Proficiency badges for dentists?

Dyb, Dyb Dyb. Or was it Dob, Dob Dob? Never could remember. But what I do remember was the nerve-tingling excitement of parading a new proficiency badge, especially when it was one that none of the other cubs (or scouts?) had got. I don’t think I ever got my sewing badge, though, so the finished look probably let the side down.

These days I guess the equivalent is having a mobile phone with apps that nobody else has got. Nor would any self-respecting teenager want to be seen around town without the statutory wires dangling from their ears. It has become today’s badge of honour, but with a dual purpose; firstly, to show that you belong to the same species as other young people with wires dangling from their ears, and secondly, more crucially, as a signal to onlookers that you and your ears are attached to a better bit of kit than they are.

“This is a victory for marketing and presentation,
a triumph of perception over reality”

Not quite so easy when the wire disappears under a voluminous pashmina or into the depths of some heavily padded coat (this requires the bit of kit to be regularly retrieved and adjusted in a matter-of-fact kind of way), but it does allow the upwardly mobile but impoverished teenager to buy just the wires and earplugs to start with, while saving up for the more expensive end.

You may already be wondering where I am going with this. But it’s more a case of where the profession is going, because I am getting very confused. The advent of specialist lists over a decade ago was a defining moment in one sense because it provided a basis for differentiating between different members of the profession who had hitherto all looked the same to the untrained eye (excuse the pun). Whether this was more use to members of the public, or to colleagues and referring dentists, or just to the people involved, I am not entirely sure.

But there has recently been a proliferation of complaints made by one dentist about a second dentist who has claimed or implied some kind of specialist status when he or she is not actually included on a specialist list (or at least, not the one claimed). In many cases the complaint is made anonymously, which adds a slightly distasteful edge to things, and in some cases there is a ‘tit for tat’ element.

Sometimes the ‘offence’, such as it is, is months or years old (and perhaps already rectified) but the evidence is salvaged from the internet or the waste paper basket and loaded into the musket just the same.

That is the trouble with proficiency badges, of course. Unlike university degrees, they have the potential to divide and create envy and petty jealousies. They can deflect and trivialise the debate into one of words and titles and external perception when the question should really be about competence. Grandparenting and mediated entry often perpetuate the problem by looking at training and experience instead of competence, and yet they are necessary evils.

Fixtures and fittings
It remains to be seen whether we get a new specialist list in implant dentistry – after a consultation last year it is now in the GDC’s ‘pending’ tray. If the GDC does decide to embark upon this curious mission, the logic of which continues to elude me, the grandparenting
challenge will make everything that has gone before it seem like a walk in the park. And the existence of a specialist list does not preclude anyone from placing implant
fixtures without being on the list, any more than one needs to be on the endodontic specialist list to carry out root canal treatments.

The slight perversity of the current situation is that we are concentrating all our energy on the ‘blunt’ end, in trying to define who might best be equipped to deliver a higher or an exceptional standard of care, as opposed to an ordinary, competent, reasonable standard of care. What we are not doing is helping the public to identify, at the ‘sharp’ end, who might be likely to deliver less than an ordinary, competent, reasonable standard. And the greatest risk for the public is that these people may appear to the uninitiated eye to be better, more highly trained and better qualified than their colleagues. This is a victory for marketing and presentation, a triumph of perception over reality.

This is why I applaud what has been happening recently regarding non-surgical cosmetic treatments such as botox and dermal fillers. A ‘shared regulation’ scheme is being launched with the agreement of the GDC, GMC and Nursing and Midwifery Council whereby dentists, doctors and (medical) adult nurses wishing to carry out these procedures can apply for
registration with CHKS (under the auspices of the Independent Healthcare Advisory Services – IHAS) subject to having completed approved training, and signing up to agreed standards and an inspection scheme. A recognisable ‘Quality Mark’ standard will differentiate these registered providers from the great unwashed.

All of this will be voluntary, but the plan is that members of the public will be able to choose their providers with better information and greater confidence. The hope is that, over time, this will move these interventive medical procedures out of the living room botox parties, beauty salons and tattoo parlours, into the hands of registered healthcare professionals.

The subject of what is, and is not, appropriate and satisfactory training in this or any other area of dentistry is a difficult one. Here in the UK we have taken a very different approach to many other countries around the world where they accredit the people/organisations that provide the training. Here we tend to focus upon the training curriculum and the documentation of the learning process, and turn something of a blind eye to who is actually providing the training. Except in vocational/foundation training, that is, where the educational content, structure and assessment/audit process has expanded beyond recognition. All the more strange, therefore, that all this comes to such a shuddering halt in the less structured ‘open market’ world that awaits the emerging VDP.

So is the beauty of proficiency badges in the eye of the beholder or the wearer? What do they tell us about the process that preceded the award of the badge, and what do they tell us about anyone who hasn’t got one on display? In order to answer these questions, we need first to ask what they are designed to achieve and (ultimately) who is intended to benefit from them.

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