to m

onito

r th

ese)

and

rec

ogni

se a

bnor

mal

ities

as

they

app

ear.

8. T

he u

se o

f or

thod

ontic

indi

ces.

29


Maj

or

Co

mp

eten

cy

(10)

Res

tora

tio

no

f Te

eth

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. E

valu

ate

a pa

tient

’s r

isk

fact

ors

for

dent

al c

arie

s an

d to

for

mul

ate

and

impl

emen

t a

suita

ble

prev

entio

n st

rate

gy.

2. E

valu

ate

the

prog

nosi

s fo

r th

e re

stor

ativ

e pr

oces

s of

indi

vidu

al t

eeth

and

rel

ate

this

to

the

over

all t

reat

men

t pl

an a

nd p

atie

nt’s

aim

s an

d ex

pect

atio

ns.

3. E

xpos

e, p

roce

ss a

nd in

terp

ret

appr

opria

te r

adio

grap

hs f

or t

he d

iagn

osis

of

carie

s.

4. R

emov

e ca

rious

too

th s

truc

ture

in p

repa

ratio

n fo

r re

stor

atio

n, u

sing

tec

hniq

ues

whi

ch m

inim

ise

unne

cess

ary

toot

h da

mag

e an

dpu

lpal

inju

ry.

5. P

resc

ribe

and

mon

itor

the

use

of c

hem

othe

rape

utic

age

nts

in o

rder

to

assi

st in

the

pre

vent

ion

of d

enta

l car

ies.

6. R

esto

re c

ario

us t

eeth

to

form

, fun

ctio

n an

d ap

pear

ance

usi

ng a

wid

e ra

nge

of r

esto

rativ

e m

ater

ials

.

7. P

erfo

rm n

on-s

urgi

cal

root

can

al t

reat

men

t an

d re

trea

tmen

t on

sin

gle

and

mul

tiroo

ted

teet

h, a

nd u

nder

stan

d w

hen

refe

rral

is

appr

opria

te.

8. R

ecog

nise

the

ind

icat

ions

for

per

iradi

cula

r su

rger

y an

d w

here

app

ropr

iate

per

form

or

refe

r th

e pa

tient

for

spe

cial

ised

adv

ice

and

/ or

tre

atm

ent

.

Domain - Clinical

30

Domain - ClinicalM

ajo

rC

om

pet

ency

(10)

Res

tora

tio

no

f Te

eth

(Co

nt.

)

Sup

po

rtin

g C

om

pet

enci

es

9. R

ecog

nise

and

man

age

trau

mat

ic in

jurie

s to

the

tee

th in

the

em

erge

ncy

situ

atio

n an

d th

en a

rran

ge f

ollo

w u

p an

d su

bseq

uent

man

agem

ent

in t

he m

ediu

m a

nd lo

ng t

erm

.

10. R

esto

re t

eeth

to

form

, fun

ctio

n an

d ap

pear

ance

usi

ng a

ppro

pria

te in

dire

ct r

esto

ratio

ns.

11.

Rest

ore

prim

ary

teet

h, i

nclu

ding

any

nec

essa

ry p

ulpa

l th

erap

y, u

sing

app

ropr

iate

res

tora

tive

mat

eria

ls a

nd f

ull

cove

rage

tech

niqu

es r

elev

ant

to t

he d

ecid

uous

den

titio

n.

Th

e tr

ain

ee:

12. C

an is

olat

e th

e to

oth

from

sal

iva

and

bact

eria

l con

tam

inat

ion

effe

ctiv

ely

and

be c

ompe

tent

in t

he u

se o

f ru

bber

dam

.

13. C

an d

emon

stra

te m

oder

n re

stor

ativ

e co

ncep

ts a

roun

d M

inim

ally

Inva

sive

Tec

hniq

ues.

31


Maj

or

Co

mp

eten

cy

(11)

Rep

lace

men

to

f Te

eth

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. O

btai

n an

d in

terp

ret

diag

nost

ic c

asts

, tak

e ra

diog

raph

s an

d ga

ther

oth

er r

elev

ant

data

in fo

rmul

atin

g a

diag

nosi

s, p

rogn

osis

and

trea

tmen

t pl

an f

or p

atie

nts

requ

iring

pro

stho

dont

ic t

reat

men

t.

2.

Eval

uate

, sel

ect

and

prep

are

teet

h, a

nd e

valu

ate

resi

dual

rid

ges,

to

supp

ort

and

reta

in f

ixed

and

rem

ovab

le p

rost

hese

s.

3.

Prov

ide

biom

echa

nica

lly s

ound

fix

ed o

r re

mov

able

pro

sthe

ses.

4.

Dia

gnos

e, p

lan,

del

iver

and

mai

ntai

n re

mov

able

par

tial a

nd c

ompl

ete

dent

ures

.

Th

e tr

ain

ee i

s ab

le t

o:

5. P

resc

ribe

to, a

nd c

omm

unic

ate

with

, the

den

tal l

abor

ator

y ac

cura

tely

, and

ass

ess

the

qual

ity o

f the

wor

k co

mpl

eted

by

labr

ator

yte

chni

cian

s.

6.

Des

crib

e in

app

ropr

iate

det

ail t

he p

rinci

ples

and

tec

hniq

ues

invo

lved

in t

he r

esto

ratio

n an

d m

aint

enan

ce o

f the

den

titio

n us

ing

osse

oint

egra

ted

impl

ants

, and

the

mai

nten

ance

(in

clud

ing

the

reco

gniti

on a

nd m

anag

emen

t of

) pe

ri-im

plan

t di

seas

e.

Domain - Clinical

32

Domain - CommunicationM

ajo

rC

om

pet

ency

Pati

ent

&Fa

mily

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. I

ncre

ase

patie

nts’

aw

aren

ess

and

unde

rsta

ndin

g by

car

eful

exp

lana

tion

of t

reat

men

t op

tions

and

pro

cedu

res,

and

the

use

of

effe

ctiv

e co

mm

unic

atio

n sk

ills.

2. In

spire

con

fiden

ce in

pat

ient

s (f

rom

all

age

grou

ps a

nd s

ituat

ions

) th

roug

h th

e us

e of

effe

ctiv

e in

terp

erso

nal a

nd c

omm

unic

atio

nsk

ills.

3. P

rese

nt q

uest

ions

to

the

patie

nt (

or c

arer

) in

a c

lear

, con

cise

and

und

erst

anda

ble

man

ner.

4. C

omm

unic

ate

bad

new

s an

d /

or r

efer

pat

ient

s fr

om d

iffer

ent

age

grou

ps o

r si

tuat

ions

for

spe

cial

ised

tre

atm

ent

in a

sen

sitiv

em

anne

r th

at c

ause

s th

e le

ast

anxi

ety

poss

ible

.

5. C

omm

unic

ate

effe

ctiv

ely

with

rel

ativ

es in

a m

anne

r w

hich

res

pect

s th

e pa

tient

’s d

igni

ty, c

onfid

entia

lity

and

self

imag

e.

6. S

elec

t an

d co

mpo

se a

sui

tabl

e st

yle

of w

ritte

n co

mm

unic

atio

n th

at is

app

ropr

iate

for

the

pat

ient

and

/ o

r gu

ardi

an in

diff

eren

tcl

inic

al s

cena

rios.

7. A

ddre

ss c

halle

ngin

g co

mm

unic

atio

n si

tuat

ions

incl

udin

g th

e ef

fect

ive

man

agem

ent

of a

nger

, con

fusi

on o

r m

isun

ders

tand

ing

ofpa

tient

s.

Th

e tr

ain

ee:

8. P

rovi

des

appr

opria

te,

rele

vant

and

up

to d

ate

prev

entiv

e ed

ucat

ion

to in

divi

dual

pat

ient

s in

a m

anne

r th

at in

spire

s m

otiv

atio

nfo

r ch

ange

.

33


Maj

or

Co

mp

eten

cy

Pati

ent

&Fa

mily

(C

on

t.)

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee:

9.

Can

ide

ntify

pat

ient

s (o

r ca

rers

) w

ith s

peci

al c

omm

unic

atio

n ne

eds

and

is a

ble

to m

ake

arra

ngem

ents

to

mee

t th

ese

requ

irem

ents

effe

ctiv

ely.

10. C

an d

emon

stra

te t

o an

app

ropr

iate

sta

ndar

d th

e ef

fect

ive

man

agem

ent

of a

ll pa

tient

s th

roug

h th

e us

e of

sui

tabl

e in

terp

erso

nal

& b

ehav

iour

al s

kills

, inc

ludi

ng t

hose

with

anx

iety

or

othe

r sp

ecia

l nee

ds.

11. L

iste

ns e

ffect

ivel

y an

d is

res

pons

ive

to n

on-v

erba

l cue

s.

Domain - Communication

34

Domain - CommunicationM

ajo

rC

om

pet

ency

Clin

ical

Tea

m&

Pee

rs

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. W

ork

effe

ctiv

ely

as p

art

of a

tea

m.

2. In

tera

ct e

ffect

ivel

y w

ith m

embe

rs o

f th

e cl

inic

al t

eam

& p

eers

, and

des

crib

e ho

w e

ach

can

cont

ribut

e to

pat

ient

car

e.

3. P

resc

ribe

(ver

bally

/ i

n w

ritin

g) t

o th

e de

ntal

hea

lthca

re t

eam

. Th

e tr

aine

e ca

n de

mon

stra

te t

he a

bilit

y to

dea

l w

ith p

robl

ems

aris

ing

with

the

qua

lity

of t

echn

ical

wor

k an

d m

anag

e pr

oble

ms

aris

ing

from

wor

k de

lega

ted

/ pr

escr

ibed

to

and

perf

orm

ed b

yot

her

mem

bers

of

the

team

.

Th

e tr

ain

ee:

4. P

rovi

des

trea

tmen

t fo

r pa

tient

s fr

om a

ll ag

e gr

oups

and

situ

atio

ns in

an

orga

nise

d an

d ef

ficie

nt m

anne

r th

roug

h th

e ap

prop

riate

inte

ract

ion

with

oth

er m

embe

rs o

f th

e cl

inic

al t

eam

.

5. C

omm

unic

ates

with

all

mem

bers

of

the

clin

ical

tea

m &

pee

rs in

an

appr

opria

te m

anne

r, w

hich

insp

ires

conf

iden

ce,

mot

ivat

ion

and

team

wor

k.

6. I

s ab

le t

o in

tera

ct w

ith a

ll m

embe

rs o

f th

e cl

inic

al t

eam

and

pee

rs t

o an

app

ropr

iate

sta

ndar

d, i

n pr

actic

e po

licie

s, r

ules

and

regu

latio

ns, h

ealth

& s

afet

y pr

oced

ures

and

app

ropr

iate

clin

ical

tec

hniq

ues.

7. U

nder

stan

ds t

he n

eed

for

and

can

orga

nise

and

fac

ilita

te t

eam

tra

inin

g ev

ents

.

35


Maj

or

Co

mp

eten

cy

Oth

erPr

ofe

ssio

nal

s

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

1. C

omm

unic

ate

effe

ctiv

ely

with

oth

er p

rofe

ssio

nals

ver

bally

and

in w

ritin

g.

2. P

rese

nt p

rofe

ssio

nal k

now

ledg

e ef

fect

ivel

y to

a w

ide

rang

e of

lay

and

prof

essi

onal

indi

vidu

als.

3. C

omm

unic

ate

effe

ctiv

ely

(ver

bally

and

in w

ritin

g) w

ith r

efer

ral b

odie

s, a

nd a

will

ingn

ess

to s

eek

advi

ce w

hen

nece

ssar

y.

4. D

iscu

ss p

rofe

ssio

nal m

atte

rs in

an

appr

opria

te m

anne

r.

5. C

omm

unic

ate

effe

ctiv

ely

(ver

bally

and

in w

ritin

g) w

ith r

elev

ant

heal

thca

re /

den

tal i

nstit

utio

ns.

Th

e tr

ain

ee:

6. Is

abl

e to

exp

lain

the

adv

anta

ges

of a

ssoc

iatio

n w

ith p

rofe

ssio

nal b

odie

s an

d pe

er g

roup

s.

Domain - Communication

36

Domain - ProfessionalismM

ajo

rC

om

pet

ency

Eth

ics

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d:

1. U

nder

stan

ding

and

the

app

licat

ion

of t

he p

rinci

ples

of

GD

C p

ublic

atio

ns o

n st

anda

rds

for

dent

al p

rofe

ssio

nals

, th

at p

rovi

degu

idan

ce t

o de

ntis

ts o

n pr

ofes

sion

al a

nd p

erso

nal c

ondu

ct.

2. U

nder

stan

ding

and

the

app

licat

ion

of t

he p

rinci

ples

of e

thic

al b

ehav

iour

rel

evan

t to

den

tistr

y, in

clud

ing

hone

sty,

con

fiden

tialit

y,pe

rson

al a

nd p

rofe

ssio

nal i

nteg

rity

and

appr

opria

te m

oral

val

ues.

3. A

pro

fess

iona

l app

roac

h to

pat

ient

com

plai

nt a

nd a

ccep

ts r

espo

nsib

ility

for

his

/her

act

ions

whe

re a

ppro

pria

te.

Th

e tr

ain

ee:

4. R

espe

cts

and

valu

es d

iver

sity

and

inte

ract

s w

ith p

atie

nts,

sta

ff, p

eers

and

the

gen

eral

pub

lic w

ithou

t di

scrim

inat

ion.

5. Is

abl

e to

exp

lain

in a

ppro

pria

te d

etai

l the

act

ions

ava

ilabl

e to

be

take

n w

ith r

egar

d to

tho

se c

olle

ague

s w

ho a

re u

nder

perf

orm

ing

or b

ehav

ing

unet

hica

lly.

6.

Can

de

mon

stra

te

appr

opria

te

inte

rper

sona

l sk

ills

in

deal

ing

with

di

fficu

lt pa

tient

s or

co

lleag

ues

who

se

beha

viou

r is

unpr

ofes

sion

al.

7. A

dher

es t

o ap

prop

riate

gui

delin

es w

here

nec

essa

ry.

37


Maj

or

Co

mp

eten

cy

Pati

ents

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee:

1. P

rovi

des

com

pass

iona

te c

are

for

all p

atie

nts.

2. D

emon

stra

tes

effe

ctiv

e an

d et

hica

l dec

isio

n m

akin

g.

3. P

rovi

des

trea

tmen

t fo

r al

l pat

ient

s w

ith c

ourt

esy

and

resp

ect,

pro

vide

s tr

eatm

ent

optio

ns t

hat

are

sens

itive

to

the

need

s of

the

patie

nt, a

nd r

ecog

nise

s th

e pa

tient

s’ r

ight

to

choo

se.

4. M

aint

ains

hon

esty

and

con

fiden

tialit

y w

ith a

ll pa

tient

s.

5. In

tera

cts

with

pat

ient

s w

ithou

t di

scrim

inat

ion.

6. M

aint

ains

the

con

fiden

tialit

y an

d se

curit

y of

pat

ient

rec

ords

, with

res

pect

to

cont

empo

rary

legi

slat

ion.

7. R

egul

arly

rev

iew

s th

e ou

tcom

es o

f tre

atm

ent

give

n in

an

effo

rt t

o pr

ovid

e th

e hi

ghes

t st

anda

rds

of p

atie

nt c

are,

and

und

erst

ands

the

impo

rtan

ce o

f cl

inic

al a

udit

and

its r

egul

ar im

plem

enta

tion.

8. P

rovi

des

rele

vant

and

app

ropr

iate

pre

vent

ive

educ

atio

n fo

r ea

ch p

atie

nt in

a m

anne

r th

at h

e /

she

can

unde

rsta

nd.

9. P

rovi

des

accu

rate

cos

tings

for

tre

atm

ent

and

can

expl

ain

a co

st /

ben

efit

anal

ysis

.

Domain - Professionalism

38

Domain - ProfessionalismM

ajo

rC

om

pet

ency

Self

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d:

1. A

tho

roug

h un

ders

tand

ing

of t

he p

rofe

ssio

nal r

espo

nsib

ility

of

a de

ntis

t an

d hi

s/he

r ro

le w

ithin

and

out

side

the

NH

S.

2. A

com

mitm

ent

to C

ontin

uing

Pro

fess

iona

l Dev

elop

men

t (C

PD)

thro

ugh

regu

lar

effo

rts

to u

pdat

e an

d im

prov

e kn

owle

dge

and

skill

s, a

nd t

he in

corp

orat

ion

of t

hese

ski

lls in

to e

very

day

prac

tice.

3. A

n un

ders

tand

ing

of t

he im

port

ance

of

Con

tinui

ng P

rofe

ssio

nal D

evel

opm

ent

with

in d

entis

try

and

its r

ecor

ding

.

4. T

he a

bilit

y (a

nd c

omm

itmen

t) t

o se

lf as

sess

and

ref

lect

upo

n hi

s/he

r ow

n ca

pabi

litie

s an

d lim

itatio

ns i

n or

der

to p

rovi

de t

he

high

est

stan

dard

s of

pat

ient

car

e.

5. T

he a

bilit

y to

crit

ical

ly e

valu

ate

new

tec

hniq

ues

and

tech

nolo

gies

.

6. T

he a

bilit

y to

crit

ical

ly e

valu

ate

publ

ishe

d re

sear

ch a

nd in

tegr

ate

this

info

rmat

ion

to im

prov

e th

e qu

ality

of

care

for

the

pat

ient

.

7. T

he a

bilit

y to

rec

ogni

se, i

nteg

rate

and

ref

lect

on

lear

ning

opp

ortu

nitie

s w

ithin

the

wor

kpla

ce.

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d:

8. K

now

ledg

e an

d un

ders

tand

ing

of t

he p

rinci

ples

invo

lved

in c

linic

al a

udit

and

peer

rev

iew

, an

d is

will

ing

to p

artic

ipat

e in

suc

h

activ

ities

.

9. K

now

ledg

e an

d un

ders

tand

ing

of t

he v

alue

of

perf

orm

ing

and

rece

ivin

g ap

prai

sal.

Th

e tr

ain

ee:

10. U

nder

stan

ds t

he s

igni

fican

ce o

f pra

ctis

ing

whi

le im

paire

d by

alc

ohol

, oth

er d

rugs

, illn

ess

or in

jury

and

can

des

crib

e th

e da

nger

s

asso

ciat

ed w

ith t

hese

situ

atio

ns.

39


Maj

or

Co

mp

eten

cy

Clin

ical

Tea

m&

Pee

rs

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee:

1. Is

abl

e to

exp

lain

in a

ppro

pria

te d

etai

l the

act

ions

ava

ilabl

e to

be

take

n w

ith r

egar

d to

inco

mpe

tenc

e, im

pairm

ent

or u

neth

ical

beha

viou

r fr

om c

olle

ague

s.

2. In

tera

cts

with

pat

ient

s, c

olle

ague

s, t

eam

mem

bers

and

pee

rs w

ithou

t di

scrim

inat

ion.

3. Is

res

pect

ful a

nd c

o-op

erat

ive

with

col

leag

ues,

sta

ff an

d pe

ers,

and

can

dem

onst

rate

a c

omm

itmen

t to

the

mai

nten

ance

of h

igh

leve

ls o

f pr

ofes

sion

alis

m, t

rain

ing

and

safe

ty f

or s

taff.

4. U

nder

stan

ds t

he d

ynam

ics

of m

ulti-

prof

essi

onal

wor

king

and

how

the

se c

an c

ontr

ibut

e to

the

del

iver

y of

qua

lity

patie

nt c

are.

Domain - Professionalism

40

Domain - Management & LeadershipM

ajo

rC

om

pet

ency

Pers

on

al &

Prac

tice

Org

anis

atio

n

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d:

1. T

he e

ffici

ent

man

agem

ent

of t

ime

and

reso

urce

s on

a d

aily

bas

is.

2. A

n un

ders

tand

ing

of t

he d

ay t

o da

y ru

nnin

g of

a g

ener

al p

ract

ice,

and

any

oth

er a

reas

of

clin

ical

pra

ctic

e re

leva

nt t

o th

eir

trai

ning

, and

whe

re t

o fin

d m

anag

eria

l ass

ista

nce

whe

n ne

cess

ary.

3. A

n un

ders

tand

ing

of d

iffer

ent

prof

essi

onal

wor

king

and

con

trac

tual

agr

eem

ents

.

4. T

he f

ull,

accu

rate

and

sec

ure

mai

nten

ance

of

patie

nts’

rec

ords

.

5. A

n un

ders

tand

ing

of th

e co

nsid

erat

ions

to b

e m

ade

durin

g th

e se

lect

ion,

car

e an

d m

aint

enan

ce o

f equ

ipm

ent f

or d

enta

l pra

ctic

e.

6. A

n un

ders

tand

ing

of t

he c

onte

xt o

f di

ffere

nt r

emun

erat

ion

syst

ems.

7. A

n un

ders

tand

ing

of t

he p

rinci

ples

of

staf

f re

crui

tmen

t an

d em

ploy

men

t le

gisl

atio

n, i

nclu

ding

int

ervi

ew t

echn

ique

s, j

obde

scrip

tions

, con

trac

ts, e

qual

opp

ortu

nitie

s an

d di

scip

linar

y m

atte

rs.

41


Maj

or

Co

mp

eten

cy

Pers

on

al &

Prac

tice

Org

anis

atio

n(C

on

t.)

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d:

8. A

n un

ders

tand

ing

of t

he r

equi

rem

ents

for

and

pro

cess

es in

volv

ed in

ris

k as

sess

men

t w

ithin

the

wor

kpla

ce a

nd r

esul

tant

act

ion.

9. T

he p

riorit

isat

ion

of p

rofe

ssio

nal d

utie

s ef

fect

ivel

y an

d ap

prop

riate

ly w

hen

face

d w

ith m

ultip

le t

asks

and

res

pons

ibili

ties.

10. T

he e

ffect

ive

use

and

unde

rsta

ndin

g of

rel

evan

t IT

sys

tem

s.

11. T

he a

naly

sis

of p

atie

nt s

afet

y in

cide

nts

and

the

deve

lopm

ent

of s

trat

egie

s (e

.g. S

igni

fican

t Ev

ent

Ana

lysi

s) t

o re

duce

the

ris

k of

reoc

cure

nce.

12. T

he u

se o

f re

sear

ch d

ata

and

evid

ence

-bas

ed k

now

ledg

e in

his

or

her

appr

oach

to

clin

ical

pra

ctic

e.

Th

e tr

ain

ee c

an d

escr

ibe

in a

pp

rop

riat

e d

etai

l:

13. T

he p

roce

dure

s fo

r lo

cal c

ritic

al in

cide

nt r

epor

ting

syst

ems.

Domain - Management & Leadership

42


ajo

rC

om

pet

ency

Leg

isla

tive

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee:

1. T

akes

an

appr

opria

te r

espo

nsib

ility

for

hea

lth a

nd s

afet

y is

sues

in

dent

istr

y, i

nclu

ding

tho

se r

elat

ing

to p

atie

nts,

one

self

and

prac

tice

staf

f. Th

e tr

aine

e ha

s up

-to-

date

kno

wle

dge

and

unde

rsta

ndin

g of

infe

ctio

n co

ntro

l pro

cedu

res

and

is c

ompe

tent

in t

heim

plem

enta

tion

of t

hese

in d

aily

pra

ctic

e.

2. C

an d

escr

ibe

in a

ppro

pria

te d

etai

l th

e sa

fety

iss

ues

in r

elat

ion

to d

enta

l ra

diog

raph

y w

ith r

egar

d to

cur

rent

gui

delin

es a

ndre

gula

tions

.

3. H

as u

p-to

-dat

e kn

owle

dge

and

unde

rsta

ndin

g of

dis

crim

inat

ion

legi

slat

ion.

4. C

an d

escr

ibe

in a

ppro

pria

te d

etai

l the

prin

cipl

es o

f co

nsen

t.

5. C

an d

emon

stra

te a

ppro

pria

te k

now

ledg

e an

d un

ders

tand

ing

of le

gisl

atio

n th

at im

pact

s on

den

tistr

y.

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d u

nd

erst

and

ing

of:

6. T

he le

gal i

ssue

s re

latin

g to

hea

lth &

saf

ety

and

infe

ctio

n co

ntro

l (in

clud

ing

CO

SHH

– C

ontr

ol o

f Sub

stan

ces

Haz

ardo

us to

Hea

lth),

and

whe

re t

o ge

t ad

ditio

nal i

nfor

mat

ion

if ne

cess

ary.

7. T

he d

efin

ition

s of

the

lega

l & e

thic

al o

blig

atio

ns o

f a d

enta

l pra

ctiti

oner

and

the

def

initi

on o

f fitn

ess

to p

ract

ice

acco

rdin

g to

the

GD

C.

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d u

nd

erst

and

ing

of:

8. T

he s

truc

ture

, rul

es a

nd r

egul

atio

ns a

ssoc

iate

d w

ith t

he N

HS

and

othe

r em

ploy

ing

heal

thca

re b

odie

s.

43


Maj

or

Co

mp

eten

cy

Leg

isla

tive

(Co

nt.

)

Fin

anci

al

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d u

nd

erst

and

ing

of:

9. G

rieva

nce

proc

edur

es a

nd c

ompl

aint

s, a

nd h

ow /

whe

n to

see

k th

e ad

vice

of

a pr

ofes

sion

al in

dem

nity

org

anis

atio

n.

10. T

he im

port

ance

of

mem

bers

hip

of a

pro

fess

iona

l ind

emni

ty o

rgan

isat

ion.

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d u

nd

erst

and

ing

of:

1. T

he f

inan

cial

mat

ters

rel

atin

g to

tre

atm

ent

prov

ided

for

pat

ient

s in

gen

eral

pra

ctic

e an

d ot

her

rele

vant

clin

ical

env

ironm

ents

,in

clud

ing

NH

S de

ntis

try,

priv

ate

fee

per

item

sch

emes

and

priv

ate

capi

tatio

n sc

hem

es.

2. T

he f

inan

cial

man

agem

ent

of a

gen

eral

den

tal p

ract

ice

and

othe

r re

leva

nt c

linic

al e

nviro

nmen

ts.

3. B

usin

ess

man

agem

ent

and

deve

lopm

ent,

incl

udin

g th

e ab

ility

to

deve

lop

a bu

sine

ss p

lan,

the

pro

duct

ion

of a

cas

h flo

w a

naly

sis

and

a w

ritte

n pr

opos

al t

o a

bank

.

Domain - Management & Leadership

44


ajo

rC

om

pet

ency

Lead

ersh

ipan

d T

rain

ing

Sup

po

rtin

g C

om

pet

enci

es

Th

e tr

ain

ee:

1. D

emon

stra

tes

effe

ctiv

e le

ader

ship

with

in t

he h

ealth

care

tea

m, w

here

app

ropr

iate

.

2. Id

entif

ies

oppo

rtun

ities

for q

ualit

y an

d sa

fety

impr

ovem

ent,

and

dev

elop

s, im

plem

ents

and

eva

luat

es s

trat

egie

s to

impr

ove

qual

ityw

here

pos

sibl

e.

3. U

nder

stan

ds t

he p

rinci

ples

of

adul

t le

arni

ng,

and

faci

litat

es t

he l

earn

ing

of p

atie

nts,

fam

ilies

, ca

rers

, de

ntal

tra

inee

s, t

eam

mem

bers

, oth

er h

ealth

pro

fess

iona

ls a

nd t

he p

ublic

as

appr

opria

te.

4. U

nder

stan

ds t

he r

ole

of b

eing

a m

ento

r an

d ro

le m

odel

for

oth

er m

embe

rs o

f th

e he

alth

care

tea

m.

5. U

nder

stan

ds h

ow t

o ac

t in

the

inte

rest

s of

pat

ient

s w

ho h

ave

been

sub

ject

to

clin

ical

har

m o

r er

rors

.

Th

e tr

ain

ee c

an d

emo

nst

rate

to

an

ap

pro

pri

ate

stan

dar

d t

he

abil

ity

to:

6. S

elec

t, im

plem

ent

and

eval

uate

the

effe

ctiv

enes

s of

tea

chin

g st

rate

gies

to

faci

litat

e ot

hers

’ lea

rnin

g.

7. A

ccep

t an

d pr

ovid

e ef

fect

ive

feed

back

in a

man

ner

that

mot

ivat

es a

nd e

ncou

rage

s le

arni

ng.

8. G

ive

an e

ffect

ive

pres

enta

tion

that

use

s re

leva

nt te

achi

ng m

ater

ials

and

is ta

rget

ed to

the

leve

l of u

nder

stan

ding

and

exp

ecta

tions

of t

he a

udie

nce.

9. D

emon

stra

te s

kills

and

com

pete

ncie

s to

oth

ers

in a

n ef

fect

ive

man

ner.

45


46


47

Part 2


48

AssessmentThis section describes the principles for an assessment system for dental foundation programmes, andrecommendations for a suitable approach. Clearly, a more detailed description of assessment will berequired once the structure of foundation programmes has been identified, and a programme forimplementation agreed.

Recommendations for an approach to assessment

The excellent principles described by PMETB14 for postgraduate medical training will apply equally todental foundation programmes. In the context of postgraduate dental training these are described below.

1. The assessment system must be fit for a range of purposes

The purpose of the assessment system should reflect closely that of the curriculum and the aims of thetraining. In dental foundation programmes the purpose would therefore include the ability to:

• identify an individual’s strengths and weaknesses, and progress towards the standard of performanceexpected upon completion of this training.

• demonstrate achievement, and readiness to progress to the next stage of training.

• inform the public and / or the appropriate authorities that the individual is ready for independentpractice, requires additional time in training, or should not pursue a career in dentistry. For this reasonit is essential that assessment is criterion referenced.

• provide feedback to enhance individuals’ reflection upon, and motivation towards achieving, personallearning and career goals.

2. The content of the assessment is based on relevant curricula

The dental foundation programme curriculum agreed by the profession will provide the framework aroundwhich an assessment system can be developed. The syllabus within this document defines the content ofthe programme from which assessment should sample, and as the competencies identified are relevantacross potential different training environments (and hence different foundation programme structures)the domains and major competencies should all be assessed to a degree if the assessment system is to bevalid. The emphasis on individual competencies will inevitably depend on the training environment andother factors e.g. location of training post15. This is partly the reason why we do not consider it appropriateat this stage to identify competencies as ‘essential’ or ‘desirable’. However, more importantly such aclassification would inevitably drive the learning in a way that would limit validity within thisheterogeneous training.

14 L Southgate and J Grant. Principles for an assessment system for postgraduate medical training. PMETB 2004.15 Trainees in a rural practice, for example, may experience a different range of cases than those in urban areas.

Similarly, it is neither possible nor desirable to formally identify a sequence to the assessment, as skills andcompetencies will be learned by trainees at different stages depending on the structure of the programmeand nature of the posts undertaken. Informally however, it is inevitable that some aspects of performancewill precede other more complex areas. A guidance document, indicating such trends, would be a usefulresource for dental foundation programme trainers and trainees alike, and should be provided as part ofthe training and implementation of the programme.

Sampling

The validity of an assessment system is (partly) dependent upon appropriate sampling of the content of acurriculum. However, sampling also depends on feasibility, and it is clearly impossible to assess everyclinical area, across all different contexts, patient types and case complexities etc. In addition, a prescriptiveapproach to sampling should also be avoided, particularly when dealing with a heterogeneous trainingprogramme such as this. For dental foundation programmes it may be more appropriate to ensure thatsampling of curricula content is appropriate by focussing at the level of competency domains and majorcompetencies, i.e. that each of these is covered adequately by assessment, with the specific aspects ofperformance being assessed being those that are encountered by the trainee in their individualprogramme. This approach would allow flexibility within the assessment system, whilst ensuring validity.

3. The methods used within the programme will be selected in the light of thepurpose and content of that component of the assessment framework.

As indicated by PMETB, the individual methods used within the system of assessment should be chosenusing evidence of “validity, reliability, feasibility, cost effectiveness, opportunities for feedback and impacton learning”. As such concepts are highly specific to the context in which the assessment is taking place,such evidence will only be available through pilot studies within postgraduate dental training itself.However, that is not to say that valuable information cannot be gained from studies carried out withinsimilar contexts such as those currently underway for medical foundation programmes. Such informationwould allow us to make an informed choice regarding the tools most likely to work, and those that shouldbe tried in early pilot studies within dental training. A brief summary of such tools is given later within thisdocument.

It is also important to consider the evidence available regarding robust assessment methods currentlybeing used within postgraduate dental training. Robust data from studies published on the evaluation ofexisting assessment systems – including those from the Royal Colleges – should be triangulated withinformation from medicine and other health professions. Where existing, robust methods are identified,these should be used in preference to developing new methods and being at risk of ‘re-inventing thewheel’16.

16 Similarly, some existing methods may be considered as ‘equivalent’ to those within the system of assessment for dental foundation programmes where evidence exists thatthis is appropriate (e.g. Royal College exams)

49


50

Level of Assessment

The type of assessment used should reflect the stage in training, and it is recommended that withinpostgraduate dental training, assessment should be at the highest level of Miller’s pyramid17 whereverpossible i.e. what the practitioner ‘does’. At this level, we are looking at the assessment of ‘performance’rather than ‘competence’, which is an appropriate approach for training within the workplace where theintegration of individual competencies into the ‘whole task’, and a consistent approach to practice isrequired for the delivery of high quality patient care.

Miller’s pyramid, highlighting the focus of assessment at each of the levels and examples of methodsrelevant to each, is shown in Figure 4. The professional authenticity of assessment increases as the pyramidis climbed.

Figure 4: Interpretation of Miller’s Pyramid18

4. The methods used to set standards for classification of trainee’s performance /competence must be transparent and in the public domain

The methods used should be based on evidence, and the standards themselves published and readilyavailable to all stakeholders. Of particular importance are the criteria for pass / fail decisions, and theprocesses in place for borderline candidates.

17 Miller GE. The assessment of clinical skills / competence / performance. Acad Med 1990; 65: S63-S67.18 Reproduced with kind permission from C van der Vleuten and E Dreissen.

Does

Shows how

Knows how

Knows

Performance (in vivo)

E.g. Observation, workplace assessment

Competence (Performance in vitro)

E.g. OSCE, Standardised patients

Cognition

e.g. Written tests, viva voce

Cognition

e.g. Written tests, viva voce

5. Assessment must provide relevant feedback

Having identified the purpose of the assessment system for dental foundation programmes as a positiveeducational impact, the provision of good quality, relevant and timely feedback to trainees on theirperformance is of paramount importance. In a system that is criterion referenced, feedback should providea degree of orientation for trainees regarding their performance in relation to the standards expected uponcompletion of the training. Such information would also be extremely useful to trainers and supervisors,enabling them to identify individuals’ strengths and weaknesses and the formulation of an individualisedtraining plan. In order to do this, feedback must be regular, following continuous assessment.

Where possible, it should be possible to triangulate the feedback from different assessments, in additionto the triangulation of the results themselves.

The use of feedback, i.e. whether purely formative, or to contribute towards a summative judgement onperformance, should be explicit from the onset of training.

6. Assessors will be recruited against criteria for performing the tasks theyundertake.

Individuals responsible for judging the performance of dental foundation programme trainees should beappropriately qualified, have relevant expertise and be adequately prepared for their role through training.

7. There will be lay input in the development of assessment

Lay representation at the GDC, Faculty and Deanery level exists at the present time.

8. Documentation will be standardised and accessible nationally.

Whilst a degree of flexibility is required of any system of assessment that will require implementation at anational level across a range of foundation programme structures and training environments, it is clear thata standardised approach, with relevant documentation and guidelines for implementation, is essential toensure that all trainees have reached the minimum standards expected.

9. There will be resources sufficient to support assessment.

Appropriate resources (financial, time, staff etc) are vital to the success of a system of assessment for dentalfoundation programmes. These issues are described in more detail in the section on implementation.

In addition to these principles, the following recommendations are given for a system of assessment fordental foundation programmes;

• The results from assessment should be triangulated wherever possible, to enhance validity and reliability.

• Continuous assessment should be supported by regular meetings with educational supervisors to discussprogress.

51


52

• A targeted training policy and plan for managing poor performance should be implemented for thosetrainees struggling in certain areas.

• A longitudinal approach to evaluation of the assessment system should be taken, in terms of both processand outcome, and the data obtained used annually to inform the process of quality management.

• The system of assessment should be underpinned by a training programme for all those directly involvedin the foundation programme, i.e. trainees, trainers, supervisors, directors etc. This training should berecognised by appropriate authorities, and contribute to the continuing professional development ofstaff.

• An appeals process should be identified for the system, to ensure a fair approach for all.

Methods

A number of methods have already been developed, and are currently being used or piloted inpostgraduate medical and dental training. A brief description, along with references highlightingevaluation data, are provided for some examples below. This list is not intended to be exhaustive.

Workplace-based assessment using observation of performance

Assessment methods using direct observation of performance in the workplace frequently have highvalidity. There are two main approaches to scoring performance – checklists and the use of global ratings.In brief, methods using checklists are usually specific to the task being assessed. The task is dividedprocedurally into stages or skills and the evaluator identifies whether or not each stage has been performedcorrectly. The advantages of this approach are that very detailed and structured feedback can be providedon individual tasks, which may be particularly useful at earlier stages of professional development such asundergraduate training, the mastery of more complex tasks at postgraduate training, or for targetedtraining when addressing poor performance. The use of global ratings to measure observed performancehas been shown to have many advantages at the postgraduate level, including more flexibility, andenhanced validity. Ratings are usually provided along a scale (e.g., 6, 8 or 9 points) with performancedescriptors, across several broad areas of performance that may be clinically-orientated (e.g. ‘historytaking’, ‘clinical judgement’) or generic (e.g. ‘professionalism’, ‘communication skills’). The majority ofmethods currently being piloted in medical foundation programmes or postgraduate dental education useglobal ratings.

LEP (Longitudinal Evaluation of Performance)19 20

The LEP uses global ratings on a 9-point scale (1-3 = ‘Need Improvement’, 4-6 = ‘Satisfactory’, 7-9 =‘Superior’ performance) to score trainees’ performance in several clinical and generic areas. This approachwas adapted from the mini-CEX (below), specifically for use within postgraduate dental training (VT andGPT). Evaluation of the LEP to date has indicated high validity and a positive educational impact. Specificfeatures of the tool include:

• high flexibility (can be used across the whole curriculum)

• continuous assessment

• judgements are made against a reference point that is the standard expected upon completion of thetraining, allowing the demonstration of progress and the identification of strengths and weaknesses atan early stage.

• high quality feedback for trainees and trainers.

• a ‘no penalty’ approach21 to assessments where scores are awarded in the ‘need improvement’ range,reducing the likelihood of leniency / halo effect and the potential for demotivation of trainees.

19 Prescott LE, Norcini JJ, McKinlay P, Rennie JS [2002]. Medical Education 36: 92-97.20 Prescott-Clements LE, Hurst Y, Rennie JS [2003]. BDJ Suppl 17-21.21 If scores are given in the ‘need improvement’ range, there are no lasting consequences for a summative judgement on satisfactory completion of the training. Trainees mustsimply have repeated the area in question to a satisfactory standard, indicating progress, before being considered competent. All quantitative feedback is based on frequencyof ratings as opposed to mean scores.

53


54

Mini-CEX (Clinical Evaluation Exercise)22 23

Developed in the U.S.A. by Dr John Norcini, this tool has had wide international success, and was one ofthe first methods of this kind, from which many others (including the LEP) have been developed. Evolvingfrom the more detailed and time consuming ‘CEX’, the mini-CEX was designed to take a ‘snapshot’ ofperformance and enhance feasibility and flexibility within the workplace.

Recent changes to the tool, for its use within medical foundation programme pilots, include the movefrom a 9-point to a 6-point scale, with descriptors highlighting that evaluators judgements are madeagainst the standard expected upon completion of F1 or F2. Previously, judgements were made in relationto the trainee’s current stage in training.

DOPS (Direct Observation of Procedural Skills)24

Originally developed and evaluated by the Royal College of Physicians, DOPS is a method similar to themini-CEX that has been designed specifically for the assessment of practical skills. This tool uses the samerating scale and descriptors as the mini-CEX used in medical foundation programme pilots, but againstareas that resemble more of a structured checklist for practical procedures.

22 Norcini JJ, Blank LL, Arnold GK, Kimball HR. [1995]. Annals of internal medicine 123 (10): 795-9.23 Durning Sj, Cation LJ, Markert LJ, Pangaro LN [2002]. Academic Medicine 77 (9): 900-4.24 For more information www.hcat.nhs.uk – Evaluation data will be published on this site once completed.

Other assessment methods

CbD (Case-based discussion)25

Also being used within medical foundation pilots, CbD allows case presentation and subsequentdiscussions with evaluators / trainers to be recorded. CbD assesses clinical judgement and the applicationof knowledge with regard to patient care. It is also used in the USA for poorly performing doctors, as itallows the decisions and thought processes of practitioners to be probed by the evaluator.

PAQ (Patient Assessment Questionnaire)26

Designed specifically for the assessment of dentists in postgraduate training, the PAQ has good validity andreliability in primary care (vocational training) and is now being piloted in the SDS and HDS. The PAQ askspatients to anonymously provide ratings on a 5-point scale (poor, fair, good, very good and excellent) forareas of communication skills and professionalism. This data can be triangulated with that from otherassessments such as the LEP, to compare the trainers and patients views of these areas of performance.

Mini-PAT / Min e-PAT (Peer Assessment Tool)27

A method of multi-source feedback for trainees, the mini-PAT is also being piloted at present in medicalfoundation programmes. Multi source feedback can assess multiple components of performance.

Dental VT / GPT ‘Test of Knowledge’

Used alongside the LEP and PAQ in Scotland, within the system of assessment for satisfactory completionof VT and GPT, this test is computer-based and focuses on aspects of knowledge that are developed withinthis training such as health and safety in practice, practice organisation, NHS rules and regulations etc. Itdoes not include clinically related questions that may have previously been assessed at an undergraduatelevel.

Development, Pilots & Evaluation

Assessment methods chosen for initial pilot studies should be done so based on robust evidence asdescribed above. In addition, consideration should be given to appropriate sampling of the curriculum,feasibility, and how they will fit together within a ‘system’ of assessment in terms of triangulation.

Whilst pilots of individual assessment methods will provide useful information, the validity, reliability,feasibility and educational impact of assessment of dental foundation programmes will ultimately need tobe determined for the system as a whole. Therefore a systems approach should be taken to pilot studies,that includes an analysis of the interaction of the different methods used within the system. For example,the validity and reliability of the whole system of assessment may be more (or less!) than that observedupon the evaluation of methods individually. Similarly, the feasibility of the entire system of assessmentcannot be inferred from data collected for individual methods, or indeed the summation of such studies.

25 For more information www.hcat.nhs.uk – Evaluation data will be published on this site once completed.26 Hurst YK, Prescott-Clements LE, Rennie JS [2004]. BDJ 197 (8): 497-500.27 For more information www.hcat.nhs.uk – Evaluation data will be published on this site once completed. See also related tool SPRAT: Archer, J.C., J. Norcini, and H.A. DaviesBMJ, 2005. 330(7502): p. 1251-3

55


56

ImplementationTraining for Trainers, Evaluators and Trainees

Perhaps one of the biggest challenges to implementing a system will be the provision of adequate trainingfor those involved. Training should be comprehensive and interactive where possible, allowing theexploration of sensitive issues, misconceptions or individuals’ concerns. Issues to be covered during thetraining for trainers / educational supervisors would include;

• Interpretation of the curriculum

• Learning styles

• Optimising learning opportunities

• The assessment system28

• Giving quality, structured feedback

• Managing the poorly performing trainee

• Motivating trainees

Similarly, all trainees should be given a detailed induction to the training. It should be compulsory for thoseresponsible for assessing trainees’ performance to complete this training prior to starting in this role.Accreditation / recognition of training courses in some way would give added value and incentive totrainers, educational supervisors and evaluators, and perhaps a degree of compensation for timecommitment.

Learning Opportunities

An experienced trainer / educational supervisor will recognise learning opportunities as they presentthemselves during everyday practice. However, taking advantage of such opportunities requires regularcontact with the trainee for supervision and assessment, in addition to protected time for educationalevents such as tutorials, case discussion, seminars or appraisals etc. Clearly, in the NHS today where waitingtime targets are crucial and the demand for primary care NHS dentistry has never been higher, apractitioners ‘time’ is extremely valuable. However, the importance of regular contact with the trainee cannot be overstated if dental foundation programmes are to be successful in being a positive educationalexperience that develops graduates into “A competent, caring, reflective practitioner, able to develop theircareer in any branch of dentistry to the benefit of patients”.

In addition to covering this important topic in training and induction programmes, guidelines forrecognising effective learning opportunities, mapped to the syllabus, should be provided for all trainersand educational supervisors involved in foundation programmes.

28 Including individual methods within the system, interpretation of data and issues around using judgement such as leniency, halo effect, central tendency etc duringobservation based assessment.

Maintaining Quality

Quality management is an area which demands long term commitment and dedicated time and resources.Postgraduate medical and dental education and training is developing continuously, and NHS care itself(including dental practice) has never experienced a time when change is so high on the agenda. Thecurriculum for dental foundation programmes must evolve with these changes, and keep up to date withcurrent best practice in education. This can be achieved through longitudinal evaluation studies that arebased on both the process and outcomes of this training. Such data would provide long term trends inperformance, and allow regular revisions to be made to the system on the basis of evidence.

Administration

It would not be appropriate to write a proposal for the implementation of a curriculum withoutconsidering the resources required and administration costs. A full business case will be required to identifythe detail of the resources required and cost implications (and indeed, the costs if nothing were to beimplemented). It is not the purpose of this document to include such an analysis, however, issues to beconsidered should include;

• Trainer / educational supervisor time

• Administrator costs for those managing the assessment data

• Training costs for implementation of the system, including induction programmes for trainees.

• Lay individuals costs (in assessment , appeals etc)

• Non-recurrent costs e.g. research and development, database production for data capture, technologyetc

• Printing, consumables etc

• Quality management costs

57


58


Appendix 1

29 Coles, C. (2003) ‘The development of a curriculum for spinal surgeons’, Observations following the Second Spine Course of the Spinal Society of Europe. Barcelona, Sept2003. http://www.eurospine.org/Teachers%20Course/C_Coles_report_03.html 30 Wojtczak, A. (2002). Glossary of medical education terms, http://www.iime.org/glossary.htm decc 2000, revised Feb 2002.

59


There are many definitions of curriculum, however for the purposes of this document we have found thefollowing definition described by Coles29 to be particularly useful.

“A curriculum is more than a list of topics to be covered by an educational programme, forwhich the more commonly accepted word is a ‘syllabus’. A curriculum is first of all a policystatement about a piece of education, and secondly an indication as to the ways in whichthat policy is to be realised through a programme of action. In practice though a curriculumis more than even this; it is useful to think of it as being much wider. As a working definitionof a curriculum I would say that it is the sum of all the activities, experiences and learningopportunities for which an institution or a teacher takes responsibility – either deliberately orby default. This includes in such a broad concept of curriculum the formal and informal, theovert and the covert, the recognised and the overlooked, the intentional and theunintentional… It is useful to think of there being three faces to a curriculum: the curriculumon paper; the curriculum in action; and the curriculum that participants actually learn.”

A more concise definition is described by Wojtczak30.

“An educational plan that spells out which goals and objectives should be achieved, which topicsshould be covered and which methods are to be used for learning, teaching and evaluation.”

Definition of ’curriculum’and 'syllabus’

60


Appendix 2

61


David Smith (Chair) Postgraduate Dental Dean, Newcastle-Upon-TyneChair, GPT Liaison Group, Chair, COPDEND

Linda Prescott-Clements Educational Projects Manager, NHS Education for Scotland

Chris Franklin Postgraduate Dental Dean, South Yorkshire / East Midlands

David H. Felix Associate Postgraduate Dental Dean, NHS Education for Scotland

Mike Mulcahy Dean, FGDP (UK)

David Hussey Postgraduate Dental Dean, NIMDTA

Gareth Holsgrove Medical Education Advisor, Royal College of Psychiatrists

Richard Oliver Director, Dental Education Unit, Cardiff University

Jonathan Cowpe Professor of Oral Surgery, University of Bristol

Ruth Gasser Department of Health, England

Paul Cook Postgraduate Dental Dean, Yorkshire Deanery

Neale Armstrong VT Adviser, NIMDTA

Mike Attenborough VT Adviser, Severn & Wessex Deanery

David Mitchell OMFS Consultant

Alison Bullock Co-Director of Research, CRMDE, University of Birmingham

Graham Orr VT Adviser, Northern Deanery

John Gamon GPT Practitioner

Matthew Thomas SHO

Yvonne Hurst NHS Education for Scotland

Karen Jack NHS Education for Scotland

Steering Group Members

62


Appendix 3

63


1. Postgraduate Dental VT / GPT

• All PG Dental Deans were contacted andasked to distribute the draft competenciesfor consultation within their region.Recommendations were given that this shouldinclude (a) Regional VT / GPT Advisers (b) GPTScheme Adviser(s) (c) a selection of trainers (d)HDS Tutors (e) SDS Advisors

• UK Conference of Advisers

• CVT Wales

• SDVTECC

• CVT (N. Ire.)

2. Undergraduate Dental Education

• Deans of all UK Dental Schools

3. Professional Bodies

• GDC

• BDA

4. UK Dental Faculties

• RCS England

• RCS Edinburgh

• RCPS Glasgow

• FGDP (UK)

5. Salaried Dental Service

6. Education

• ADEE

• University Maastricht

• Zoe-Jayne Playdon

• Mark Brennan

• Peter Mossey

• Liz Davenport

7. Others

• Department(s) of Health

• MMC (Professor Dame Lesley Southgate)

• Patient groups

• Dental Health Service Research Unit (J Clarkson)

• British Dental Health Foundation (involvingpatients / public)

• Directors of Dental Public Health

• Senior Dental Leadership Team – Helen Falcon

Consultation Group -Stakeholders

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