Onwards and upwards

Seb Evans spoke to Manjula Das, head of education policy and quality assurance at the General Dental Council, about the recent and upcoming work of the dental regulator and the challenges facing the sector

Seb Evans (SE): What are the highlights of what the General Dental Council (GDC) has done over the past year?

Manjula Das (MD): We quality assure all undergraduate education and training for dentists and dental care professionals (DCPs), and the first thing to say is that we’re moving away from a ‘big bang’ approach to how we do this. It used to be the case that every institution would be inspected every four to five years against all 21 requirements. We want to be more focused with our approach and responsive to key areas of concern, so have developed a different approach.

We talked about this in Shifting the Balance and, after consulting on new proposals last year, we have introduced a risk-based approach to quality assurance where we focus on the key issues most relevant to the specific educational provider and use a range of evidence to focus on specific themes. The idea is we can be more effective when we inspect and, this year, we are piloting this approach with all BDS programmes. It’s an iteractive learning process in which we will continue to develop how it works in practice.

Last June, we ran a survey of foundation and vocational trainees, which achieved a response rate of over 90%. A similar survey was run with educational supervisors and trainers too, which achieved a lower, but statistically significant, response rate of around 50%. Using the combined information, we are going to be probing identified issues at individual inspections this year.

We are also carrying out a rapid impact assessment – a type of focused literature review and further qualitative research this spring to further inform the work.

In addition to this change at institutional level, we also wanted to introduce a way of looking at issues that span the whole dental education sector and, to this end, we have introduced ‘thematic reviews’.

In 2013, we undertook a project to better understand the transition to independent practice for new dentists. This found there was no evidence to suggest increased risk of a fitness to practise referral or a greater risk to patients from new registrants. However, we continue to hear anecdotal evidence that there may be gaps in the knowledge and skills of new registrants. Therefore, we selected new dentists’ preparedness for practice as the subject of our first thematic review and have commenced research in this area to get a clearer picture. We look forward to talking more about this when we get the result of that work later in the year.

SE: Is the end goal to come up with guidance for all educational providers?

MD: The thematic review will come up with recommendations for a range of different stakeholders and we are working in partnership with them to identify the key issues. We are aiming to publish this report at the end of 2019.

One of the things I’m particularly excited about is we’ve drawn together a meeting with all postgraduate and undergraduate deans. We’re going to be discussing preparedness for practice, that transitional year, a potential for a passport to practice and a range of other issues. By working together, we can make greater progress in identifying issues of concern and devising solutions that work.

SE: What are the speciality developments that have been announced?

MD: So, we have already revised the standards in speciality training and are going to start quality assuring speciality training for the first time this year. We developed these two areas in collaboration with the royal colleges and a number of deaneries – and that work culminated in a consultation in 2018.

The really exciting thing for us on this now though is we are consulting on the fundamental principles of specialist listings. This breaks into three different areas. One is we’re proposing a revision of the purpose and criteria of specialist listings.

SE: What does that mean for specialists at the moment? Will they remain specialists?

MD: Yes. This is not about pulling the rug from under anyone’s feet. We have developed the proposals in partnership with a wide range of professional stakeholders, who have been working with us on this since May 2017. That group includes CDO representation, postgraduate deans, royal colleges, the Dental Schools Council, the Advisory Board for Specialty Training in Dentistry and the Association of Dental Hospitals.

We asked the group if the purposes we previously set in 2005 are still relevant, fit for purpose, whether times have moved on and what might need to change. We had some really good discussions and concluded there were things that did need to change. The consultation (which closes on 25 April) includes proposals for a revised set of purposes and criteria for specialties. So, that’s the first part.

The second part of the proposals is about improving clarity around how specialities should be added and removed from the list. I want to be clear, we have no plans to remove or add any specific speciality: we don’t have the process for this at the moment, so we wanted to take this opportunity to explore what a process should look like and what evidence should be required. That’s the second part.

The third part addresses the issue of maintaining accreditation on a specialist list. At the moment, professionals who are successful in specialist training apply to be added to a specialist list and, if accepted, pay the fee to join. They then stay on that list. We’re asking the question, is that right? If it’s not right, then what should we be doing, who should pay for any additional checks and what should a changed process look like?

So, one is purpose and criteria, two is principles for the addition or removal of specialties and three is the way of making sure what we have is right for staying on a specialist list. These are open questions and we’re keen to hear what people have to say.

SE: In Moving Upstream, you talk about a climate of fear as soon as dentists graduate. What is the GDC doing about its role in this?

MD: It disheartens me there seems to be many people who do not know about all the good things we are doing at the GDC to help support education and training, students and trainees, so we need to do more to raise awareness of this. There is a climate of fear among students and new registrants – we understand the GDC plays a part in this and are working hard to address this.

In 2016, we undertook research with students, foundation trainees and other regulators. This was followed up in 2018 when we spoke with education providers and groups of students, which helped us develop pilots of face-to-face engagement in seven different dental schools.

We want to put a face to the GDC, meet with students and explain what we do, underlining we’re here to protect patients. We have developed some great interactive sessions to help promote professionalism and we found this stimulated some lively discussions.

We want to tell students more about what we do regarding education, quality assurance, CPD, lifelong learning, talk about registers and the whole dental team – the standards. So yes, we have a role in investigating complaints, but that’s not all we’re about.

In addition to these pilots, we are thinking about how to develop this face-to-face engagement with students more widely. In the pilots, we focused on dental students and were also able to meet with hygiene, therapy and nursing students, too. Ideally, we want to see students at the very beginning and again towards the end of their studies.

We’d also like to see all foundation/vocational dentists near the beginning of their training. As well as thinking about dentists, we also need to think about what’s appropriate for the different DCP groups as well. We plan to have meetings with these education providers and hope to get feedback from DCP students to see how we can gain the furthest possible reach. We are aiming to start rolling this out in the next academic year, so watch this space.

This is all important work, but we know tackling the climate of fear will take more than just the efforts of the GDC alone and, as such, we will continue to work in partnership with the many organisations who also have a role to play.

SE: It’s good to hear you are engaging more with students. Do you have any other plans?

MD: Yes. In 2020, we are planning to start work on student and new registrant liaison groups, so that we can draw people together from across the country and get their input into developments. I’m really excited about this.

With student engagement and representation at the heart of how we develop, we can really start to hear from our future registrants. In time, I hope for professionals in this group to become champions for what regulation is really about – putting the patient and their care first – so that when they go back to their schools and practices, they can help in breaking down the climate of fear.

Read the full Moving Upstream report on the GDC’s website at www.gdc-uk.org

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